Review and prospect of parenteral nutrition support for burn patients in China / 中华烧伤杂志

Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standardized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immuno nutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immuno nutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly, the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parenteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition.

Progress in gut-derived mechanism of multiple organ dysfunction syndrome after burns and trauma / 中华烧伤杂志

Multiple organ dysfunction syndrome (MODS) is a serious complication with higher mortality in patients with burns and trauma. It is important to study the mechanism of MODS for prevention and control of it. Mesenteric lymph mechanism of MODS is a new viewpoint of gut-derived mechanism of MODS in recent years. In this review, we elucidate the mechanism of gut-derived origin of MODS and role of mesenteric lymph path in development of MODS after burns and trauma injury.

Analysis of susceptibility of Pseudomonas aeruginosa isolated from a burn ward to antibiotics in vitro / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the isolation and the in vitro susceptibility of P. aeruginosa to antibiotics in our burn ward.</p><p><b>METHODS</b>Five hundred and thirty six burn patients admitted to our ward from 1997 to 2003 were enrolled in the study, and the wound excretion, the tips of the venous catheter, the subeschar tissue samples, and the blood samples were collected for bacterial identification and antibiotic susceptibility test with VITEK-AMS system.</p><p><b>RESULTS</b>The isolation rate of P. aeruginosa from 1997 to 2003 was 24.51%, 23.94%, 21.01%, 40.06%, 36.17%, 46.76% and 55.72%, respectively. The antibiotic effect of the third generation of Cephalosporins against the said bacteria showed a tendency to decline. The susceptibility rate to Cefoperazone, Ceftazidime and Cefotaxime were respectively 71%, 66% and 79% in 1997; 47%, 25%, 39% in 1998; 22%, 16%, 25% in 2002; The third generation cephalosporins had almost lost their antibiotic activity against P. aeruginosa in 2003, with the susceptibility rate to Cefotaxime lowered to 2%. The susceptibility rate to Imipenem from 1997 to 2003 was 76%, 33%, 45%, 11%, 41%, 31%and 4%, respectively.</p><p><b>CONCLUSION</b>The isolation rates of P. aeruginosa were steady during the period from 1997 to 1999, and they began to increase in 2000. The bacterial resistance to antibiotics increased gradually in recent years, and the strains of P. aeruginosa had become multi-drug resistant.</p>

Bacteriological surveillance in a burn intensive care unit and the analysis of bacterial resistance to antibiotics / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the dynamic changes of the bacterial flora in our burn intensive care unit (ICU) in the past 6 years, and to analyze resistance of bacteria to various antibiotics.</p><p><b>METHODS</b>A retrospective analysis of bacterial culture and drug-sensitivity results from 209 patients in our burn intensive care unit during a period of 1998 to 2003 was carried out.</p><p><b>RESULTS</b>Eight hundred and forty-five strains of bacteria were isolated from 209 specimens, among which 486 strains were gram negative (G(-)) (57.51%), and 339 were gram positive (G(+)) (40.12%). Among all the G(+) bacteria, Enterococcus faecalis accounted for 34.51%, Staphylococcus aureus accounted for 31.27%, and 72.64% of Staphylococcus aureus strains were MRSA. Pseudomonas aeruginosa was predominant among all G(-) bacteria, and it accounted for 66.26% of the latter. All the bacteria isolated showed multiple resistance to antibiotics.</p><p><b>CONCLUSION</b>G(-) bacilli were still predominant in our burn intensive care unit. The isolated bacteria exhibited multiple resistance to antibiotics. The results imply that antibiotics should be administered rationally in the burn wards guided by the bacterial resistance test.</p>

Modulation effects of recombinant human growth hormone on postburn hypermetabolism in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effects of recombinant human growth hormone (rhGH) on postuburn hypermetabolism in burn patients and its mechanism.</p><p><b>METHODS</b>Thirty-two patients inflicted with burn of 50% to 90% TBSA admitted to our department during past 5 years (1998-2002) were enrolled in the study and randomly divided into A (with 0.25 U.kg(-1).d(-1) of rhGH treatment on 7-10 PBD, n=16) and B (with 0.25 U.kg(-1).d(-1) of normal saline as control, n = 16) groups. The changes in the rest energy expenditure (REE), non-protein respiratory quotient (NPRQ), glucose metabolism, nitrogen balance as well as plasma levels of endocrines and inflammatory mediators were determined before and after the administration of rhGH.</p><p><b>RESULTS</b>rhGH was given to patients in group A during 7 - 10 PBD. The NPRQ in group A began to increase at the 7th PBD, raised to 0.80 +/- 0.09 in the 21st PBD. The plasma levels of PGE2, TXB2, TNF-alpha and IL-6 significantly decreased and insulin, rhGH and IGF-1 obviously increased when compared with those in group B. The accumulated nitrogen loss in group A was also much lower than that in group B. The plasma levels of adrenaline, cortisol, glucagon in group A were significantly higher than those in group B (P < 0.05).</p><p><b>CONCLUSION</b>The postburn administration of rhGH timely could regulate postburn hypermetabolism in severely burned patients by increasing the plasma levels of GH, IGF-1 and insulin, which was beneficial to the improvement of nutrition state and to the promotion of protein synthesis and wound healing.</p>