营养支持在重症中毒性坏死性表皮松解型药疹病人中的应用

发布时间：2018-09-06 17:50

【摘要】：目的:探讨早期、合理的营养支持治疗在重症中毒性坏死性表皮松解型药疹(TEN)病人中的应用价值。方法:将46例重症TEN病人随机分为治疗组(营养支持治疗)和对照组(非营养支持治疗)。两组均给予常规基础治疗,并鼓励病人经口进食。治疗组病人早期给予肠外营养,后逐渐过渡至全肠内营养。检测入院后第1、10、19和28天的体重、清蛋白、前清蛋白、纤维连接蛋白、转铁蛋白及尿乳果糖/甘露醇比值等指标,观察并发症、ICU住院时间以及28 d病人病死率。结果:入院后两组病人体重、清蛋白、前清蛋白、纤维连接蛋白、转铁蛋白均出现下降,对照组下降更明显。对照组病人入院第19天后,前清蛋白、纤维连接蛋白降低更显著,与治疗组比有显著性差异(P0.05),而白细胞和C-反应蛋白较治疗组上升更显著,两组间存在显著差异(P0.05);治疗组病人尿乳果糖/甘露醇比值显著低于对照组(P0.01);此外,ICU入住时间、感染相关并发症的发生率和28 d病死率等,两组间均存在显著性差异(P0.05)。结论:早期、合理的营养支持可改善重症TEN病人的营养状况和肠黏膜通透性,减少感染相关并发症,缩短入住ICU时间和降低病死率。
[Abstract]:Objective: to evaluate the value of early and reasonable nutrition support therapy in (TEN) patients with severe toxic necrotic epidermolysis type drug rash. Methods: 46 patients with severe TEN were randomly divided into treatment group (nutritional support therapy) and control group (non-nutritional support therapy). Both groups were given routine basic treatment and patients were encouraged to eat through mouth. The patients in the treatment group were given parenteral nutrition at the early stage and then gradually transitioned to total enteral nutrition. Body weight, albumin, prealbumin, fibronectin, transferrin and lactofructose / mannitol ratio were measured on the 19th and 28th days after admission. Results: the body weight, albumin, prealbumin, fibronectin and transferrin were decreased in both groups, especially in the control group. The prealbumin and fibronectin levels in the control group were significantly lower than those in the treatment group (P0.05), while the levels of WBC and C- reactive protein were significantly higher in the control group than in the treatment group. There was significant difference between the two groups (P0.05); the ratio of lactofructose / mannitol in the treatment group was significantly lower than that in the control group (P0.01); in addition, the ICU stay time, the incidence of infection related complications and the fatality rate of 28 days were significantly different between the two groups (P0.05). Conclusion: early nutrition support can improve the nutritional status and intestinal mucosal permeability of patients with severe TEN, reduce infection related complications, shorten the time to stay in ICU and reduce the mortality.
【作者单位】：武汉市第一医院重症医学科;
【分类号】：R758.25;R459.3

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