重度烧伤病人早期肠内营养支持的研究

目的:研究重度烧伤病人早期应用肠内营养支持的疗效及安全性。方法:41例烧伤面积超过30%的病人随机分为肠内营养组(TEN,n=21)和肠外营养支持为主的常规治疗组(CONT,n=20)。给与相当氮量和能量,7d后观察两组内脏蛋白、肿瘤坏死因子-α和预后炎症营养指数(prognosticinflammatoryandnutritionalindex,PINI)等的变化及不良反应。结果:TEN组前白蛋白水平(mg/L)从99.9±25.1上升至115.8±31.0,CONT组从96.0±31.8显著下降至69.4±17.3(P<0.01)。TEN组C-反应蛋白与TNF-α水平显著低于CONT组,CONT组的PINI值比TEN组显著升高;两组不良反应发生情况相当。结论:早期肠内营养支持改善重度烧伤病人营养状况的疗效优于常规治疗,安全可行。

EFFECTS OF EARLY TOTAL ENTERAL NUTRITION ON SEVERELY BURNED PATIENTS

Objective: To evaluate the clinical effectiveness and safety of early total enteral nutrition (TEN) in severely burned patients. Methods: Forty one burned patients with total burn surface area over 30% were randomly assigned to TEN group (n=21) and CONT group (n=20). The two nutritional support protocols were similar in calorie and nitrogen intake within 7 d of treatment. Serum levels of visceral proteins and TNF-α were measured. Prognostic inflammatory and nutritional index (PINI) was postulated from formula. Results: Contrasting to a significant reduction (from 96.0±31.8mg/L to 69.4±17.3 mg/L, P<0.01) of prealbumin in CONT group, remarkable increase (from 99.9±25.1mg/L to 115.8±31.0 mg/L) was observed in TEN group. C-reaction protein(CRP)and TNF-αlevels were significantly lower in the TEN group than in the CONT group. PINI increase was significantly higher in CONT group than in TEN group. Side-effects were similar in both groups. Conclusions: Early total enteral nutritional support improved nutritional status compared to conventional nutritional support,and was good in safety and practice in severely burned patients.