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目的通过对重度烧伤小儿早期给予胃肠道营养支持治疗进行临床观察,评价其临床效果,探讨更为合理有效的胃肠道营养支持方法。方法选择2011年2月至2013年2月收治的76例重度烧伤小儿,其中男46例、女30例,平均年龄(3.5±1.3)岁;烧伤总面积为15%~31%TBSA,平均(20.2±1.9)%TBSA;烧伤深度为深Ⅱ度~Ⅲ度;伤后入院时间1~6.5 h,平均(3.8±1.7)h;伤前均无心肺等重要器官器质性疾病,无胃肠道疾病及消化道出血。应用交替法随机将其分为喂养组和对照组,每组38例。喂养组在积极抗休克治疗的同时早期口服自配混合奶,以后根据患儿耐受情况逐渐增加喂养量,直至达到氮平衡。对照组休克期禁食,仅给予部分肠外营养,休克期度过且肠蠕动恢复后逐渐添加辅食。观察两组患儿全身营养性生化指标、达到氮平衡所需时间、创面愈合时间、全身性感染发生时间、胃肠道并发症及全身性感染发生率。结果喂养组患儿血浆白蛋白(Alb)(38.5±2.4)g/L、前白蛋白(PALB)(120.6±24.2)mg/L、转铁蛋白(Trf)(138.5±24.1)mg/L水平均分别高于对照组(32.1±2.0)g/L、(97.6±27.4)mg/L、(99.8±23.6)mg/L,而C-反应蛋白(CRP)(116.7±33.8)mg/L、肿瘤坏死因子-α(TNF-α)(21.3±12.7)pg/L水平均分别显著低于对照组(208.6±29.4)mg/L、(43.5±13.6)pg/L,差异有统计学意义(P<0.05)。喂养组氮平衡时间(13.4±4.9)d、创面愈合时间(18.2±5.3)d、全身性感染发生时间(10.2±1.1)d明显短于对照组(20.1±5.8)d、(25.3±4.7)d、(18.9±2.5)d,两组差异有统计学意义(P<0.05)。喂养组消化不良发生率(18.42%)、消化道出血发生率(5.26%)、全身感染发生率(13.16%)均分别低于对照组(47.37%)、(23.68%)、(34.21%),两组差异有统计学意义(P<0.05)。早期喂养组患儿致病细菌均为非肠道致病菌,大多可找到明确的感染病灶,而对照组感染菌种多为肠道致病菌,大多无明确感染灶。结论小儿重度烧伤早期积极给予胃肠道营养支持,能有效维护胃肠道功能,降低高代谢反应,减少并发症及全身性感染发生,改善机体营养状况,提高治疗效果;自制配方的混合奶具有取材方便、价格低廉、配制方法简单、营养价值高、患儿耐受好等优点,值得推广。
OBJECTIVE: To evaluate the clinical effect of gastrointestinal nutrition support on early burn patients with severe burns and to explore a more reasonable and effective method of gastrointestinal nutrition support. Methods Totally 76 severe burn children were enrolled from February 2011 to February 2013, including 46 males and 30 females, with an average age of 3.5 ± 1.3 years. The total burn area was 15% -31% 20.2 ± 1.9)% TBSA; the depth of burn was deep Ⅱ ~ Ⅲ degrees; the average time of admission was 1 ~ 6.5 h (3.8 ± 1.7) h after injury; no organic or other important organic diseases such as heart and lung Disease and gastrointestinal bleeding. Application of alternating method randomly divided into feeding group and control group, 38 cases in each group. Feeding group actively treated with anti-shock oral self-formulated mixed milk early, after the gradual increase in feeding capacity according to children’s tolerance until the nitrogen balance. The control group was fasted during the shock period, and only part of the parenteral nutrition was given. After the shock period was over and the gut motility was gradually restored, complementary food supplement was gradually added. Nutritional and biochemical indexes of whole body, time to reach nitrogen balance, wound healing time, time of systemic infection, gastrointestinal complications and systemic infection were observed in both groups. Results The serum levels of Alb (38.5 ± 2.4) g / L, prealbumin (120.6 ± 24.2) mg / L and transferrin (138.5 ± 24.1) mg / L (97.6 ± 27.4) mg / L and (99.8 ± 23.6) mg / L, respectively, while C-reactive protein (CRP) was 116.7 ± 33.8 mg / L in the control group (32.1 ± 2.0) The levels of tumor necrosis factor-α (TNF-α) (21.3 ± 12.7) pg / L were significantly lower than those of the control group (208.6 ± 29.4 mg / L, 43.5 ± 13.6 pg / L, P <0.05). In the feeding group, the time of nitrogen fixation (13.4 ± 4.9) d and wound healing time (18.2 ± 5.3) days were significantly shorter than those in the control group (10.2 ± 1.1) days and (25.3 ± 4.7) d, (18.9 ± 2.5) d, the difference between the two groups was statistically significant (P <0.05). The rates of dyspepsia (18.42%), gastrointestinal bleeding (5.26%) and systemic infection (13.16%) in the feeding group were significantly lower than those in the control group (47.37%, 23.68%, 34.21% The difference between the two groups was statistically significant (P <0.05). Pathogenic bacteria in the early feeding group were all non-enteric pathogens, most of which could find a clear infection, while the control group were mostly intestinal bacteria, most of which had no definite infection. Conclusion In early stage of severe burn in children, gastrointestinal nutrition is positively supported, which can effectively maintain gastrointestinal function, reduce high metabolic reaction, reduce complications and systemic infection, improve the nutritional status of the body and improve the therapeutic effect. The homemade formula milk has Convenient, inexpensive, preparation method is simple, high nutritional value, good tolerance in children, etc., it is worth promoting.