本文選題：間接測熱法 + 靜息代謝率�。� 參考：《中國科學(xué)技術(shù)大學(xué)》2017年博士論文

【摘要】：營養(yǎng)不良是指因能量或營養(yǎng)素的不平衡而對人體產(chǎn)生有害影響的一種營養(yǎng)狀態(tài),營養(yǎng)不良及其造成的住院病人重要生命器官受損和大眾健康領(lǐng)域的慢病高發(fā)已成為住院病人面臨的巨大風(fēng)險和重要的公共健康問題。通過測量人體代謝速率和代謝底物,確定營養(yǎng)需求,進而進行合適的營養(yǎng)支持,是防治營養(yǎng)不良的有效手段。在代謝測量方法中,間接測熱法具有相對廉價、便捷等優(yōu)點,已成為臨床營養(yǎng)中營養(yǎng)評估和營養(yǎng)支持的重要方法。然而,我國間接能量測試儀(IC)的普及程度仍然很低,尤其對于中小型醫(yī)院和大眾健康領(lǐng)域。其原因主要在于:①測量儀器依賴于進口,價格昂貴,測量成本及器維護成本高;②測量相對耗時,不能滿足我國醫(yī)院病人服務(wù)高效率的需求;③測量需要專業(yè)操作人員�；谏鲜銮闆r,本文開展如下研究:1、一種基于頭罩式稀釋法的間接能量測試方法的建立基于間接能量測試原理,本研究通過呼吸氣體分析方法設(shè)計、氣體采集與分析軟硬件平臺搭建,建立了具備自主知識產(chǎn)權(quán)的基于頭罩式稀釋法的間接能量測試方法。該方法采用了電子壓力自動控制技術(shù),通過反饋機制調(diào)節(jié)比例閥孔徑,控制管路壓力恒定,確保濃度測量的準(zhǔn)確性;采用了穩(wěn)定狀態(tài)識別技術(shù),不僅實時監(jiān)測和顯示被測試者呼吸交換參數(shù)VO_2和VCO_2的穩(wěn)定程度指標(biāo)(CV%),為操作者獲取穩(wěn)定狀態(tài)下的代謝參數(shù)提供直觀的參考,而且自動獲取穩(wěn)定狀態(tài)區(qū)間的數(shù)據(jù)計算最終測量結(jié)果,降低了操作人員依賴性。2、間接能量測試系統(tǒng)的重復(fù)性與有效性研究重復(fù)性:通過38名受試者開展短期重復(fù)測量實驗,用組內(nèi)相關(guān)系數(shù)(ICC)、變異系數(shù)(CV%)、Bland-Altman分析的一致性范圍(LoA)作為評價指標(biāo)。結(jié)果顯示,兩次測量的VO_2和VCO_2的ICC分別為0.945和0.907, CV%分別為5.9%和8.3%,LoA分別為-21.0～29.1和-27.7～30.9,重復(fù)性較好且達(dá)到國際同類設(shè)備的水平。有效性采用兩種方法:①體外模擬驗證:模擬的呼吸交換參數(shù)與測量值的相關(guān)系數(shù)高(r=0.99,p0.001), LoA 范圍窄(VO_2: -1.14～6.48,VCO_2:-0.87～8.11);②體內(nèi)實驗驗證:采用本設(shè)備和同類設(shè)備(VO_2000)對38人進行測量結(jié)果比較。結(jié)果顯示,二者相關(guān)系數(shù)高(VO_2: r=0.91,p0.001,VCO_2:r=0.89,p0.001),均值差異小(V02: 5.9%, VCO_2: 5.5%),一致性尚可(V02:-26.9～50.3,VCO_2: -24.8～43.2)。上述結(jié)果表明,自主研制的間接能量測試儀有效性較好。3、靜息代謝率快速獲取方法研究針對當(dāng)前靜息代謝率(RMR)測量耗時的現(xiàn)狀,本研究重點探索了 RMR快速獲取方法。首先,研究了當(dāng)前RMR測量協(xié)議簡化的可行性。提出1-min步長滑動時間窗法,通過32個受試者實驗,觀察分析RMR測量過程中人體狀態(tài)穩(wěn)定程度(CV%)和代謝率的動態(tài)變化過程。結(jié)果發(fā)現(xiàn)優(yōu)化當(dāng)前測量協(xié)議、縮短測量時間具有可行性。其次,研究了基于心率監(jiān)測的RMR快速獲取方法�；谛穆逝c耗氧量、代謝率之間的關(guān)系,提出了一種基于心率監(jiān)測的RMR快速獲取方法。通過42名健康人群實驗,驗證了該快速獲取方法的準(zhǔn)確性。實驗結(jié)果也表明,該方法不僅能夠大幅減少平均測量時間(14分鐘),而且能夠根據(jù)被測試者個體狀態(tài)進行判斷,個性化測量時間。4、非肥胖健康成年人RMR最佳預(yù)測公式研究靜息代謝率預(yù)測公式具有無成本、使用簡單等特點,在缺乏IC的情況下能夠發(fā)揮重要作用。RMR預(yù)測公式的適用與否在不同人群中存在差異。然而,針對我國非肥胖健康成年人群的RMR預(yù)測公式準(zhǔn)確性研究仍然缺乏。因此,本研究應(yīng)用所研制的間接能量測試儀,通過對46位該類人群RMR進行測量,評估14中常見預(yù)測公式的準(zhǔn)確性。研究結(jié)果表明,該14個預(yù)測公式的準(zhǔn)確性均不理想,IC法仍是評估該類人群RMR的首選方法。相對而言,Henry公式最適用,能夠準(zhǔn)確估算約70%該類人群的RMR,在缺乏IC的情況下,可將Henry公式作為IC的替代方法。未來的研究中,需要建立基于大樣本、適用于我國特定人群的RMR預(yù)測公式。
[Abstract]:Malnutrition is a nutritional state that is harmful to the human body because of the imbalance of energy or nutrients. Malnutrition and the damage of vital organs in the inpatient and the high incidence of slow disease in the field of public health have become a huge risk and important public health problem for inpatient. Rate and metabolic substrates, to determine the nutritional requirements, and then carry out appropriate nutritional support, is an effective means to prevent malnutrition. In the metabolic measurement, indirect calorimetry has the advantages of relatively cheap and convenient, which has become an important method for nutritional assessment and nutritional support in clinical nutrition. However, our country's indirect energy testing instrument (IC) is popular. And the degree is still very low, especially for the small and medium hospitals and the public health areas. The main reasons are: (1) the measurement instruments are dependent on the import, the price is expensive, the cost of measurement and the maintenance cost are high, and the relative consumption of the measurement can not meet the high efficiency of the hospital patient service in our country; and the measurement needs professional operators. Based on the above situation The following research is carried out in this paper: 1, an indirect energy testing method based on head bell type dilution method is based on the principle of indirect energy test. This study is designed by breathing gas analysis method, and the software and hardware platform of gas acquisition and analysis is built, and the indirect energy test based on head bell type dilution method with independent intellectual property right is established. This method uses the electronic pressure automatic control technology, adjusts the aperture of the proportional valve through the feedback mechanism, controls the constant pressure of the pipeline to ensure the accuracy of the concentration measurement, and adopts