[1]付 娟,谢卫国,褚志刚,等.重症烧伤病人的营养治疗及临床指标分析[J].肠外与肠内营养杂志,2022,(06):351-357.[doi:10.16151/j.1007-810x.2022.06.006]
　FU Juan,XIE Wei-guo,CHU Zhi-gang,et al.Nutritional therapy and clinical index analysis of severe burn patients[J].PARENTERAL & ENTERAL NUTRITION,2022,(06):351-357.[doi:10.16151/j.1007-810x.2022.06.006]
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重症烧伤病人的营养治疗及临床指标分析
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2022年06期
页码:
351-357
栏目:
论著
出版日期:
2022-11-10

文章信息/Info

Title:
Nutritional therapy and clinical index analysis of severe burn patients
作者:
付 娟1; 谢卫国 2; 褚志刚 2; 席毛毛 2
武汉市第三医院/武汉大学附属同仁医院，1.临床营养科；2.烧伤科，湖北武汉 430060
Author(s):
FU Juan1;  XIE Wei-guo2;  CHU Zhi-gang2;  XI Mao-mao2
1.Department of Clinical Nutrition; 2.Department of Burns, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Hubei 430060, Wuhan, China
关键词:
重症 ; 烧伤 ; 营养治疗 ; 治疗结局
Keywords:
Critical illness;  Burns;  Nutrition therapy;  Treatment outcome
分类号:
R644，R459.3
DOI:
10.16151/j.1007-810x.2022.06.006
文献标志码:
A
摘要:
目的：描述重症烧伤病人营养治疗情况，探讨其不能早期进食和能量蛋白质不达标的影响因素。方法：收集62例武汉市第三医院2019年9月至2021年10月入院的重症烧伤病人，分析其伤后第1、2、3、7、14、21、28天的胃肠营养、肠外营养（PN）及总营养摄入。24 h内进食为早期进食组，24 h后进食为非早期进食组；根据病人伤后第7、14、21、28天的能量及蛋白质摄入量平均值是否至少有一项达标分为达标组和未达标组。统计两组间差异及影响因素。 结果：伤后第7 ~ 28天94.9% ~ 98.0%的病人采用胃肠营养。所有病人所有时期均予以PN，非蛋白热氮比均高于270:1。蛋白质较能量的达标人数比例更低。与非早期进食组相比，早期进食组的伤后第7天总胆红素（TBIL）及伤后第3 天C反应蛋白（CRP）更低（P < 0.05）。与能量蛋白质未达标组相比，达标组的伤后第7天TBIL更低，伤后第21天白蛋白（ALB）及前白蛋白（pALB）更高（P < 0.05）。多因素logistic回归分析显示，休克期度过不平稳、呕吐、年龄大是不能早期进食的独立危险因素；年龄大、伤后第7天TBIL高是能量蛋白质不达标的独立危险因素因素（P < 0.05）。 结论：重症烧伤病人的营养治疗尤其是蛋白质供给尚需进一步优化。早期进食及能量蛋白质达标病人的TBIL、ALB、pALB及CRP水平更优。
Abstract:
Objective: To describe the nutritional treatment of severe burn patients and explore the influencing factors of non-early feeding and not meeting the energy or protein target. Methods: We collected 62 severe burn patients admitted to our hospital from September 2019 to October 2021 and analyzed their gastrointestinal nutrition, parenteral nutrition (PN) and total nutrition intake on 1st, 2nd, 3rd, 7th, 14th, 21st and 28th days after injury. Eating within 24 hours was the early feeding group and eating after 24 hours was the non-early feeding group. The patients were divided into the standard group and the non-standard group based on whether there is at least one item that meets the average values of energy and protein intake on the 7th, 14th, 21st and 28th days after injury. The differences between the two groups and the influencing factors were analyzed. Results: 94.9% ~ 98.0% of patients were given gastrointestinal nutrition at 7~28 days after injury. All patients were treated with PN at all stages, and the ratio of non-protein caloric to nitrogen was higher than 270:1. The proportion of patients who met the protein standard was lower than that of patients who reached the energy target. Compared with the non-early feeding group, the early feeding group had lower total bilirubin (TBIL) on 7th day after injury, and C-reactive protein (CRP) on 3rd day after injury (P < 0.05). Compared with the protein and energy non-standard group, the TBIL level on 7th day after injury was lower, and the albumin (ALB) and prealbumin (pALB) levels on 21st day after injury were higher in the standard group (P < 0.05). Multivariate logistic regression analysis showed that unstable shock phase, old age and vomiting were the independent risk factors for non-early feeding. Old age and high TBIL level on 7th day after injury were independent risk factors for failing to reach the energy or protein target (P < 0.05). Conclusions: Nutritional treatment especially the protein supply in severe burn patients needs further optimization. The levels of TBIL, ALB, pALB and CRP is better in patients who ate early and met energy and protein standards.

