重症烧伤并发肠系膜上动脉综合征的营养治疗策略分析

Analysis of nutritional treatment strategy for severe burn complicated with superior mesenteric artery syndrome

回顾性分析烧伤重症监护病房(BICU)收治的4例重症烧伤并发肠系膜上动脉综合征(SMAS)患者的临床资料。患者为3女1男,其中1例为女性儿童。烧伤原因均为火焰烧伤,深度以Ⅱ~Ⅲ°为主,入院时均合并有不同严重程度吸入性损伤。将患者按年龄从小到大编号, 1、2、3、4号患者年龄分别为10、30、40、62岁,烧伤总面积为70%~92%、平均烧伤总面积(80.5±12.2)%,Ⅲ°烧伤面积为55%~80%、平均Ⅲ°烧伤面积(68.8±13.1)%。2号患者于伤后3 h直接收治入本院, 1、3、4号患者分别于伤后456、192及16 h由外院转入本院。并发SMAS的时间分别为伤后20、35、10、50 d。4例患者SMAS诊断均通过临床症状、腹部X线平片和腹部CT结果综合判定。SMAS确诊后治疗上予禁食,留置鼻胃管和鼻空肠管,胃肠减压,翻身床俯卧位治疗,肠内、肠外营养支持。深度烧伤创面早期采用切削痂后异体皮临时覆盖,后期分别用自体MEEK皮、网状皮或邮票皮移植修复创面。4例患者分别行5、8、6、7次手术,分别禁食和胃肠减压3、4、7、5 d,鼻空肠管肠内营养支持治疗13、29、60、17 d,鼻胃管肠内营养支持治疗42、70、97、45 d,肠外营养支持治疗17、53、81、25 d后,患者体重增加,营养指标显著改善,创面均完全愈合后出院,随访6~36个月后SMAS无复发。

The clinical data of 4 patients with severe burn complicated with superior mesenteric artery syndrome(SMAS)admitted to Burn intensive Care Unit(BICU)were retrospectively analyzed.The patients were 3 females and 1 male,one of which was a female child.The cause of burn was flame burn,the depth was mainlyⅡ-Ⅲ°,and there were inhalation injury of different severity at admission.Patients were numbered from the youngest to the oldest.Patient No.1,2,3,and 4 were 10,30,40,and 62 years old,respectively,with a total burn area of 70%-92%and an average burn area of(80.5±12.2)%,and aⅢ°burn area of 55%-80%and an averageⅢ°burn area of(68.8±13.1)%.Patient No.2 was admitted directly to this hospital at 3 h post-injury,while patient No.1,3,and 4 were transferred to this hospital from an outside hospital at 456,192,and 16 h post-injury,respectively.The time of complication of SMAS was 20,35,10 and 50 d post-injury,respectively.The diagnosis of SMAS in 4 patients was determined by clinical symptoms,plain abdominal X-ray and abdominal CT results.After the diagnosis of SMAS was confirmed,the patients were treated with fasting,indwelling nasogastric tube and nasojejunal tube,gastrointestinal decompression,turning bed and prone position treatment,enteral and parenteral nutritional support.Deep burn wounds were temporarily covered with allograft skin after cutting scabs in the early stage,and the wounds were repaired with autologous MEEK skin,mesh skin or stamp skin grafts in the later stage,respectively.4 patients underwent 5,8,6,and 7 surgeries,respectively,with fasting and gastrointestinal decompression for 3,4,7,and 5 d,enteral nutritional support treatment with nasojejunal tube for 13,29,60,and 17 d,enteral nutritional support treatment with nasogastric tube for 42,70,97,and 45 d,and parenteral nutritional support treatment for 17,53,81,and 25 d.The patients were discharged from the hospital with weight gain and significant improvement in nutritional indexes,and their wounds were all completely healed,and there were no recurrences of SMAS after a followup of 6-36 months.