严重烧伤患者早期营养支持护理方式的研究

Study on the early nutritional support nursing model in patients with severe burns

目的比较严重烧伤早期肠内营养和肠外营养的影响,以期选择更佳的营养护理选择方式。方法 19例严重烧伤患者随机分为全肠内营养组和全胃肠外营养组。烧伤后1 d、4 d、8 d、14 d测定血浆胃动素、丙二醛、超氧化物歧化酶(SOD)、内毒素、肿瘤坏死因子、血清胃泌素、二胺氧化酶和尿乳果糖/甘露醇比(L/M)。结果全肠内营养组血清胃泌素、血浆胃动素、SOD均明显高于烧伤后4 d、8 d(P<0.05或P<0.01)。全肠内营养组血浆丙二醛水平明显低于烧伤后4 d、8 d全胃肠外营养组(P<0.01)。全肠内营养组血浆内毒素水平明显低于烧伤后4 d全胃肠外营养组(P<0.01)。全肠内营养组血浆肿瘤坏死因子含量明显低于烧伤后4 d、8 d、14 d全胃肠外营养组(P<0.01)。全肠内营养组血清二胺氧化酶和尿L/M水平分别明显低于烧伤后4 d和8 d全胃肠外营养组水平(P<0.05)。L/M和二胺氧化酶、丙二醛、肿瘤坏死因子(r=0.5822,0.7459,0.7598,P<0.05或P<0.01)之间呈正相关,L/M与SOD呈负相关(r=-0.7771,P<0.01),血浆内毒素与肿瘤坏死因子、丙二醛呈正相关(r=0.9038和0.6705,P<0.05或P<0.01)。结论肠内营养是保持胃泌素分泌和胃肠道运动,降低肠缺血和再灌注损伤,降低肠通透性,降低血浆内毒素和炎性介质并保持黏膜屏障功能的更有效途径。每当胃肠功能允许时,肠内营养在烧伤早期优于肠外营养。

Objective To compare the effects of enteral nutrition and parenteral nutrition on severe burns at early stage. Methods Nineteen patients with severe burn were randomly divided into total enteral nutrition group（ TEN group） and total parenteral nutrition group（ TPN group）. The levels of plasma motilin,malondialdehyde（ MDA）,superoxide dismutase（ SOD）,endotoxin,tumor necrosis factor（ TNF）,serum gastrin,diamine oxidase（ DAO）,and ratio of urine lactulose/mannitol（ L/M） on 1d,4d,8d,14 d after burns were detected and compared between two groups. Results The levels of serum gastrin,plasma motilin,and SOD in TEN group on 4d,8d after burns were significantly higher than those in TPN group（ P 〈0. 05 or P 〈0. 01）,however,the levels of plasma MDA in TEN group on 4d,8d after burns were significantly lower than those in TPN group（ P 〈0. 01）. Moreover the levels of plasma endotoxin on 4d after burns in TEN group were significantly lower than those in TPN group（ P 〈0. 01）. The levels of TNF on 4d,8d,14 d after burns in TEN group were significantly lower than those in TPN group（ P 〈0. 01）,and the levels of serum DAO and urine L/M ratio on 4d,8d after burns in TEN group were significantly lower than those in TPN group（ P 〈0. 05 or P 〈0. 01）. In addition the ratio of L/M was positively correlated with DAO,MDA,TNF（ P 〈0. 05 or P 〈0. 01）,however,the ratio of L/M was negatively correlated to SOD（ P 〈0. 01）,moreover,endotoxin was positively correlated with TNF,MDA（ P 〈0. 05 or P 〈0. 01）. Conclusion The enteral nutrition is a more effective route to preserve gastrin secretion and motion of gastrointestinal tract,decrease intestinal ischemia and reperfusion injury,reduce intestinal permeability,decrease the levels of plasma endotoxin and inflammatory mediators,and maintain mucosa barrier function. Whenever gastrointestinal function is available,enteral nutrition is superior to parenteral nutrition at early period of severe burns.