肠内免疫营养支持治疗对具有营养风险的成年烧伤患者疗效的前瞻性随机对照研究  

A prospective randomized controlled study on the curative effects of enteral immunonutrition support therapy in adult burn patients at nutritional risk

作　　者：娄家祺 李琦 崔庆伟 张盼 孙晗 唐浩 庄梦梦 孙勇 Lou Jiaqi;Li Qi;Cui Qingwei;Zhang Pan;Sun Han;Tang Hao;Zhuang Mengmeng;Sun Yong(Department of Burns and Plastic Surgery,the 71st Group Army Hospital of Army,Affiliated Huaihai Hospital of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属淮海医院陆军第七十一集团军医院烧伤整形科,徐州221004

出　　处：《中华烧伤与创面修复杂志》2022年第8期722-734,共13页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(81772082)。

摘　　要：目的探讨应用肠内免疫营养支持治疗对二次改良营养风险筛查(NRS)2002评定结果为具有营养风险的成年烧伤患者的营养代谢、免疫功能和炎症反应的影响。方法采用前瞻性随机对照研究方法。将2019年12月—2022年1月,于徐州医科大学附属淮海医院住院的500例经二次改良NRS 2002筛选为具有营养风险的成年烧伤患者纳入研究,按烧伤严重程度分为一般烧伤患者(450例)与严重烧伤患者(50例),按随机数字表法将一般烧伤患者分为一般烧伤膳食营养组和一般烧伤膳食+肠内免疫营养组,每组225例;将严重烧伤患者分为严重烧伤膳食+肠内非免疫营养组与严重烧伤膳食+肠内免疫营养组,每组25例。各组患者在常规烧伤救治基础上分别采用相应的营养支持治疗。伤后1、3、7、14、21 d,记录4组患者摄入总能量及总蛋白质摄入量;检测4组患者血浆前白蛋白、白蛋白、转铁蛋白,血清免疫球蛋白A(IgA)、IgG、IgM,外周血CD3阳性T细胞比例、CD4阳性T细胞计数、CD8阳性T细胞计数、CD4阳性T细胞与CD8阳性T细胞的比值、自然杀伤细胞比例,血浆白细胞介素6(IL-6)、游离线粒体DNA(mtDNA)拷贝数、可溶性髓系细胞触发受体1(sTREM-1);计算4组患者当日氮平衡。于伤后7、14、21 d,重新对4组患者行二次改良NRS 2002评分。记录4组患者治疗期间脓毒症发生率及住院时间,严重烧伤2组患者住重症监护病房(ICU)时间。对数据行χ^(2)检验、Fisher确切概率法检验、Mann-Whitney U检验、独立样本t检验、重复测量方差分析、Bonferroni校正。结果476例患者顺利完成试验,其中一般烧伤膳食营养组213例[男112例、女101例,年龄(37±19)岁]、一般烧伤膳食+肠内免疫营养组218例[男115例、女103例,年龄(42±16)岁]、严重烧伤膳食+肠内非免疫营养组22例[男女各11例、年龄(35±8)岁]、严重烧伤膳食+肠内免疫营养组23例[男12例、女11例,年龄(35±8)�Objective To explore the effects of enteral immunonutrition support therapy on nutritional metabolism,immune function,and inflammatory response in adult burn patients at nutritional risk as assessed by the modified 2nd nutrition risk screening(NRS)2002.Methods A prospective randomized controlled study was conducted.From December 2019 to January 2022,500 adult patients who were admitted to the Affiliated Huaihai Hospital of Xuzhou Medical University and had nutritional risk assessed by the modified 2nd NRS 2002 were recruited into the study.According to burn severity,the patients were divided into common burn patients(n=450)and severe burn patients(n=50).According to the random number table,the patients with common burn were divided into common burn diet nutrition group and common burn diet enteral immunonutrition group,with 225 patients in each group,and the patients with severe burn were divided into severe burn diet enteral non-immunonutrition group and severe burn diet enteral immunonutrition group,with 25 patients in each group.The patients in each group were given the corresponding nutritional support therapies on the basis of routine burn treatment.On post injury day(PID)1,3,7,14,and 21,the total energy intake and total protein intake of the patients in 4 groups were recorded,the plasma prealbumin,albumin,transferrin,serum immunoglobulin A(IgA),IgG,IgM,peripheral blood CD3 positive T cell percentage,CD4 positive T cell count,CD8 positive T cell count,the ratio of CD4 positive T cells to CD8 positive T cells,natural killer cell percentage,plasma interleukin-6(IL-6),free mitochondrial DNA(mtDNA)copy number,and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)of the patients in 4 groups were detected,and the nitrogen balance of the patients in 4 groups on the day was calculated.On PID 7,14,and 21,the modified 2nd NRS 2002 scores of the patients in 4 groups were reassessed.The sepsis incidence during treatment and the length of hospital stay of the patients in 4 groups and the length of intensiv

关 键 词：烧伤 营养评价 营养支持 肠道营养 免疫 感染 炎症趋化因子类 营养风险筛查 

分 类 号：R644[医药卫生—外科学]