烧伤患者热量供应——尚待探讨课题

After a series of study of early feeding(EF),we consider the evaporative heat loss from the burn wound is not the main mechanism of burn hypermetabolism.EF could resuscitate the intestine,preserve its structural inte-gnty and function,prevent bacterial translocation and release of inflammatory mediators,reduce muscle protein catabolism and hypermetabolism.Our studies concerning the relationship between EF and hypermetabolism have already extended to involve hypothalamus now.At the end of 1960s,the advancement in "Intravenous Hyperalimentation" has epoch-making significance,but it has been found later that energy has been oversupplied by this measure,thus it exacerbated visceral loading and led to disorder of internal environment,and it has been found not beneficial to alleviate hypermetabolism.Whether "hypoealoric nutrition" for post-operative patients of G-I(gastro-intestine)surgery is applicable to severe bum patients remains as a problem.Some specialists suggest it is better to supply 126～146 kJ·kg-1·d-1 in severe burn patients.After evaluating the bias and precision of 46 methods of estimating energy supply of burn patients reported from 1953 to 2000,Dikerson RN et al.concluded that the most precise,unbiased methods were those of Milner(1994),Zawaeki(1970)and TMMU(1993,Third Military Medical University formula).Though formulas are simple and convenient to estimate energy supplementation,however,it is difficult to evaluate the requirement of energy when the patient's condition changes immensely.