CAJ | 학술논문

目的　观察早期肠内营养对烧伤高代谢反应的调节作用。　方法　通过30例烧伤患者用间接测热法监测静息能量消耗(REE)，监测血浆激素、脂类调节因子、细胞因子水平，并结合临床疗效和氮平衡变化来评价早期肠内营养的作用。　结果　早期肠内营养(EEN)组较延迟肠内营养(DEN)组REE显著下降(P＜0.05～0.01)，升高的时间缩短(P＜0.05)；EEN组非蛋白呼吸商(NPRQ)较DEN组更接近生理状态，负氮平衡时间缩短。伤后第4天EEN组血浆去甲肾上腺素(NE)、胰高糖素(GLUCAGON)、前列腺素E2(PGE2)、血栓素B2(TXB2)、低于DEN组(P＜0.05)；伤后8～12d肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)显著低于DEN组(P＜0.05～0.01)，胰岛素水平呈相反变化。　结论　严重烧伤患者伤后尽早开始肠内营养对高代谢反应有重要的调节作用
목적　관찰조기장내영양대소상고대사반응적조절작용。　방법　통과30례소상환자용간접측열법감측정식능량소모(REE)，감측혈장격소、지류조절인자、세포인자수평，병결합림상료효화담평형변화래평개조기장내영양적작용。　결과　조기장내영양(EEN)조교연지장내영양(DEN)조REE현저하강(P＜0.05～0.01)，승고적시간축단(P＜0.05)；EEN조비단백호흡상(NPRQ)교DEN조경접근생리상태，부담평형시간축단。상후제4천EEN조혈장거갑신상선소(NE)、이고당소(GLUCAGON)、전렬선소E2(PGE2)、혈전소B2(TXB2)、저우DEN조(P＜0.05)；상후8～12d종류배사인자α(TNF-α)、백세포개소-6(IL-6)현저저우DEN조(P＜0.05～0.01)，이도소수평정상반변화。　결론　엄중소상환자상후진조개시장내영양대고대사반응유중요적조절작용
Objective　This study was to explore the regulative effect of early enteral nutrition(EEN) on hypermetabolic response in patients suffering from burn.　Methods　Thirty burned patients with the average burn area of 49.90% (TBSA) were randomly divided into two groups:EEN(n=14),and delayed enteral nutrition(DEN)(n=16).Resting energy expenditure(REE),and non-protein respiratory quotient(NPRQ) were measured every day.We worked out the plan of enteral nutrition.The patients were observed for 10-14 days.On postburn days(PBD) 0,4,8,12,we tested for the plasma levels of catecholamine(CA),insulin,glucagon,PGE2,TXB2,TNF-α and IL-6.The nitrogen balance was calculated.　Results　In EEN group REE was much lower than that in DEN group(P＜0.05),the NPRQ was close to normal levels.On PBD4,the plasma levels of noradrenaline,dopamine,glucagon,PGE2,TXB2 in EEN were lower than that in DEN.On PBD8,the serum levels of TNF-α and IL-6 were lower in EEN than in DEN.The insulin level in EEN was higher than that in DEN.On PBD12,the degree and duration of negative nitrogen balance were significantly different between the two groups.　Conclusion　EEN for severe burned patients had important regulative effect on the hypermetabolism.