早期肠内喂养MCT/LCT改善烧伤病人高代谢的临床研究

Effects of Early Enteral Feeding Containing MCT/LCT on Improving Protein Catabolism of 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的肠内营养制剂对烧伤后高代谢的不同影响 ,探讨MCT/LCT改善烧伤后代谢状态的作用及可能机制。方法 选取 3 0例TBSA >3 0 %的烧伤病人 ,并随机分为两组 ,一为Fresubin75 0MCT组 (F组 ) ,即饲以含MCT/LCT的肠内营养制剂Fresubin 75 0MCT ;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 2 4h内进行完全肠内营养支持 ,共支持 10d。在PBD1、4、7、10分别观察了两组患者影响代谢的严重因子的变化情况 (包括血浆胰岛素、胰高血糖素、肿瘤坏死因子 (TNF)及皮质醇。尿 3 -甲基组氨酸排泄率 )。结果 烧伤后机体分解代谢增加 ,两组相比血浆皮质醇水平无显著差异 ;F组患者血浆胰岛素与胰高血糖素浓度的比值明显升高 ,尿 3 -甲基组氨酸排泄率及血浆TNF明显下降。结论 含MCT/LCT的肠内营养制剂较只含LCT者 ,能促进烧伤后机体合成激素的分泌 ,减少肌肉蛋白分解排出量 ,从而改善烧伤病人代谢状况 ,并有利于提高全身营养及免疫状况 。

Objectives To compare the effects of different early enteral nutrition formula on improving metabolic status of burned patients. Methods Thirty cases of burned patients with total burn surface area (TBSA) more than 30% were randomly divided into two groups:⑴Group F, enteral feeding with Fresubin 750MCT containing MCT/LCT as fat source, ⑵Group N, enteral feeding with Nutrison containing only LCT as fat source. All of the thirty patients received isocaloric, isonitrogenous and isolipidic enteral feeding with intragstric tube and enteral feeding pump, within 24h of postburn. Plasma insulin, glucagons, tumor necrosis factor (TNF) and 3-methylhistidine in urine were measured on day 1,4,7and 10 days of postburn. Results The results showed that the patients of group F had an increased blood concentration of insulin and the ratio of insulin/ glucagons, a decreased plasma concentration of TNF, and a reduced excretion of 3-methylhistidine in urine as compared with the patients of group N. Conclusions An enteral compound diet containing MCT/LCT in the early enteral feeding in burned patients can improve the metabolic status of burned patients more effectively.