严重烧伤延迟复苏病人营养支持的临床研究

An clinical study on nutritional support in severely burned patients with delayed fluid resuscitation

目的 :探讨进一步提高严重烧伤延迟复苏病人的营养支持方法。 方法 :6 2例严重烧伤延迟复苏病人依不同营养支持措施 ,按不同时期分为常规组 (n =2 6 )及改进组 (n =36 )。改进组在传统营养支持措施的基础上增加早期肠道喂养 (EEF)、重组人生长激素 (rhGH)、谷氨酰胺 (Gln)等治疗。观察两组创面愈合时间、治愈率及脓毒症发生率 ;入院即刻、伤后 (PBD)第 1、7、14、2 8天定时采血 ,测定淋巴细胞计数、前白蛋白、血清白蛋白 ;入院即刻及应用rhGH后第 3、7、14、2 1天 ,测定空腹微量血糖、尿糖、血清胰岛素。 结果 :①改进组供皮区、植皮区、深浅二度创面及烧伤创面平均愈合时间较常规组缩短 (P <0 .0 5～ 0 0 1)。②改进组包括应激性溃疡、脓毒症在内的并发症发生率明显下降 (P <0 .0 5 )。③烧伤后常规组及改进组血清白蛋白、前白蛋白、淋巴细胞计数均明显下降 ,但常规组下降更为明显 (P <0 .0 5 )。④改进组及常规组空腹血糖、胰岛素水平均明显升高 ,但胰岛素以改进组升高更为明显(P <0 .0 5 )。⑤ 13例尿糖明显升高 ,尿糖阳性多为一过性。改进组中尿糖升高以≥ (3+)为主 ,与常规组比较有显著差异 (P <0 .0 5 )。 结论 :综合营养支持措施 (包括EEF、Gln、rhGH等 )

Objectives:To investigate nutritional support in severely burned patients with delayed fluid resuscitation. Methods:From January 1990 through December 2000,62 cases with delayed fluid resuscitation were admitted to our burn department and were divided by different periods into two groups:group N(1990-1994,n=26) and group A(1995-2000,n=36).Group A was treated with recombinant human growth hormone(rhGH),early enteral feeding(EEF) and glutamine(Gln). Plasma albumin,pre-albumin,insulin,blood glucose and urine glucose levels were measured and lymphocyte was counted immediately after hospitalization and postburn day(PBD) 1,3,7,14,21,28. Results:①The survival rate in group A was very significantly higher than in group N.The complication in group A was significantly lower than in group N.②The time of wound healing in group A was shorter than in group N.③Plasma albumin,pre-albumin levels and lymphocyte count were decreased in two groups and was more serious in the group N(P<0.05).④Plasma insulin and blood glucose levels were increased in two groups and was more obvious in the group A(P<0.05). Conclusions:The combination use of recombinant human growth hormone(rhGH),early enteral feeding(EEF), and glutamine(Gln) can improve the nutrition status of severely burned patients with delayed fluid resuscitation.