醋酸精氨酸对创烧伤患者预后的影响及安全性分析——86例多中心、随机、双盲、安慰剂对照试验

目的观察服用醋酸精氨酸对创烧伤患者预后的影响及可能出现的不良反应。方法采用多中心、随机、双盲、安慰剂平行对照的研究方法,将96例创烧伤患者(实际完成86例)随机分为治疗组和对照组,治疗组41例,服用醋酸精氨酸0．4 g·kg-1·d-1;对照组45例,服用安慰剂酪氨酸,剂量同前,均连用7 d。两组患者采用等氮、等热量的营养支持疗法。比较患者创面(切口)愈合时间、住院时间及不良反应发生情况。结果创伤患者治疗组(29例)创面(切口)愈合时间和住院时间分别为(11．1±2．8)、(19±6)d,明显短于对照组(13．2±5．5)、(22±6)d(33例,P< 0．05);烧伤患者治疗组(12例)创面愈合时间和住院时间各为(20±5)、(28±6)d,与对照组(22±8)、(29±8)d(12例)比较,差异无统计学意义(P>0．05)。在整个试验过程中,患者出现的不良反应为恶心、腹泻,其中治疗组1例占2．44％,对照组1例占2．22％,两组比较差异无统计学意义(P= 1．000)。以上不良反应停药后消失。结论服用醋酸精氨酸能显著促进创伤患者创面(切口)愈合,缩短住院时间,且无明显不良反应,但对烧伤患者的预后无明显改善,这可能与病例数较少有关,其确切疗效有待于通过大样本的临床试验予以确定。

Analysis of the influence on the prognosis and safety of arginine in patients with severe trauma and burns——A multi-center randomized double blinded, placebo controlled, clinical trail in 86 patients

OBJECTIVE: To observe the influence on prognosis and possible side-effects of arginine in METHODS: Multi-center clinical trial, randomized double blinded patients with severe trauma and burns. and placebo control methods were employed in the study. Eighty-six patients with severe trauma and burns were randomly divided into control (C, n = 45) and arginine treatment (Arg, n = 41) groups. The patients in Arg group received arginine in dose of 0. 4 g x kg(-1) x d(-1) orally, while those in C group received same dose of placebo (tyrosine) for 7days. All the patients in both groups were given diet with equal calories and equal nitrogen content. The changes in the wound healing time, hospotal stay, and the incidence of side-effects of the medication in both groups of patients were observed and compared before and after the supplementation of arginine. RESULTS: The wound healing time and hospital stay days of severe trauma patient in Arg group (n = 29) were 11. 1+/-2. 8 d and 19+/-6 d, which were all obviously shorter than those in C group (13. 2+/-5. 5 d, 22 +/-6 d, n =33, P <0.05). On the other hand, in severe burn patients there were no significant difference of the wound healing time (20+/-5 d vs 22+/-8 d, n = 12, P > 0. 05) and hospital stay days (28+/-6 d vs 29+/-8 d, n = 12, P >0. 05) between the Arg and C groups. In addition, in C and Arg groups, the occurrence of the side-effects were seldom (2. 44% vs 2. 22% , P = 1. 000) and it disappeared when the supplementation of drugs was stopped. CONCLUSION: Oral feeding of arginine is beneficial in enhancing wound healing, reduction of hospital stay days in severe trauma patients and with little side-effects, but it is not beneficial to improve the prognosis of severe burn patients. Maybe this is due to inadequate number of case involved in the study.