重度烧伤病人早期肠内营养支持的研究

EFFECTS OF EARLY TOTAL ENTERAL NUTRITION ON SEVERELY BURNED PATIENTS

目的:研究重度烧伤病人早期应用肠内营养支持的疗效及安全性。方法:41例烧伤面积超过30%的病人随机分为肠内营养组(TEN,n=21)和肠外营养支持为主的常规治疗组(CONT,n=20)。给与相当氮量和能量,7d后观察两组内脏蛋白、肿瘤坏死因子-α和预后炎症营养指数(prognosticinflammatoryandnutritionalindex,PINI)等的变化及不良反应。结果:TEN组前白蛋白水平(mg/L)从99.9±25.1上升至115.8±31.0,CONT组从96.0±31.8显著下降至69.4±17.3(P<0.01)。TEN组C-反应蛋白与TNF-α水平显著低于CONT组,CONT组的PINI值比TEN组显著升高;两组不良反应发生情况相当。结论:早期肠内营养支持改善重度烧伤病人营养状况的疗效优于常规治疗,安全可行。

Objective： To evaluate the clinical effectiveness and safety of early total enteral nutrition （TEN） in severely burned patients. Methods： Forty one burned patients with total burn surface area over 30% were randomly assigned to TEN group （n=21） and CONT group （n=20）. The two nutritional support protocols were similar in calorie and nitrogen intake within 7 d of treatment. Serum levels of visceral proteins and TNF-α were measured. Prognostic inflammatory and nutritional index （PINI） was postulated from formula. Results： Contrasting to a significant reduction （from 96.0±31.Smg/L to 69.4± 17.3 mg/L, P〈0.01） of prealbumin in CONT group, remarkable increase （from 99.9±25.1mg/L to 115.8±31.0 mg/L） was observed in TEN group. C-reaction protein （CRP） and TNF- α levels were significantly lower in the TEN group than in the CONT group. PINI increase was significantly higher in CONT group than in TEN group. Side-effects were similar in both groups. Conclusions： Early total enteral nutritional support improved nutritional status compared to conventional nutritional support, and was good in safety and practice in severely burned patients.