Mahmoud W H, Mostafa W, Abdel-Khalek A H, Shalaby H
Plastic, Reconstructive and Burns Unit, Tanta Faculty of Medicine, Tanta, Egypt.
Ann Burns Fire Disasters. 2014 Dec 31;27(4):192-6.
The use of immune-enhancing diets (IEDs) has been shown to be beneficial in some categories of critically ill patients. This study aimed to evaluate the effect of early enteral feeding supplemented with glutamine and omega-3 fatty acids, as immune-enhancing diets, on the outcomes of patients after major burns. Forty thermally injured adult patients with 30-50% total body surface area (TBSA) burns, including deep areas ranging from 5-20%, were randomized into a prospective, double-blind, controlled clinical trial. They were placed into two equal groups: group A (IED group), in which patients received early enteral feeding supplemented with glutamine and omega-3 fatty acids as immune-enhancing diets; and group B (control group), in which patients received early enteral feeding not supplemented with immune-enhancing diets. Laboratory assessment of serum albumin, serum C-reactive protein, total lymphocytic count and serum immunoglobulins (IgA, IgG and IgM) was performed at admission, and on days 4, 7 and 14. Finally, outcomes were assessed by monitoring the survival rate, the length of hospital stay and the incidence of infection. There were no significant differences between the IED and control group regarding age (28.7±5.32 versus 29.85±5.94), sex, weight, %TBSA (37.75±4.4 versus 38.3±4.84) and %burn depth (11.7±2.36 versus 10.7±2.036). The incidence of infection (2 versus 8) and the length of hospital stay (16.3±0.92 days versus 17.95±2.96 days) were decreased significantly in the IED group versus the control group. There was no significant difference between the survival rates in both groups as there was only one death in the control group. Thanks to IEDs, patient outcome was improved and infectious morbidity and length of hospital stay were reduced, but there was no effect on the survival rates following major burns.
免疫增强饮食（IEDs）已被证明对某些类型的重症患者有益。本研究旨在评估补充谷氨酰胺和ω-3脂肪酸的早期肠内喂养作为免疫增强饮食对重度烧伤患者预后的影响。40名成年热烧伤患者，烧伤总面积为30%-50%体表面积（TBSA），其中深度烧伤面积为5%-20%，被随机纳入一项前瞻性、双盲、对照临床试验。他们被分为两组：A组（IED组），患者接受补充谷氨酰胺和ω-3脂肪酸的早期肠内喂养作为免疫增强饮食；B组（对照组），患者接受不补充免疫增强饮食的早期肠内喂养。在入院时以及第4、7和14天对血清白蛋白、血清C反应蛋白、总淋巴细胞计数和血清免疫球蛋白（IgA、IgG和IgM）进行实验室评估。最后，通过监测生存率、住院时间和感染发生率来评估预后。IED组和对照组在年龄（28.7±5.32对29.85±5.94）、性别、体重、TBSA百分比（37.75±4.4对38.3±4.84）和烧伤深度百分比（11.7±2.36对10.7±2.036）方面无显著差异。与对照组相比，IED组的感染发生率（2例对8例）和住院时间（16.3±0.92天对17.95±2.96天）显著降低。两组的生存率无显著差异，因为对照组仅有1例死亡。得益于免疫增强饮食，患者预后得到改善，感染性发病率和住院时间缩短，但对重度烧伤后的生存率没有影响。
