Service of Adult Intensive Care Medicine and Burns, University Hospital, Lausanne, Switzerland.
Department of Intensive Care Medicine, Bern University Hospital, Switzerland.
Clin Nutr. 2019 Feb;38(1):246-251. doi: 10.1016/j.clnu.2018.01.025. Epub 2018 Feb 15.
BACKGROUND & AIMS: Major burn patients are characterized by large exudative losses of Cu, Se and Zn. Trace element (TE) repletion has been shown to improve clinical outcome. Having increased the TE doses over time, the study aimed at analysing if our repletion protocol corrected TE plasma concentrations and if the necessity for continuous renal replacement therapy (CRRT) might increase the TE needs.
Retrospective analysis of prospectively collected data in burn patients requiring intensive care (ICU) between 1999 and 2015.
Admission on day 1, full treatment, burned surface area (TBSA) ≥20% and ≥1 TE plasma determination during the stay. Four groups were constituted according to protocol changes. Period 1 (P1): 1999-2000, P2: 2001-2005, P3: 2006-2010, P4: 2011-2015. Changes consisted in increasing TE repletion doses and duration. Demographic data, daily TE intakes and weekly plasma concentrations were retrieved for the first 21 ICU-days. Data as median (IQR).
139 patients completed the criteria, aged 37 (28) years, burned on 35 (25) % TBSA. As a result of prescription, Cu, Se and Zn intakes increased significantly between P1 and P4, resulting in normalization of plasma Cu (16 μmol/l) since P3 and Zn (13.5 μmol/l) since P2. Median plasma Se were above reference range (1400 nmol/l) during P3 and P4. CRRT patients required higher doses of Cu for maintenance within normal ranges.
This dose finding study shows that the latest repletion protocol is safe and normalizes Cu and Zn concentrations. Se doses result in supra-normal Se concentrations, suggesting prescription reduction. CRRT patients are at high risk of Cu depletion and require specific monitoring.
大面积烧伤患者的铜（Cu）、硒（Se）和锌（Zn）会大量渗出丢失。补充微量元素（TE）已被证明可改善临床预后。随着时间的推移，我们逐渐增加了 TE 的剂量，本研究旨在分析我们的补充方案是否能纠正 TE 的血浆浓度，以及连续性肾脏替代治疗（CRRT）的必要性是否会增加 TE 的需求。
对 1999 年至 2015 年期间需要重症监护（ICU）的烧伤患者进行前瞻性数据的回顾性分析。
第 1 天入院、接受完整治疗、烧伤面积（TBSA）≥20%、住院期间至少有 1 次 TE 血浆测定。根据方案变更将患者分为 4 组。第 1 期（P1）：1999-2000 年；第 2 期（P2）：2001-2005 年；第 3 期（P3）：2006-2010 年；第 4 期（P4）：2011-2015 年。变更包括增加 TE 补充剂量和持续时间。检索前 21 天 ICU 期间的人口统计学数据、每日 TE 摄入量和每周血浆浓度。数据以中位数（IQR）表示。
139 名患者符合纳入标准，年龄为 37（28）岁，TBSA 为 35（25）%。由于处方，Cu、Se 和 Zn 的摄入量在 P1 至 P4 期间显著增加，导致血浆 Cu（16μmol/L）从 P3 开始正常化，Zn（13.5μmol/L）从 P2 开始正常化。P3 和 P4 期间，血浆 Se 的中位数均高于参考范围（1400nmol/L）。CRRT 患者需要更高剂量的 Cu 来维持正常范围。
这项剂量探索研究表明，最新的补充方案是安全的，可使 Cu 和 Zn 浓度正常化。Se 的剂量导致超正常 Se 浓度，提示需要减少处方。CRRT 患者存在 Cu 耗竭的高风险，需要进行特定监测。
