摘要
目的:探讨不同肠内营养热卡供给对Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)病人临床结局的影响。方法:回顾性分析2013年1月至2023年12月在杭州市第三人民医院住院的125例SJS/TEN病人,根据每日肠内营养热卡供给分为低热卡组(<25 kcal/kg,75例)、常规热卡组(25~30 kcal/kg,27例)和高热卡组(> 30 kcal/kg,23例)。比较三组病人的炎症指标、营养指标、皮损愈合时间、住院时间、并发症及死亡率。结果:出院时常规热卡组白细胞计数[WBC,(6.08±0.60)10^(9)/L]、C反应蛋白[CRP,(19.04±7.09)mg/L]和高热卡组WBC(6.34±0.71)10^(9)/L、CRP(27.78±8.94)mg/L均显著低于低热卡组WBC(8.31±0.41)10^(9)/L、CRP(62.07±7.41)mg/L,均P <0.05。同时,常规热卡组白蛋白[Alb(34.92±0.84)g/L]、前白蛋白[PA,(243.48±12.38)mg/L]和高热卡组Alb(35.07±0.96)g/L、PA(250.30±12.32)mg/L显著高于低热卡组Alb(27.31±0.38)g/L、PA(146.31±6.01)mg/L,均P <0.05。常热卡组的皮损愈合时间(11.00±3.84)d、住院时间(14.93±4.68)d显著低于低热卡组皮损愈合时间(15.52±4.61)d、住院时间(19.92±6.17)d,均P <0.05;高热卡组的皮肤愈合时间(10.60±2.96)d、住院时间(14.07±4.05)d显著低于低热卡组(P <0.05),高热卡组和低热卡组的感染率(8.70%vs 8.00%)、胃肠道不耐受发生率(8.70%vs 10.67%)无显著差异(P> 0.05)。结论:肠内营养热卡供给在25~30 kcal/kg之间较为合理,能够满足SJS/TEN病人的能量需求,改善预后。
Objective:To evaluate the impact of different levels of enteral caloric support on clinical outcomes in patients with Stevens-Johnson Syndrome(SJS)/Toxic Epidermal Necrolysis(TEN).Methods:A retrospective analysis was conducted in 125 patients with SJS/TEN admitted to the Third People's Hospital of Hangzhou from January 2013 to December 2023.Patients were categorized into three groups based on their daily enteral caloric intake:low-calorie group(<25 kcal/kg,n=75),conventional calorie group(25~30 kcal/kg,n=27),and high-calorie group(>30 kcal/kg,n=23).The inflammatory markers,nutritional indicators,skin lesion healing time,length of hospital stay,complications rates,and mortality were compared among the groups.Results:At discharge,the white blood cell count[WBC,(6.08±0.60)10^(9)/L]and C-reactive protein[CRP,(19.04±7.09)mg/L]in the conventional calorie group,as well as the high-calorie group[WBC(6.34±0.71)10^(9)/L,CRP(27.78±8.94)mg/L],were significantly lower than those in the low-calorie group[WBC(8.31±0.41)10^(9)/L、CRP(62.07±7.41)mg/L](P<0.05).Meanwhile,the albumin[Alb(34.92±0.84)g/L]and prealbumin[PA,(243.48±12.38)mg/L]levels in the conventional calorie group,as well as the high-calorie group[Alb(35.07±0.96)g/L;PA(250.30±12.32)mg/L],were significantly higher than those in the low-calorie group[Alb(27.31±0.38)g/L;PA(146.31±6.01)mg/L](P<0.05).The skin lesion healing time(11.00±3.84)days,length of hospital stay(14.93±4.68)days,in the conventional calorie group were significantly lower than those in the low-calorie group[skin lesion healing time(15.52±4.61)days,length of hospital stay(19.92±6.17)days,P<0.05];the skin healing time(10.6±2.96)d and length of hospital stay(14.07±4.05)d in the high-calorie group were significantly lower than those in the low-calorie group(P<0.05).There was no significant difference in infection rates(8.70%vs 8.00%)and gastrointestinal intolerance rates(8.70%vs 10.67%)between the two groups(P>0.05).Conclusion:Enteral caloric support of 25~30 kcal/kg/day appears to be optimal for patients with SJS/TEN,effectively meeting energy demands,improving nutritional and inflammatory markers,and promoting better clinical outcomes with fewer complications.
作者
张文磊
潘金波
李辉
ZHANG Wen-lei;PAN Jin-bo;LI Hui(Department of Critical Care Medicine,Hangzhou People's Third Hospital,Hangzhou 310009,Zhejiang,China)
出处
《肠外与肠内营养》
北大核心
2025年第3期151-154,164,共5页
Parenteral & Enteral Nutrition
