Yan Hong, Peng Xi, Wang Pei, Huang Yue-sheng, Wang Shi-liang
Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing 400038, P.R. China.
Zhonghua Shao Shang Za Zhi. 2005 Aug;21(4):251-4.
To investigate the effects and the mechanism of action of postburn dietary supplementation of levorotatory arginine (L-Arg) on burn shock resuscitation in severely burned patients.
This study was designed to be a prospective, randomized, single blinded and controlled one. Twenty burn patients with total burn surface area (TBSA) more than 30% were enrolled and randomized into two groups; 1) Group A (n = 10): enteral feeding of 50 g/L glucose normal saline (GNS) 500 ml per day containing L-Arg (400 mg/kg.day) at equal pace with fluid infusion for shock resuscitation for 4 days. 2) Group C (n = 10): enteral feeding with only 50 g/L GNS 500 ml per day for 4 days. All of the twenty patients received equal amount of enteral feeding via an intra-gastric tube with the aid of an enteral feeding pump, started within 24 postburn hours (PBH). Venous blood was harvested from all the patients in both groups on 1, 2, 3 and 4 postburn day (PBD) for the determination of serum content of nitric oxide (NO), malondialdehyde (MDA) and the activity of serum superoxide dismutase (SOD). And the arterial content of lactate (BL) was also determined concomitantly.
The results indicated that the serum SOD activity in group A was increased after burns, peaked on 4 PBD (68 +/- 23 U/ml), and it was obviously higher than that in group C (31 +/- 9 U/ml, P < 0.01). The serum contents of MDA and NO were decreased in both groups after burns. On 2 PBD, the serum NO level in group A decreased to the lowest level (50 +/- 14 micromol/L), which was obviously lower compared with group C (78 +/- 22 micromol/L, P < 0.01). On 4 PBD, serum MDA levels in group A (3.4 +/- 0.8 micromol/L) and group C (3.5 +/- 1.3 micromol/L) were decreased to the lowest level. The BL content in group A was obviously lower than that in group C on 2 and 3 PBD (P < 0.05 or 0.01).
Enteral supplementation of L-arginine can decrease excessive NO production to a relatively normal level, and it might be beneficial to resuscitation of burn shock. It might also exert a protective effect against ischemia/reperfusion injury to burn patients.
探讨烧伤后补充左旋精氨酸（L-Arg）对严重烧伤患者烧伤休克复苏的影响及其作用机制。
本研究设计为前瞻性、随机、单盲对照研究。纳入20例烧伤总面积（TBSA）超过30%的患者，随机分为两组：1）A组（n = 10）：每天经肠内给予含L-Arg（400 mg/kg·天）的50 g/L葡萄糖生理盐水（GNS）500 ml，与休克复苏补液同步进行，共4天。2）C组（n = 10）：每天仅经肠内给予50 g/L GNS 500 ml，共4天。20例患者均在烧伤后24小时内通过胃管借助肠内营养泵给予等量肠内营养。在烧伤后第1、2、3和4天采集两组患者的静脉血，测定血清一氧化氮（NO）、丙二醛（MDA）含量及血清超氧化物歧化酶（SOD）活性，并同时测定动脉血乳酸（BL）含量。
结果表明，A组烧伤后血清SOD活性升高，在烧伤后第4天达到峰值（68±23 U/ml），明显高于C组（31±9 U/ml，P < 0.01）。两组烧伤后血清MDA和NO含量均降低。在烧伤后第2天，A组血清NO水平降至最低（50±14 μmol/L），明显低于C组（78±22 μmol/L，P < 0.01）。在烧伤后第4天，A组（3.4±0.8 μmol/L）和C组（3.5±1.3 μmol/L）血清MDA水平均降至最低。在烧伤后第2和3天，A组BL含量明显低于C组（P < 0.05或0.01）。
肠内补充L-精氨酸可使过量的NO生成降至相对正常水平，可能有利于烧伤休克的复苏，对烧伤患者的缺血/再灌注损伤也可能具有保护作用。
