强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响  

Effects of arginine enriched enteral nutrition on nutritional status and cellular immunity in burn patients

作　　者：郭光华[1] 徐成[2] 白祥军[1] 詹剑华[2] 张红艳[2] 张志安[2] 王艳霞[2] 方方[2] 李国辉[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030 [2]南昌大学第一附属医院烧伤科

出　　处：《中华烧伤杂志》2009年第3期211-214,共4页Chinese Journal of Burns

基　　金：江西省教育厅资助项目

摘　　要：目的了解强化精氨酸肠内营养（EN）对严重烧伤患者营养状况及细胞免疫功能的影响。方法采用随机、单盲、平行、阳性对照的原则，将30例严重烧伤患者分为肠内免疫营养（EIN）组和EN组。EIN组16例患者接受强化精氨酸EN治疗，EN组14例接受标准EN治疗，均持续1dd。观察2组患者治疗期间胃肠道反应，于其接受营养治疗前和治疗第7、14天清晨抽取空腹静脉血，检测血清蛋白水平、肝肾功能指标、空腹血糖值及外周血T淋巴细胞亚群。结果（1）EIN组患者胃肠道不良反应发生率（25．0％）与EN组（21．4％）接近（P〉0．05）。（2）与营养治疗前比较，2组患者治疗后第7、14天血清前白蛋白和转铁蛋白水平均显著升高（P〈0．05或P〈0．01），但组间比较水平接近（P〉0．05）；治疗第14天，2组患者血清总蛋白均显著高于治疗前，且EIN组水平[（66±7）g／L]显著高于EN组[（64±11）g／L，P〈0．05]；EIN组治疗第7、14天血清白蛋白水平[（29±5）、（32±5）g／L]显著高于治疗前[（26±4）g／L，P〈0．05或P〈0．01]，EN组治疗前后白蛋白值无明显变化。（3）2组患者营养治疗前后大部分肝。肾功能指标及空腹血糖值无明显变化（P〉0．05）。（4）治疗第14天，EIN组CD4^＋、CD8^＋细胞百分比与治疗前相近，EN组CD4^＋显著低于治疗前而CD8^＋显著高于治疗前（P〈0．05）；EIN组CD4^＋细胞百分比[（56±8）％]显著高于EN组[（55±12）％，P〈0．05]；2组患者CD3^＋细胞百分比均显著高于治疗前（P〈0．05或P〈0．01），CD4^＋／CD8^＋均无明显变化。结论强化精氨酸EN能有效改善烧伤患者营养状况及细胞免疫功能。Objective To investigate the effects of arginine enriched enteral nutrition （EN） on nutritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were divided into enteral immune nutrition （EIN） group and EN group. Sixteen patients in EIN group received enteral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nutrition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7^th , 14^th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results （ 1 ） Incidence of gastrointestinal side effect in EIN group （25.0%） was close to that of EN group （21.4% , P 〉0.05）. （2） Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in ：2 groups on 7^th and 14^th post-treatment days were significantly increased （ P 〈 0.05 or P 〈 0.01 ） , but there was no significant difference between 2 groups. The level of total serum protein on 14^th day of treatment of patients was significantly increased in both groups, and that of EIN group （66 ±7 g/L）was significantly higher compared with that in EN group （64 ±11 g/L, P 〈0.05）. The level of serum albumin （29±5, 32±5 g/L, respectively） of patients in EIN group on 7^th and 14^th day of treat-ment were significantly higher than that （26 ± 4 g/L, P 〈 0.05 ） in pre-treatment days, however there was no significant difference in EN group. （3） There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment

关 键 词：烧伤 精氨酸 肠道营养 细胞免疫 

分 类 号：R644[医药卫生—外科学] R285.5[医药卫生—临床医学]