The purpose of this study was to assess the outcomes of enteral immune –enhancing formula in severe burned patients. From August 1998 until October 2002 , 21 burned patients from Burn Center of National Cheng Kung University hospital were randomized to receive early enteral nutrition with a enteral enhaning - immune formula（experimental n=11）or a high protein enteral formula.（control：10）Various nutritional, clinical, urinary, immunologic parameters were observed on postburned day 2, 4, 7, 14. Data analysis were performed by student t- test. , paired t- test and chi-square.
Result：After 12 days of feeding the two groups had increased in energy ,protein, arginine and glutamine intake. Patients receiving “enteral enhaning-immune formula” experienced significantly better gastrointestinal tolerance than control group (p<0.05)，increase of serum prealbumin different between postburned day 7and day 14. (p<0.05) , and serum transferrin on postburned day 7. (p<0.05)
In conclusion, this trial suggested this “enteral enhaning-immune formula” offer clinical benefits in severe burned patients.
Key words：severe burned patients、enteral enhaning-immune formula 、gastrointestinal tolerance、mortality
目錄
中文摘要----------------------------------------------------------------- -------I
英文摘要-------------------------------------------------------------------------iii
誌謝-------------------------------------------------------------------------------iv
目錄--------------------------------------------------------------------------------v
圖目錄----------------------------------------------------------------------------vi
表目錄----------------------------------------------------------------------------vii
附錄目錄-------------------------------------------------------------------------viii
第一章 緒論
第一節 研究動機-------------------------------- ---- 1
第二節 研究目的------------------------------------- 2
第二章 文獻回顧
第一節 燒傷後的生理、代謝變化-----------------4
第二節 燒燙傷患者營養支持的建議--------------6
第三節 免疫營養素在燒傷-------------------------10
第三章 材料和方法
第一節 實驗設計及流程----------------------------18
第二節 研究對象與方法----------------------------20
一、研究對象-------------------------------20
二、研究時間-------------------------------20
三、營養配方內容-------------------------20
四、營養支持方法-------------------------21
五、營養需求評估-------------------------21
六、傷口深度和面積評估----------------23
第三節 血液及尿液的收集及檢驗方法----------24
第四節 體位測量-------------------------------------33
第五節 併發症的診斷-------------------------------33
第六節 燒傷嚴重度的評估-------------------------35
第七節 統計分析-------------------------------------35
第四章 研究限制--------------------------------------------------37
第五章 結果
第一節 病患基本資料-------------------------------38
第二節 營養素攝取分析----------------------------39
第三節 血清生化值分析----------------------------40
第四節 尿液分析-------------------------------------42
第五節 免疫能力分析-------------------------------43
第六節 併發症分析----------------------------------44
第七節 死亡率與住院天數比較-------------------44
第六章 討論
第一節 腸道免疫加強配方對營養素攝取的探
討----------------------------------------------45
第二節 腸道免疫加強配方對血清生化值影
響的探討-------------------------------------45
第三節 腸道免疫加強配方對尿素氮排出與
氮平衡影響的探討-------------------------47
第四節 腸道免疫加強配方對併發症影響的
探討-------------------------------------------48
第七章 結論---------------------------------------------------------51
第八章 參考文獻---------------------------------------------------52

表目錄

表 2.1-1 燒燙傷後的生理病理變化----------------------------68
表 2.1-2 燒燙傷後的代謝變化----------------------------------69
表 5.1-1 病患基本資料-------------------------------------------70
表 5.2-1 兩組患者熱量、蛋白質之每日平均攝取量-------71
表 5.2-2 兩組患者精胺酸、麩胺酸之每日平均攝取量----72
表 5.3-1 血清生化數值的比較----------------------------------73
表 5.3-2 血清生化數值的比較----------------------------------74
表 5.3-3 血清白蛋白、前白蛋白、運鐵蛋白變化值比較-75
表 5.4-1尿素氮排出量、一日總尿素氮排出量、氮平衡
的比較----------------------------------------------------76
表 5.5-1 總淋巴球數的比較-------------------------------------77
表 5.5-1 總淋巴球數便化值的比較----------------------------78
表 5.6-1 併發症比較----------------------------------------------79
表 5.7-1 死亡率、存活者住院天數----------------------------80
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