严重烧伤患者应用含合生元制剂的早期肠内营养初步观察  

Preliminary comparative study on the effects of early enteral supplementation of synbiotics on severely burned patients

作　　者：陆新[1] 韩春茂[2] 余建新[2] 付素珍[3] 

机构地区：[1]解放军第一一七医院烧伤整形科,杭州310013 [2]浙江大学医学院附属第二医院烧伤科 [3]浙江大学医学院传染病研究所

出　　处：《中华烧伤杂志》2004年第4期198-201,共4页Chinese Journal of Burns

摘　　要：目的　探讨含合生元制剂的早期肠内营养对严重烧伤患者血浆内毒素水平、炎症应激营养状态及感染并发症的影响。　方法　采用双盲、对照、随机的方法。 4 0例重度烧伤患者随机分为A、B组各 2 0例。A组患者用含乳酸菌合生元制剂 ( 4种益生菌 + 4种纤维 )的早期肠内营养治疗 ;B组用含 4种纤维制剂的早期肠内营养治疗。另将两组中烧伤面积系数 (UBS)为 80 %～ 2 80 %的患者分别设为A1组 ( 10例 )与B1组 ( 11例 )。伤后第 1、3、7、10、14、2 1天测定A、B组患者血浆内毒素水平 ,根据内毒素水平正常参考值统计各组中该指标的异常率。比较A、B组患者血培养结果、感染并发症发生情况及死亡情况。于上述时相点检测A1、B1组患者血浆白细胞介素 (IL)1、IL 6及预后炎症营养指数 (PINI)水平。　 结果　伤后第 10天A组患者血浆内毒素为 ( 37.9± 5 .4 )ng/L,明显低于B组 ( 5 9.1± 7.9)ng/L(P <0.0 5)。整个观察期内A组血浆内毒素异常率为 36 .7% ,明显低于B组 4 9.2 % ( P <0.0 5 )。A组血培养阳性者 3例、B组 5例。A组感染发生率为 4 0 % ,与B组 5 5 %比较 ,差异无显著性意义 (P >0.0 5 )。A组患者死亡 2例、B组 1例。伤后各时相点A1、B1组患者IL 1水平差异无显著性意义 (P >0.0 5)。A1组伤后第 10、14天IL 6水平明?Objective To investigate the influence of early enteral nutrition with synbiotics on the plasma endotoxin level, the nutritional state, the inflammatory response and the incidence of infectious complications in severely burned patients. Methods Randomized double blind and control method was employed in the study. Forty severely burned patients were randomly divided into A and B groups with 20 in each group. The patients in group A received early enteral nutrition with synbiotics including four kinds of lactic acid bacteria and four kinds of fibers, while those in group B received early enteral nutrition with synbiotics including only four kinds of fibers. The patients with 80% to 280% coefficient unit burned surface (UBS) were further divided into A1(n=10) and B1(n=11) groups. The plasma endotoxin level in group A and B was determined dynamically on the 1st, 3rd, 7th, 10th, 14th and 21st postburn days (PBD),and its abnormal rate in both groups was statistically analyzed in correlation with the normal endotoxin level. Meanwhile, the mortality, the incidence of infectious complications and the blood bacterial culture results were compared between the two groups. The plasma levels of IL 1, IL 6 and prognostic inflammatory nutrition index (PINI) were alsp determined at the above time points. Results The plasma endotoxin level in group A (37.9±5.4) ng/L was evidently lower than that in group B (59.1±7.9)ng/L (P<0.05) on 10 PBD.The abnormal rate of plasma endotoxin in group A (36.7%) was evidently lower than that (49 2%) in group B (P<0.05). Blood culture was positive in 3 patients in group A, and 5 in group B. There was no obvious difference in the incidence of infectious complication between the two groups.Two patients died in group A, and 1 in group B. There was no obvious difference in plasma IL 1 level between A1 and B1 groups at different time points. The plasma IL 6 level in A1 group on 10th and 14th PBD was evidently lower than that in B1 group (P<0.05). The PINI in A1 group on the 10th PBD was rem

关 键 词：烧伤 肠道营养 炎症 感染 合生元 

分 类 号：R644[医药卫生—外科学]