综合营养策略在危重烧伤脓毒症防治中的应用  

A new combined nutrition strategy in the prevention and treatment of patients with severe burn sepsis

作　　者：吴祖煌[1] 卓燕舞[2] 宋斌[1] 姜新华 黄永新[1] 陈建崇[1] 

机构地区：[1]解放军福州总医院第一附属医院烧伤整形科福建医科大学福总临床医学院,福建莆田351100 [2]莆田学院附属医院小儿科 [3]解放军马尾海军医院

出　　处：《中国医师杂志》2009年第12期1610-1612,共3页Journal of Chinese Physician

基　　金：南京军区“十一五”医药卫生科研基金资助项目（06251）

摘　　要：目的探讨综合营养策略在危重烧伤脓毒症防治中的作用。方法将46例危重烧伤病例随机分为二组，综合营养组（综合组，n=26）和常规营养组（常规组，n=20），综合组采用由早期肠道喂养（EEF）、谷胺酰胺（Gin）、重组人生长激素（rhGH）等构成营养新策略进行治疗。观察2组治愈率、脓毒症发生率，观察2组间前白蛋白（PA）、C反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子d（TNFct）的动态变化。结果（1）综合组平均住院时间较常规组缩短。（2）综合组脓毒症发生率、心肌损害和应激性溃疡发生率较常规组明显下降（P〈0．01～0．05）。（3）2组血浆PA均下降，但常规组更明显（P〈0．01～0．05）。（4）2组CRP、PCT、TNFα均升高，但以常规组更为明显（P〈0．001～0．05）。结论由EEF、Gin、rhGH构成的综合营养策略有助于改善危重烧伤患者的营养状况，促进烧伤创面愈合，降低烧伤脓毒症的发生率，从而有效地提高了危重烧伤救治成功率。Objective To analyze the effect of a combined strategy of enteral nutrition in the prevention and treatment of patients with severe burn sepsis. Methods 46 cases were random divided into combined group （group C ） and routine group （group R）. Besides general supportive treatment ,group C was treated with early enteral feeding （EEF） ,recombinant human growth hormone （rhGH） and glutamine （ Gln）, while group R was given general supportive treatment only. The plasma concentration levels of pre-albumin （ PA）, C-reactive protein （CRP） , procalcitonin （PCT） and tumor necrosis faetorα（TNFα） were measured immediately ＂after hospitalization and postburn day （PBD） 7, 14, 28. Results The survival rate of group C was significantly higher than group R. The incidence of sepsis, the complication of heart and gastrointestin in group C was significantly lower than group R （ P 〈 0.01 -0.05 ）. The days in hospitalization of group C was shorter than that of group R. Plasma PA levels was decreased in two groups and was markedly decreased in the group R（ P 〈 0. 01 - 0. 05 ）. Plasma CRP, PCT and TNFαlevels were both increased in two groups and markedly increased in the group R （ P 〈 0. 001 - 0. 05 ）. Conclusions We have shown that a combined method including rhGH, EEF, Gin and anisodamin can effectively reduce the morbidity and mortality rates of burn sepsis and improve prognosis.

关 键 词：肠道营养 谷氨酰胺/治疗应用 人生长激素/治疗应用 烧伤/并发症 脓毒症/并发症/预防和控制 

分 类 号：R6[医药卫生—外科学] R45[医药卫生—临床医学]