Brown R O, Hunt H, Mowatt-Larssen C A, Wojtysiak S L, Henningfield M F, Kudsk K A
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163.
Pharmacotherapy. 1994 May-Jun;14(3):314-20.
To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral formula with those receiving standard enteral therapy.
Prospective, randomized clinical trial.
Level 1 trauma center at a county government hospital.
Forty-one consecutive patients with major trauma who required enteral nutrition support. Thirty-seven patients completed the study. Four patients (two in each group) were excluded, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury.
Nineteen patients fed the specialized enteral formula received supplemental arginine, linolenic acid, beta-carotene, and hydrolyzed protein for up to 10 days. Eighteen control patients received standard enteral nutrition.
After study entry, patients who received the specialized enteral formula had fewer infections than those receiving standard enteral nutrition (3/19 vs 10/18; p < 0.05). The change in nitrogen balance was significantly better (p < 0.05) from day 1 (-11.8 +/- 1.8 g/day) to day 5 (-5.9 +/- 2.0 g/day) for the group who received the specialized formula compared with the group who received standard enteral nutrition (-7.3 +/- 1.7 g/day to -7.4 +/- 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly better (p < 0.05) from day 1 (18.0 +/- 2.1 mg/dl) to day 5 (11.8 +/- 1.5 mg/dl) in the group who received the specialized formula compared with the group who received standard enteral nutrition (17.6 +/- 1.2 mg/dl to 14.4 +/- 1.7 mg/dl). The CD4:CD8 ratio increased more in the group who received the specialized formula, although this difference did not reach statistical significance.
Trauma patients who received the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive patient outcomes are necessary before these specialized enteral formulas are used as the standard of practice in critically ill patients.
比较接受特殊肠内营养配方的创伤患者与接受标准肠内治疗的创伤患者在选定的营养和免疫指标以及感染方面的情况。
前瞻性随机临床试验。
某县政府医院的一级创伤中心。
41例连续的需要肠内营养支持的严重创伤患者。37例患者完成了研究。4例患者（每组2例）被排除，因为额外的手术操作导致在受伤后7天内无法开始肠内喂养。
19例接受特殊肠内营养配方的患者接受补充精氨酸、亚麻酸、β-胡萝卜素和水解蛋白，持续10天。18例对照患者接受标准肠内营养。
研究开始后，接受特殊肠内营养配方的患者感染例数少于接受标准肠内营养的患者（3/19 vs 10/18；p<0.05）。与接受标准肠内营养的组（从-7.3±1.7g/天至-7.4±2.8g/天）相比，接受特殊配方的组从第1天（-11.8±1.8g/天）到第5天（-5.9±2.0g/天）的氮平衡变化明显更好（p<0.05）。同样，与接受标准肠内营养的组（从17.6±1.2mg/dl至14.4±1.7mg/dl）相比，接受特殊配方的组从第1天（18.0±2.1mg/dl）到第5天（11.8±1.5mg/dl）的C反应蛋白血清浓度变化明显更好（p<0.05）。接受特殊配方的组CD4:CD8比值升高更多，尽管这一差异未达到统计学意义。
接受特殊肠内营养配方的创伤患者感染发生率降低，氮平衡及其他应激指标改善。在这些特殊肠内营养配方被用作重症患者的标准治疗方法之前，还需要更多证明患者有良好预后的临床试验。
