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严重烧伤患者早期口服混合肠内营养剂对肠黏膜屏障的作用

Effects of early oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury

摘要:

目的 探讨严重烧伤患者早期服用混合肠内营养剂对肠黏膜屏障的影响. 方法 选择笔者单位2013年8月-2014年9月收治且符合入选标准的24例严重烧伤患者,采用随机数字表法分为常规治疗组12例和早期肠内营养组12例.2组患者入院后立即接受常规治疗,早期肠内营养组患者同时每天口服混合谷氨酰胺、益生菌、益生元的肠内营养剂100 mL,连续服用7d.分别于治疗前及治疗第1、3、7、14、21天,采用ELISA法检测患者血清二胺氧化酶(DAO)、血清降钙素原(PCT)、血浆LPS水平;治疗21 d内,行创面分泌物和血液细菌学培养;观察治疗后21d内是否发生MODS.对数据行Fisher确切概率法检验、秩和检验、重复测量方差分析及LSD-t检验. 结果 (1)早期肠内营养组患者治疗第7、14、21天血清DAO水平分别为(14.9±3.7)、(12.4±3.1)、(9.5±0.7)ng/mL,均明显低于常规治疗组的(17.5±4.0)、(16.3±3.3)、(13.0±1.1)ng/mL(t值为2.913~ 15.304,P值均小于0.01);组间其余时相点血清DAO水平接近(t值为-0.598 ~0.139,P值均大于0.05).(2)治疗第7、14天,早期肠内营养组患者血清PCT水平分别为(2.7±8.1)、(2.0±5.6) ng/mL,明显低于常规治疗组的(11.7 ±20.9)、(12.9±23.9) ng/mL(Z值分别为-2.919、-2.139,P<0.05或P<0.01);其余时相点组间血清PCT水平接近(Z值为-1.833~-0.346,P值均大于0.05).(3)治疗第7天,早期肠内营养组患者血浆LPS水平为(33±56) pg/mL,明显低于常规治疗组的(102±108) pg/mL(Z=-2.046,P<0.05);其余时相点组间血浆LPS水平接近(Z值为2.003 ~-0.526,P值均大于0 05).(4)治疗21 d内,2组患者创面分泌物细菌学培养阳性结果接近(P>0.05).常规治疗组7例患者血液细菌学培养结果呈阳性,明显多于早期肠内营养组的1例(P<0.05).治疗21d内,常规治疗组1例患者发生了MODS,而早期肠内营养组患者均未发生MODS,组间比较差异无统计学意义(P>0.05). 结论 严重烧伤患者在常规治疗基础上早期服用混合肠内营养剂能促进肠黏膜屏障的修复并给予保护,具有减轻肠道损害和炎症反应的作用.

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abstracts:

Objective To explore the effects of oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury at early stage.Methods Twenty-four pa tients with severe burn injury admitted to our burn ward from August 2013 to September 2014,conforming to the study criteria,were divided into conventional therapy group (n =12) and early enteral feeding group (n =12) according to the random number table.Patients in conventional therapy group received conventional treatment immediately after admission,while those in early enteral feeding group were orally given 100 mL of a mixture of glutamine,probiotics,and prebiotics once a day besides conventional treatment for 7 days.Serum levels of diamine oxidase (DAO) and procalcitonin (PCT) and plasma level of LPS were determined by ELISA before treatment and on treatment day (TD) 1,3,7,14,and 21.Wound secretion and blood samples were collected for bacterial culture within the 21 TD.The incidence of MODS within the 21 TD was observed.Data were processed with Fisher's exact test,rank sum test,analysis of variance for repeated measurement,and LSD-t test.Results (1) Serum levels of DAO in patients of early enteral feeding group on TD 7,14,and 21 were respectively (14.9 ±3.7),(12.4 ±3.1),and (9.5 ±0.7) ng/mL,which were significantly lower than those of conventional therapy group [(17.5 ± 4.0),(16.3 ± 3.3),and (13.0 ± 1.1) ng/mL,with t values from 2.913 to 15.304,P values below 0.01].Serum levels of DAO at the other time points were close between the two groups (with t values from-0.598 to 0.139,P values above 0.05).(2) Compared with serum levels of PCT in patients of conventional therapy group [(11.7 ±20.9) and (12.9 ± 23.9) ng/mL],those of early enteral feeding group were significantly lower on TD 7and 14 [(2.7±8.1) and (2.0±5.6) ng/mL,with Z values respectively-2.919 and-2.139,P <0.05 or P < 0.01].Serum levels of PCT at the other time points were close between the two groups (with Z values from-1.833 to-0.346,P values above 0.05).(3) Plasma level of LPS in patients of early enteral feeding group on TD 7 was (33 ± 56) pg/mL,which was significantly lower than that of conventional therapy group [(102 ± 108) pg/mL,Z =-2.046,P <0.05].Plasma levels of LPS at the other time points between the two groups showed no significant difference (with Z values from-2.003 ~-0.526,P values above 0.05).(4) Positive results in bacterial culture of wound secretion were approximately the same between the two groups (P > 0.05).Bacterial culture of blood was positive in 7 patients of conventional therapy group and 1 patient of early enteral feeding group,showing significantly statistical difference (P < 0.05).MODS was observed in 1 patient of conventional therapy group,showing no significantly statistical difference with that of early enteral feeding group (no patient,P > 0.05).Conclusions Early intestinal feeding of mixed enteral nutritional agent in addition to conventional therapy can effectively promote repair of the impairment of intestinal mucosal barrier,protect integrity of intestinal mucosa,reduce damage to intestines,and alleviate inflammatory response in patients suffering from severe burn injury.

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作者: 孙珂岱 [1] 董志伟 [1] 陈婧 [1] 刘攀 [1] 龚雅利 [1] 彭毅志 [1]
期刊: 《中华烧伤杂志》2015年31卷1期 25-29页 MEDLINEISTICPKUCSCD
栏目名称: 感染与免疫
DOI: 10.3760/cma.j.issn.1009-2587.2015.01.007
发布时间: 2015-03-26
基金项目:
卫生部卫生行业科研专项 “十二五”全军后勤科研计划重点项目 军队临床高新技术重大项目
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