CAJ | 학술논문

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(Gln)、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α(TNFα)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、Gln、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.
목적 탐토종합영양책략재위중소상농독증방치중적작용.방법 장46례위중소상병례수궤분위이조,종합영양조(종합조,n=26)화상규영양조(상규조,n=20),종합조채용유조기장도위양(EEF)、곡알선알(Gln)、중조인생장격소(rhGH)등구성영양신책략진행치료.관찰2조치유솔、농독증발생솔,관찰2조간전백단백(PA)、C반응단백(CRP)、강개소원(PCT)、종류배사인자α(TNFα)적동태변화.결과 (1)종합조평균주원시간교상규조축단.(2)종합조농독증발생솔、심기손해화응격성궤양발생솔교상규조명현하강(P＜0.01～0.05).(3)2조혈장PA균하강,단상규조경명현(P＜0.01～0.05).(4)2조CRP、PCT、TNFα균승고,단이상규조경위명현(P＜0.001～0．05).결론 유EEF、Gln、rhGH구성적종합영양책략유조우개선위중소상환자적영양상황,촉진소상창면유합,강저소상농독증적발생솔,종이유효지제고료위중소상구치성공솔.
Objective To analyze the effect of a combined strategy of enteral nutrition in the prevention and treatment of patients with severe bum 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 gluta-mine (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 factora (TNFα) were measured immediately after hospitalization and postbum 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, Gln and anisodamin can effectively reduce the morbidity and mortality rates of burn sepsis and improve prognosis.