Kurmis Rochelle, Parker Andrea, Greenwood John
Adult Burns Service, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia.
J Burn Care Res. 2010 Sep-Oct;31(5):677-91. doi: 10.1097/BCR.0b013e3181eebf01.
The aim of this study is to review the current evidence for immunonutrition use in patients with burn injury. Nutrients of interest included glutamine, arginine, and omega-3 fatty acids (fish oil). A literature review was conducted to identify studies that evaluated the use of immunonutrients in pediatric and adult patients with burn injury. Search terms included burns, immunonutrition, pharmaconutrition, glutamine, arginine, omega-3, and fish oil. Glutamine: Nine randomized controlled trials (four represented in abstract only) investigating enteral supplementation and two trials investigating parenteral supplementation of glutamine were identified. Arginine: Five trials investigating the effect of arginine supplementation were identified (three represented in abstract only). Omega-3 fatty acids: Three studies investigating the effect of enteral fish oil supplementation were identified (one represented in abstract only). Combined immunonutrients: Six studies were identified that investigated immunonutrients as a combination of active dietary constituents (rather than as individual nutrients). Despite the semiessential nature of arginine after burn injury, there were surprisingly little data regarding nutritional supplementation. Literature around supplementation of omega-3 fatty acids is found to be lacking in the burn injury population. The combination of immunonutrients as a component of enteral formulae limits identification of the active nutrient and ideal dosage. Current evidence supports the use of enteral glutamine supplementation for patients with severe burn injuries. Questions remain regarding dosage, timing, and length of supplementation.
本研究的目的是回顾目前烧伤患者使用免疫营养的证据。感兴趣的营养素包括谷氨酰胺、精氨酸和ω-3脂肪酸（鱼油）。进行了一项文献综述，以确定评估免疫营养素在小儿和成人烧伤患者中使用情况的研究。检索词包括烧伤、免疫营养、药理营养、谷氨酰胺、精氨酸、ω-3和鱼油。谷氨酰胺：确定了9项调查肠内补充谷氨酰胺的随机对照试验（4项仅以摘要形式呈现）和2项调查肠外补充谷氨酰胺的试验。精氨酸：确定了5项调查补充精氨酸效果的试验（3项仅以摘要形式呈现）。ω-3脂肪酸：确定了3项调查肠内补充鱼油效果的研究（1项仅以摘要形式呈现）。联合免疫营养素：确定了6项研究，这些研究将免疫营养素作为活性膳食成分的组合（而非单一营养素）进行调查。尽管烧伤后精氨酸具有半必需性质，但令人惊讶的是，关于营养补充的数据很少。发现烧伤人群中关于补充ω-3脂肪酸的文献不足。作为肠内配方组成部分的免疫营养素组合限制了对活性营养素和理想剂量的确定。目前的证据支持对重度烧伤患者使用肠内补充谷氨酰胺。关于补充的剂量、时间和时长仍存在疑问。
