小儿重度烧伤早期胃肠道营养支持治疗的临床研究  

Clinical study of early gastrointestinal nutrition support in the severely burned children

作　　者：姚兴伟[1] 陈向军[1] 王静[1] 韩德志[1] 孙伟晶[1] 刘艳红[1] 薛晓蕾[1] 葛亮[1] 赵晓春[1] 

机构地区：[1]解放军第二五三医院烧伤整形科,呼和浩特010051

出　　处：《中华损伤与修复杂志（电子版）》2014年第1期42-46,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的 通过对重度烧伤小儿早期给予胃肠道营养支持治疗进行临床观察,评价其临床效果,探讨更为合理有效的胃肠道营养支持方法.方法 选择2011年2月至2013年2月收治的76例重度烧伤小儿,其中男46例、女30例,平均年龄（3.5±1.3）岁;烧伤总面积为15％～31％TBSA,平均（20.2±1.9）％ TBSA;烧伤深度为深Ⅱ度～Ⅲ度;伤后入院时间1～6.5 h,平均（3.8±1.7）h;伤前均无心肺等重要器官器质性疾病,无胃肠道疾病及消化道出血.应用交替法随机将其分为喂养组和对照组,每组38例.喂养组在积极抗休克治疗的同时早期口服自配混合奶,以后根据患儿耐受情况逐渐增加喂养量,直至达到氮平衡.对照组休克期禁食,仅给予部分肠外营养,休克期度过且肠蠕动恢复后逐渐添加辅食.观察两组患儿全身营养性生化指标、达到氮平衡所需时间、创面愈合时间、全身性感染发生时间、胃肠道并发症及全身性感染发生率.结果 喂养组患儿血浆白蛋白（Alb） （38.5 ±2.4） g/L、前白蛋白（PALB）（120.6±24.2） mg/L、转铁蛋白（Trf）（138.5±24.1） mg/L水平均分别高于对照组（32.1±2.0）g/L、（97.6±27.4） mg/L、（99.8±23.6）mg/L,而C-反应蛋白（CRP）（116.7 ±33.8）mg/L、肿瘤坏死因子-α（TNF-α）（21.3±12.7）pg/L水平均分别显著低于对照组（208.6±29.4） mg/L、（43.5±13.6）pg/L,差异有统计学意义（P＜ 0.05）.喂养组氮平衡时间（13.4±4.9）d、创面愈合时间（18.2±5.3）d、全身性感染发生时间（10.2±1.1）d明显短于对照组（20.1±5.8）d、（25.3±4.7）d、（18.9±2.5）d,两组差异有统计学意义（P＜0.05）.喂养组消化不良发生率（18.42％）、消化道出血发生率（5.26％）、全身感染发生率（13.16％）均分别低于对照组（47.37％）、（23.68％）、（34.21％）,两组差异有统计学意义（P＜0.05）.早期喂养组患儿致病细菌均为非肠道致病�Objective To evaluate the utility of early gastrointestinal nutrition support treatment in the severely burned children and to explore a more reasonable and effective method of gastrointestinal nutrition support.Methods A total of 76 severely burned children including 30 female and 46 males,who were 1-5 years old （average age is 3.5 ± 1.3）,burned area was 15％ ～ 31％ TBSA （average burned area was 20.2％ ± 1.9 ％ TBSA） ; Ⅱ ～ Ⅲ,1-6.5 h （averaged time was 3.8 ± 1.7h） after they hurt; with no important organs such as heart and lung disease,gastrointestinal disease and gastrointestinal bleeding were choosed from February 2011 to February 2013.Divided into two groups （feeding group and control group） in random,each group has 38 cases.The patients in feeding group were gaven the mixed with milk in the early and the gram was increased by their own situation until nitrogen balance.Control group fast during shock stage,only partial parenteral nutrition,when the burn shock stage was passed through and intestinal peristalsis was recovery,supplementary food was added gradually.The systemic nutritional biochemistry index,reach the time needed for nitrogen balance,wound healing time,systemic infections,gastrointestinal complications and the incidence of systemic infection of the two groups were observed.Results Feeding group （38.5 ±2.4） g/L,PALB （120.6 ± 24.2） mg/L,the agency （138.5 ± 24.1） mg/L,levels were higher than the control group （32.1 ± 2.0） g/L,（97.6 ± 27.4） mg/L,（99.8± 23.6） mg/L,and C-CRP （116.7 ±33.8） g/L,the TNF alpha （21.3 ± 12.7） pg/L were significantly lower than the control group （208.6 ± 29.4） g/L,（43.5 ± 13.6） pg/L,the difference was statistically significant （P ＜ 0.05）.Feeding group,time of nitrogen balance （13.4 ± 4.9） d,wound healing time （18.2 ± 5.3） d,systemic infection time （10.2 ± 1.1） d significantly shorter than the control group （20.1 ±5.8） d,（25.3 ±4.7） d,（18.9 ± 2.5） d,the differenc

关 键 词：儿童 烧伤 营养支持 肠内营养 

分 类 号：R726.5[医药卫生—儿科]