参考文献/References:


[1] Knuth CM, Auger C, Jeschke MG. Burn-induced hypermetabolism and skeletal muscle dysfunction. Am J Physiol Cell Physiol, 2021,321(1):C58-C71.
[2] 彭 曦.重视谷氨酰胺在烧伤临床的规范应用.肠外与肠内营养,2021,(1):1-4.
[3] 彭 曦.重症烧伤患者的代谢分期及营养治疗策略. 中华烧伤杂志, 2021, 37(9): 805-810.
[4] 杨月欣. 中国食物成分表标准版（第6版 第一册）. 北京：北京大学医学出版社，2018.
[5] 杨月欣. 中国食物成分表标准版（第6版 第二册）. 北京：北京大学医学出版社，2019.
[6] 刘 琰,王际壮 . 烧伤应激反应及其调控策略 . 中华烧伤杂志,2021,37(2):126-130.
[7] van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care,2019,23(1):368.
[8] 吴 迪,房文通.2017-2019年南京地区肠内营养药的应用分析.肠外与肠内营养,2021,(4):220-224.
[9] 李金桥,韩 夏,张明谏,等.严重烧伤成年患者能量和蛋白质摄入状况调查分析.中华烧伤杂志,2019,35(2):143-147.
[10] ISBI Practice Guidelines Committee, Advisory Subcommittee , Steering Subcommittee .ISBI Practice Guidelines for Burn Care, Part 2.Burns,2018,44(7):1617-1706.
[11] 广东省药学会 . 肠外营养临床药学共识(第二版). 今日药学,2017,27(5):289-303.
[12] 中国老年医学学会烧创伤分会 . 烧伤休克防治全国专家共识(2020版).中华烧伤杂志,2020,36(9):786-792.
[13] 郭光华, 江政英 . 危重烧伤救治的过去与现在和将来. 中华烧伤杂志, 2021, 37(10): 905-910.
[14] Wise AK, Hromatka KA, Miller KR. Energy Expenditure and Protein Requirements Following Burn Injury. Nutr Clin Pract, 2019,34(5):673-680.
[15] Xi P, Kaifa W, Yong Z, et al. Establishment and assessment of new formulas for energy consumption estimation in adult burn patients.PloS one, 2014,9(10):e110409.
[16] Rousseau AF, Losser MR, Ichai C, et al. ESPEN endorsed recommendations: nutritional therapy in major burns . Clin Nutr, 2013, 32(4):497-502.
[17] Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr,2019,38(1):48-79.
[18] Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr,2022,46(1):12-41.
[19] Grammatikopoulou MG, Theodoridis X, Gkiouras K, et al. AGREEing on Guidelines for Nutrition Management of Adult Severe Burn Patients. JPEN J Parenter Enteral Nutr, 2019 43(4):490-496.
[20] Hampton V, Hampton T, Dheansa B, et al. Evaluation of high protein intake to improve clinical outcome and nutritional status for patients with burns: a systematic review. Burns 2021, 47(8):1714-1729.
[21] 孙 勇,彭 曦.重视烧伤创面愈合中的蛋白质营养问题.肠外与肠内营养,2022,(2):65-68.
[22] Hew JJ, Parungao RJ, Tsai KH, et al. Geometric framework reveals that a moderate protein, high carbohydrate intake is optimal for severe burn injury in mice. Br J Nutr. 2020, 123(9):1056-1067.
[23] 郇京宁,张利军.微循环障碍研究进展对烧伤休克和烧伤脓毒症休克治疗的启发 . 中华烧伤与创面修复杂志,2022,38(5):401-407.
[24] 潘艳艳, 徐思达, 范友芬, 等 . 特重度烧伤患者早期肠内营养不耐受的危险因素分析. 中华烧伤杂志, 2021, 37(9): 831-838.
[25] 罗 月, 黎 宁 . 严重烧伤患者早期肠内营养治疗的研究进展. 中华烧伤杂志, 2021, 37(9): 880-884.
[26] Sierp EL, Kurmis R, Lange K, et al. Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study. JPEN J Parenter Enteral Nutr, 2021,45(5):1052-1060.
[27] 李 晗,田李均,徐俊贤,等.早期肠内营养治疗对脓毒症及脓毒性休克治疗效果的Meta分.肠外与肠内营养,2022,(1):35-40,45.
[28] Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr, 2021,40(7):4745-4761.
[29] Reignier J, Boisramé -Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in entilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).Lancet,2018,391(10116):133-143.
[30] 谢肖霞,吴丽萍,李晓琳,等.早期管饲肠内营养支持在特重度烧伤患者中的应用与护理.中华损伤与修复杂志（电子版）,2020,15(3):235-237.
[31] 中华医学会老年医学分会,《中华老年医学杂志》编辑委员会.老年人衰弱预防中国专家共识(2022) . 中华老年医学杂志,2022, 41(5) : 503-511.
[32] 中国营养学会. 中国居民膳食指南（2022）. 北京：人民卫生出版社，2022.

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备注/Memo

备注/Memo:
基金项目 ：武汉市卫生健康科研基金资助（WG20B01、WG19B02）；武汉市卫生和计划生育委员会科研项目（WG18Q10）；黎介寿肠道屏障研究专项基金（LJS_201304） 作者简介 ：付 娟，主治医师，医学硕士，主要从事临床营养研究。E-mail：fjfjhappy@foxmail.com 通讯作者 ：谢卫国，E-mail: wgxie@Hotmail.com
更新日期/Last Update: 1900-01-01