the stable state recognition technology, which not only monitors and displays the stability index of the respiratory exchange parameters VO_2 and VCO_2 of the tested person in real time (CV%), and is obtained for the operator. An intuitive reference is provided for the metabolic parameters in the stable state, and the data of the stable state interval is automatically obtained to calculate the final results, and the operator dependence.2 is reduced. The repeatability and validity of the indirect energy test system is repeatable: the intra group correlation coefficient (ICC) is used by 38 subjects. The coefficient of variation (CV%) and the consistency range (LoA) of Bland-Altman analysis were used as evaluation indicators. The results showed that the ICC of VO_2 and VCO_2 for two measurements were 0.945 and 0.907 respectively, CV% was 5.9% and 8.3% respectively, and LoA was -21.0 to 29.1 and -27.7 to 30.9 respectively. The reproducibility was good and reached the level of international similar equipment. The effectiveness was used in two methods: 1 body External simulation verification: the correlation coefficient of the simulated respiratory exchange parameters and the measured values is high (r=0.99, p0.001), the LoA range is narrow (VO_2: -1.14 to 6.48, VCO_2:-0.87 ~ 8.11). 2. In vivo experiments verify that this equipment and similar equipment (VO_2000) are used to compare the measurement results to the 38 people. The results show that the correlation coefficient of the two is higher (VO_2: r=0.91, p0.001, VCO_2:r). =0.89, p0.001), the mean difference was small (V02: 5.9%, VCO_2: 5.5%), and the consistency was still available (V02:-26.9 to 50.3, VCO_2: -24.8 to 43.2). The results showed that the effectiveness of the self developed indirect energy testing instrument was good.3. The study on the rapid acquisition method of resting metabolic rate was focused on the status of the time-consuming metabolic rate (RMR) measurement in the rest of the rest period. RMR fast acquisition method. First, the feasibility of simplifying the current RMR measurement protocol is studied. A sliding time window method of 1-min step length is proposed. Through the experiment of 32 subjects, the dynamic change process of the state stability degree (CV%) and the metabolic rate in the RMR measurement process is observed and analyzed. The result shows that the current measurement protocol is optimized and the measurement time can be shortened. Secondly, the fast acquisition of RMR based on heart rate monitoring is studied. Based on the relationship between heart rate and oxygen consumption and metabolic rate, a fast RMR acquisition method based on heart rate monitoring is proposed. The accuracy of the fast acquisition method is verified by 42 healthy population experiments. The experimental results also show that this method can not only be greatly reduced. Less average time (14 minutes), and can be judged according to the individual state of the tested person, individual measurement time.4, the best prediction formula of RMR for non obese healthy adults, the prediction formula of resting metabolic rate has no cost, and the use of simple and other characteristics can play an important role in the application of the.RMR prediction formula under the absence of IC. There are differences in different populations. However, the accuracy of the RMR prediction formula for the non obese healthy adult population is still lacking. Therefore, the indirect energy testing instrument developed by this study is used to measure the accuracy of the common pretest formulas in 14 of the 46 groups of people. The results show that the 14 pretests have been made. The accuracy of the measurement formula is not ideal, IC method is still the first choice to evaluate the RMR of this group. Relative, the Henry formula is the most suitable and can accurately estimate the RMR of about 70% of the group. In the absence of IC, the Henry formula can be used as a substitute for IC. In the future study, it is necessary to establish a large sample based on the specific population of our country. The RMR prediction formula.

【學(xué)位授予單位】：中國科學(xué)技術(shù)大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R459.3;TP274

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