MCT/LCT对于烧伤病人肠道的保护作用

Effects of early enteral nutrition containing medium and long-chain triglyceride on the protection of intestinal tract in burned patients

目的 通过比较烧伤病人早期肠内喂养含ＭＣＴ／ＬＣＴ与只含ＬＣＴ的肠内营养制剂对肠道功能的不同影响，探讨ＭＣＴ／ＬＣＴ对烧伤后肠道的保护作用及可能机制。方法 选取３０例ＴＢＳＡ＞３０％的烧伤病人，并随机分为两组，一组为Ｆｒｅｓｕｂｉｎ７５０ＭＣＴ组（Ｆ组），即饲以含 ＭＣＴ／ＬＣＴ的肠内营养制剂 Ｆｒｅｓｕｂｉｎ ７５０ ＭＣＴ；另一组为 Ｎｕｔｒｉｓｏｎ组（Ｎ组），即饲以只含 ＬＣＴ的肠内营养制剂 Ｎｕｔｒｉｓｏｎ。于伤后２４ ｈ进行完全肠内营养支持，共支持 １０ ｄ。在烧伤后第 １、４、７、１０天分别观察了两组患者肠道损伤的情况（包括血浆 ＳＯＤ、ＭＤＡ、尿Ｌ／Ｍ及血浆胃泌素水平）。结果 烧伤后肠道缺血及再灌流损伤明显，肠道通透性增加。两组相比Ｆ组患者血浆ＳＯＤ及血清胃泌素明显升高，ＭＤＡ及尿Ｌ／Ｍ值明显下降。结论 含ＭＣＴ／ＬＣＴ的肠内营养制剂较只含ＬＣＴ者，在减轻烧伤后肠道缺血及再灌流损伤，促进营养性胃肠激素的分泌，降低肠道通透性等方面有更佳的疗效，从而能更有效地保护烧伤后肠道的屏障功能。

Objective To compare the effects of different fat nutrients (MCT/LCT is LCT only) on the protection of intestinal mucosa in burned patients. Mothods A total of 30 burned patients injured by various causes with total burn surface area (TBSA) more than 30% were chosen and randomized into two groups. ① Group F: enteral feeding with Fresubin 750MCT containing MCT/LCT as fat source. ② Group N: enteral feeding with Nutrison, which contained only LCT as fat source. All of the 30 patients received enteral feeding with intragstric tube and enteral feeding pump, started within 24 h after burn. The following parameters were observed on postburn day (PBD) 1, 4, 7 and 10. i. e. plasma content of superoxide dismutase (SOD), malondialdehyde (MDA) serum gastrin, and the permeability of intestine. Results In F group concentration of plasma SOD and serum gastrin increased and plasma MDA decreased. Lactulose/mannitol ratio in urine were also markedly reduced in patients fed with nutrients con- taining MCT/LCT compared with LCT. Conclusion An enteral compound diet containing MCT/LCT used in the early enteral feeding on burned pa- tients can protect the barrier function of intestinal tract better than LCT only.