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目的:评价蛋白强化的营养制剂在严重蛇咬伤病人中的应用效果及临床意义。方法:将45例上肢毒蛇咬伤需行负压封闭引流术(VSD)治疗的病人随机分为试验组和对照组。试验组病人给予口服蛋白强化的营养制剂,对照组口服普通饮食治疗。比较两组病人的住院时间、VSD治疗5 d后伤口新鲜肉芽组织增生满意率和住院总费用。比较两组病人VSD治疗前后血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)、纤维连接蛋白(FN)水平的变化。两组病人住院期间死亡、伤口感染、肺部感染和胃肠道不良反应的发生率。结果:试验组病人住院时间较对照组明显缩短(P<0.05),VSD治疗5 d后伤口新鲜肉芽组织增生满意率明显高于对照组(P<0.05)。对照组病人VSD后的营养学指标水平较前有明显下降(P<0.05)。结论:对严重毒蛇咬伤病人,给予蛋白强化的营养治疗可通过改善病人营养状况来加快伤口愈合、缩短住院时间、减少伤口和其他部位感染率的发生。
Objective: To evaluate the effect and clinical significance of protein-fortified nutritional preparations in patients with severe snake bites. Methods: Forty-five cases of upper venomous snake bite patients undergoing negative pressure closed drainage (VSD) were randomly divided into experimental group and control group. Patients in the experimental group were given oral protein fortified nutritional preparations and the control group were given oral common dietary therapy. The length of hospital stay was compared between the two groups. The rate of fresh granulation tissue hyperplasia and total cost of hospitalization after 5 days of VSD treatment were compared. The changes of serum albumin (ALB), transferrin (TF), prealbumin (PA) and fibronectin (FN) before and after VSD were compared between the two groups. The incidence of death, wound infection, lung infection and gastrointestinal adverse reactions in both groups during hospitalization. Results: The hospitalization time was significantly shorter in the experimental group than in the control group (P <0.05). The satisfaction rate of fresh granulation tissue in the wounds after 5 days of VSD treatment was significantly higher than that in the control group (P <0.05). The nutritional indexes of VSD patients in the control group were significantly lower than those before (P <0.05). CONCLUSIONS: Intensive nutrition therapy for patients with severe snakebite may improve wound healing, shorten length of hospital stay, and reduce the incidence of wounds and other infections by improving the patient’s nutritional status.