Coudray-Lucas C, Le Bever H, Cynober L, De Bandt J P, Carsin H
Laboratoire de Biologie de la Nutrition, Faculté des Sciences de Pharmacie et de Biologie, Paris, France.
Crit Care Med. 2000 Jun;28(6):1772-6. doi: 10.1097/00003246-200006000-00012.
To compare the effectiveness on wound healing time in severe burn patients of ornithine alpha-ketoglutarate supplementation of enteral feeding vs. an isonitrogenous control. Previous clinical and experimental studies suggest a beneficial effect of enterally administered ornithine alpha-ketoglutarate supplementation on protein metabolism in burn patients, but few data deal with clinical outcome.
Prospective double-blind randomized trial.
Burn treatment center of an army hospital.
Forty-seven severe burn patients with total burned body surface areas of 25% to 95% and presence of full thickness burn who were prescribed early exclusive enteral nutrition. Either ornithine alpha-ketoglutarate or isonitrogenous control (soy protein mixture, Protil-1) were administered twice a day as a bolus (2 x 10 g) at 9 am and 9 pm for 3 wks. The patients were evaluated for wound healing time (primary end point), antibiotic use, tolerance, duration of enteral nutrition, and nutritional status.
Serial blood samples were collected in each patient for determination of serum transthyretin and plasma phenylalanine, and urine sampling was performed for determination of 3-methylhistidine excretion at day 4 and day 21 after burn injury.
Wound healing times in patients receiving ornithine alpha-ketoglutarate or Protil-1 were 60 +/- 7 and 90 +/- 12 days, respectively (p < .05) for similar grafted surfaces. Based on increased serum transthyretin concentrations, both groups showed an improvement of nutritional status at day 21 after burn. Taking a cut-off value of 110 unit burn standard for severity of injury, plasma phenylalanine concentrations, and urinary 3-methylhistidine/creatinine ratio were significantly reduced (p < .05) in the less severe burn patients (<110 unit burn standard) supplemented with ornithine alpha-ketoglutarate.
Ornithine alpha-ketoglutarate supplementation of enteral feeding significantly shortens wound healing time in severe burn patients. In addition, ornithine alpha-ketoglutarate administration was safe and well tolerated and decreased protein hypercatabolism in the less severe burn patients.
比较补充鸟氨酸α-酮戊二酸的肠内营养与等氮对照对重度烧伤患者伤口愈合时间的影响。既往临床和实验研究表明，肠内给予鸟氨酸α-酮戊二酸对烧伤患者的蛋白质代谢有益，但关于临床结局的数据较少。
前瞻性双盲随机试验。
一家军队医院的烧伤治疗中心。
47例重度烧伤患者，烧伤总面积为25%至95%，存在全层烧伤，接受早期完全肠内营养。每天上午9点和晚上9点将鸟氨酸α-酮戊二酸或等氮对照（大豆蛋白混合物，Protil-1）作为推注（2×10 g）给药两次，持续3周。对患者的伤口愈合时间（主要终点）、抗生素使用情况、耐受性、肠内营养持续时间和营养状况进行评估。
在每位患者中采集系列血样以测定血清转甲状腺素蛋白和血浆苯丙氨酸，并在烧伤后第4天和第21天进行尿液采样以测定3-甲基组氨酸排泄量。
对于相似的植皮面积，接受鸟氨酸α-酮戊二酸或Protil-1的患者伤口愈合时间分别为60±7天和90±12天（p<0.05）。基于血清转甲状腺素蛋白浓度升高，两组在烧伤后第21天营养状况均有所改善。以110单位烧伤标准作为损伤严重程度的临界值，补充鸟氨酸α-酮戊二酸的轻度烧伤患者（<110单位烧伤标准）血浆苯丙氨酸浓度和尿3-甲基组氨酸/肌酐比值显著降低（p<0.05）。
补充鸟氨酸α-酮戊二酸的肠内营养可显著缩短重度烧伤患者的伤口愈合时间。此外，给予鸟氨酸α-酮戊二酸安全且耐受性良好，并可降低轻度烧伤患者的蛋白质高分解代谢。
