肠内营养支持在重度烧伤患者中的应用

Application of Enteral Nutrition Support in Severe Burn Patients

目的探讨肠内营养支持护理对重度烧伤患者免疫功能、创面恢复的影响。方法回顾性分析河南省人民医院/郑州大学人民医院2019年1月至2022年9月收治的174例大面积重度烧伤患者临床资料,接受肠道外营养支持的98例患者纳入B组,将接受肠内营养支持护理的76例患者纳入A组,比较两组创面恢复情况、营养指标、炎症指标、免疫功能、不良反应发生情况。结果A组供皮区、植皮区、深二度、浅二度创面愈合时间以及创面基本愈合时间均短于B组(P<0.05);A组入院后7、14 d血清总蛋白(TP)、白蛋白(Alb)水平高于B组(P<0.05);A组入院后7、14 d病原菌定植率25.00%、15.79%,低于B组的39.80%、29.59%(P<0.05);A组入院后7、14 d C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)水平低于B组(P<0.05);A组入院后7、14 d细胞免疫指标CD4^(+)、CD4^(+)/CD8^(+)水平高于B组,体液免疫指标IgA、IgG、IgM水平高于B组(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论肠内营养支持护理可促进重度烧伤患者创面尽快愈合,增进营养,减少病原菌定植,减轻炎症反应,提高免疫功能。

Objective To explore the effects of enteral nutrition support nursing on immune function and wound recovery of patients with extensive severe burns.Methods The clinical data of 174 patients with extensive severe burns in Henan Provincial People’s Hospital/Zhengzhou University People’s Hospital from January 2019 to September 2022 were retrospectively analyzed.Among them,98 cases who were given parenteral nutrition support were included in group B,while another 76 cases who were given enteral nutrition support nursing were included in group A.The wound recovery,nutrition indexes,gastrointestinal function and occurrence of adverse reactions were compared between the two groups.Results The healing time and basic healing time of skin donor site,skin graft site,deep second-degree and superficial second-degree wounds in group A were shorter than those in group B(P<0.05).At 7 days and 14 days after admission,levels of serum total protein(TP)and albumin(Alb)in group A were higher than those in group B(P<0.05).At 7 days and 14 days after admission,colonization rates of pathogens in group A were 25.00%and 15.79%,lower than those in group B(39.80%,29.59%)(P<0.05).At 7 days and 14 days after admission,levels of inflammatory indexes[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6)]in group A were lower than those in group B(P<0.05).At 7 days and 14 days after admission,levels of cellular immunity indexes(CD4^(+),CD4^(+)/CD8^(+))in group A were higher than those in group B,and levels of humoral immune indexes(IgA,IgG,IgM)were higher than those in group B(P<0.05).There was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Enteral nutrition support nursing can promote wound healing in patients with extensive severe burns as soon as possible,enhance nutrition,reduce colonization of pathogens,alleviate inflammatory response,and improve immune function.