Buonpane E A, Brown R O, Boucher B A, Fabian T C, Luther R W
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163.
Crit Care Med. 1989 Feb;17(2):126-32. doi: 10.1097/00003246-198902000-00004.
Enteral nutrition support was provided to 12 critically ill, traumatized patients by continuous NG infusion with a nutritionally complete formula for at least 7 consecutive days. Serum for fibronectin (Fn) and somatomedin-C (Sm-C) was collected and nitrogen balance (NB) was measured on days 1, 4, 7, 14, 21, and 28 of the study period. Estimated energy and protein requirements were based, respectively, on the patient's calculated basal energy expenditure multiplied by a stress factor and urea nitrogen excretion (plus 4) during 24-h urine collections. Enteral feedings were started 5.3 +/- 3.8 days after injury; patients received an average of 33.2 +/- 3.9 kcal/kg.day and 1.5 +/- 0.4 g protein/kg.day. Fn concentrations increased significantly (p less than .05) from baseline on study days 7, 14, 21, and 28, whereas NB increased significantly (p less than .05) on study days 4, 7, 14, 21, and 28. Significant correlations were found between Fn and NB (r = .52, p less than .005), Fn and cumulative caloric intake (r = .54, p less than .005), and Fn and cumulative nitrogen intake (r = .62, p less than .005). There were no significant changes observed with Sm-C concentrations during the study period. Measurement of Fn concentrations appears to have potential as a nutrition support marker in traumatized patients, particularly in monitoring short courses of nutrition support. The role of Sm-C as a nutrition marker requires further investigation.
通过持续鼻胃管输注营养完全配方，为12例重症创伤患者提供肠内营养支持，持续至少7天。在研究期的第1、4、7、14、21和28天收集血清纤维连接蛋白（Fn）和生长调节素-C（Sm-C），并测量氮平衡（NB）。估计能量和蛋白质需求分别基于患者计算的基础能量消耗乘以应激系数，以及24小时尿液收集期间的尿素氮排泄量（加4）。肠内喂养在受伤后5.3±3.8天开始；患者平均每天接受33.2±3.9千卡/千克和1.5±0.4克蛋白质/千克。在研究第7、14、21和28天，Fn浓度较基线显著增加（p<0.05），而在研究第4、7、14、21和28天，NB显著增加（p<0.05）。发现Fn与NB（r = 0.52，p<0.005）、Fn与累积热量摄入（r = 0.54，p<0.005）以及Fn与累积氮摄入（r = 0.62，p<0.005）之间存在显著相关性。在研究期间，Sm-C浓度未观察到显著变化。测量Fn浓度似乎有可能作为创伤患者营养支持的标志物，特别是在监测短期营养支持过程中。Sm-C作为营养标志物的作用需要进一步研究。
