重症烧伤病人的营养治疗及临床指标分析

Nutritional therapy and clinical index analysis of severe burn patients

目的:描述重症烧伤病人营养治疗情况,探讨其不能早期进食和能量蛋白质不达标的影响因素。方法:收集62例武汉市第三医院2019年9月至2021年10月入院的重症烧伤病人,分析其伤后第1、2、3、7、14、21、28天的胃肠营养、肠外营养(PN)及总营养摄入。24 h内进食为早期进食组,24 h后进食为非早期进食组;根据病人伤后第7、14、21、28天的能量及蛋白质摄入量平均值是否至少有一项达标分为达标组和未达标组。统计两组间差异及影响因素。结果:伤后第7~28天94.9%~98.0%的病人采用胃肠营养。所有病人所有时期均予以PN,非蛋白热氮比均高于270:1。蛋白质较能量的达标人数比例更低。与非早期进食组相比,早期进食组的伤后第7天总胆红素(TBIL)及伤后第3天C反应蛋白(CRP)更低(P<0.05)。与能量蛋白质未达标组相比,达标组的伤后第7天TBIL更低,伤后第21天白蛋白(ALB)及前白蛋白(pALB)更高(P<0.05)。多因素logistic回归分析显示,休克期度过不平稳、呕吐、年龄大是不能早期进食的独立危险因素;年龄大、伤后第7天TBIL高是能量蛋白质不达标的独立危险因素因素(P<0.05)。结论:重症烧伤病人的营养治疗尤其是蛋白质供给尚需进一步优化。早期进食及能量蛋白质达标病人的TBIL、ALB、pALB及CRP水平更优。

Objective:To describe the nutritional treatment of severe burn patients and explore the influencing factors of non-early feeding and not meeting the energy or protein target.Methods:We collected 62 severe burn patients admitted to our hospital from September 2019 to October 2021 and analyzed their gastrointestinal nutrition,parenteral nutrition(PN)and total nutrition intake on 1st,2nd,3rd,7th,14th,21st and 28th days after injury.Eating within 24 hours was the early feeding group and eating after 24 hours was the non-early feeding group.The patients were divided into the standard group and the non-standard group based on whether there is at least one item that meets the average values of energy and protein intake on the 7th,14th,21st and 28th days after injury.The differences between the two groups and the influencing factors were analyzed.Results:94.9%~98.0%of patients were given gastrointestinal nutrition at 7~28 days after injury.All patients were treated with PN at all stages,and the ratio of non-protein caloric to nitrogen was higher than 270:1.The proportion of patients who met the protein standard was lower than that of patients who reached the energy target.Compared with the non-early feeding group,the early feeding group had lower total bilirubin(TBIL)on 7th day after injury,and C-reactive protein(CRP)on 3rd day after injury(P<0.05).Compared with the protein and energy non-standard group,the TBIL level on 7th day after injury was lower,and the albumin(ALB)and prealbumin(pALB)levels on 21st day after injury were higher in the standard group(P<0.05).Multivariate logistic regression analysis showed that unstable shock phase,old age and vomiting were the independent risk factors for non-early feeding.Old age and high TBIL level on 7th day after injury were independent risk factors for failing to reach the energy or protein target(P<0.05).Conclusions:Nutritional treatment especially the protein supply in severe burn patients needs further optimization.The levels of TBIL,ALB,pALB and CRP is better in patients who ate early and met energy and protein standards.