Yan Hong, Peng Xi, Huang Yuesheng, Zhao Mingyue, Li Fangyong, Wang Pei
Institute of Burn Research, Southwest Hospital, The Third Military Medical University, State Key Laboratory of Trauma, Burns, and Combined Injury (SKLTBC), Chongqing 400038, PR China.
Burns. 2007 Mar;33(2):179-84. doi: 10.1016/j.burns.2006.06.012. Epub 2006 Nov 27.
To investigate the effects of dietary supplementation of l-arginine (l-Arg) on shock in severely burned patients.
This was a prospective, randomized, single blind, controlled study. Forty-seven severely burned patients due to various causes with a total burn surface area (TBSA) more than 50% each admitted in early postburn phase (within 10h postburn) were included in this study. All patients were treated by the traditional resuscitation program of our institute. After the nasogastric feeding tube was placed, they were randomly divided into three groups-(1) group A400 (n = 16): giving gastrointestinal feeding with 500 ml 5% GNS, containing l-Arg (400 mg/ kgday) at equal pace with fluid resuscitation; (2) group A200 (n = 16): giving gastrointestinal feeding with 500 ml 5% GNS containing l-Arg (200 mg/ kgday); (3) group C (n = 15): giving gastrointestinal feeding with 500 ml 5% GNS without any supplementation. The feeding started within 12h after burn and lasted for 72 h, the feeding rate was controlled by an enteral feeding pump. The following parameters were observed on days (PBD) 1-4: serum nitric oxide content (NO), mean arterial blood pressure (MAP), oxygenation index (PO2/FiO2), and arterial blood content of lactic acid (LA). Gastric mucosal blood flow was measured by laser Doppler flow-metry on PBD1 and PBD2.
(1) Enteral feeding of l-Arg did not change MAP of severely burned patients, with no difference in MAP between the l-Arg supplemented and control groups. (2) There were significant changes of the l-Arg supplemented groups (A400 and A200), with an increased gastric mucosa blood flow, oxygenation index, and a decreased LA content in arterial blood, compared with the control group. (3) The serous NO content was significantly decreased in the A400 group on PBD2-4 (P < 0.01), and in the A200 group on PBD4 (P < 0.05) compared with the control group.
Enteral feeding with l-arginine supplementation on early stage of burn decreases NO production to a relatively normal level and exerts beneficial effects on the resuscitation of burned shock.
探讨膳食补充L-精氨酸（L-Arg）对严重烧伤患者休克的影响。
这是一项前瞻性、随机、单盲、对照研究。本研究纳入47例因各种原因导致烧伤总面积（TBSA）超过50%且在烧伤后早期（烧伤后10小时内）入院的严重烧伤患者。所有患者均接受我院传统复苏方案治疗。放置鼻胃饲管后，将他们随机分为三组：（1）A400组（n = 16）：给予含L-Arg（400 mg/kg·天）的500 ml 5%葡萄糖氯化钠溶液进行胃肠喂养，与液体复苏同步进行；（2）A200组（n = 16）：给予含L-Arg（200 mg/kg·天）的500 ml 5%葡萄糖氯化钠溶液进行胃肠喂养；（3）C组（n = 15）：给予不含任何添加剂的500 ml 5%葡萄糖氯化钠溶液进行胃肠喂养。喂养在烧伤后12小时内开始，持续72小时，喂养速度由肠内喂养泵控制。在烧伤后第1至4天观察以下参数：血清一氧化氮含量（NO）、平均动脉血压（MAP）、氧合指数（PO2/FiO2）和动脉血乳酸含量（LA）。在烧伤后第1天和第2天通过激光多普勒血流仪测量胃黏膜血流量。
（1）肠内给予L-Arg对严重烧伤患者的MAP无影响，补充L-Arg组与对照组的MAP无差异。（2）与对照组相比，补充L-Arg的组（A400和A200）有显著变化，胃黏膜血流量、氧合指数增加，动脉血LA含量降低。（3）与对照组相比，A400组在烧伤后第2至4天血清NO含量显著降低（P < 0.01），A200组在烧伤后第4天血清NO含量显著降低（P < 0.05）。
烧伤早期肠内补充L-精氨酸可使NO生成降至相对正常水平，并对烧伤休克复苏产生有益影响。
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