综合营养策略在危重烧伤脓毒症防治中的应用

A new combined nutrition strategy in the prevention and treatment of patients with severe burn sepsis

目的探讨综合营养策略在危重烧伤脓毒症防治中的作用。方法将46例危重烧伤病例随机分为二组，综合营养组（综合组，n=26）和常规营养组（常规组，n=20），综合组采用由早期肠道喂养（EEF）、谷胺酰胺（Gin）、重组人生长激素（rhGH）等构成营养新策略进行治疗。观察2组治愈率、脓毒症发生率，观察2组间前白蛋白（PA）、C反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子d（TNFct）的动态变化。结果（1）综合组平均住院时间较常规组缩短。（2）综合组脓毒症发生率、心肌损害和应激性溃疡发生率较常规组明显下降（P〈0．01～0．05）。（3）2组血浆PA均下降，但常规组更明显（P〈0．01～0．05）。（4）2组CRP、PCT、TNFα均升高，但以常规组更为明显（P〈0．001～0．05）。结论由EEF、Gin、rhGH构成的综合营养策略有助于改善危重烧伤患者的营养状况，促进烧伤创面愈合，降低烧伤脓毒症的发生率，从而有效地提高了危重烧伤救治成功率。

Objective To analyze the effect of a combined strategy of enteral nutrition in the prevention and treatment of patients with severe burn sepsis. Methods 46 cases were random divided into combined group （group C ） and routine group （group R）. Besides general supportive treatment ,group C was treated with early enteral feeding （EEF） ,recombinant human growth hormone （rhGH） and glutamine （ Gln）, while group R was given general supportive treatment only. The plasma concentration levels of pre-albumin （ PA）, C-reactive protein （CRP） , procalcitonin （PCT） and tumor necrosis faetorα（TNFα） were measured immediately ＂after hospitalization and postburn day （PBD） 7, 14, 28. Results The survival rate of group C was significantly higher than group R. The incidence of sepsis, the complication of heart and gastrointestin in group C was significantly lower than group R （ P 〈 0.01 -0.05 ）. The days in hospitalization of group C was shorter than that of group R. Plasma PA levels was decreased in two groups and was markedly decreased in the group R（ P 〈 0. 01 - 0. 05 ）. Plasma CRP, PCT and TNFαlevels were both increased in two groups and markedly increased in the group R （ P 〈 0. 001 - 0. 05 ）. Conclusions We have shown that a combined method including rhGH, EEF, Gin and anisodamin can effectively reduce the morbidity and mortality rates of burn sepsis and improve prognosis.