管灌配方中添加魚油、 γ-亞麻油酸及抗氧化維生素對使用呼吸器之燒燙傷病患的影響

本研究目的為探討使用呼吸器之燒燙傷病患於管灌配方中添加魚油 (Eicosapentaenoic acid; EPA) 、 γ- 亞麻油酸 (γ-linolenic acid; GLA) 及抗氧化維生素 (Vitamin A,C,E) 是否可以改善發炎程度及減少呼吸器使用情形，進而改善預後。方法： 43 名於入院時有氣管插管並使用呼吸器之燒燙傷病患，隨機分配為實驗組及對照組。實驗組灌食添加 EPA 、GLA 及抗氧化維生素之配方，對照組灌食等氮、等熱量之配方。入院第一天、第八天及第十五天抽血測定腫瘤壞死因子 (TNF-α) 、介白素 -6 (IL-6) 及 IL-10 之濃度，比較兩組之細胞激素、呼吸功能、呼吸器使用情形及預後。結果： 10 個實驗組與 13 個對照組病人完成第八天的抽血， 5 個實驗組與 9 個對照組病人完成第十五天的抽血。熱量及蛋白質攝取量，兩組之間無顯著差異。 EPA (5.2+1.5g Vs 0g) 、 GLA(5.2+1.5g Vs 0g) 、維生素 E (362+112 IU Vs 97+115 IU) 、維生素 C (965+298 mg Vs 478+260 mg) 及維生素 A (13727+298 IU Vs 5840+447 IU)之攝取量，實驗組明顯高於對照組 (p < 0.001) ，但是除了實驗組之每分鐘換氣量有明顯改善， TNF-α 、 IL-6 、 IL-10 、呼吸功能、呼吸器使用情形及住院天數，兩組都無顯著差異。結論：使用呼吸器燒燙傷病患，灌食添加 EPA 、 GLA 及抗氧化維生素配方，雖然每分鐘換氣量有明顯改善，但是對於呼吸器使用情形、血中細胞激素及預後並無影響。

Effect of Enteral Feeding Formula with Eicosapentaenoic Acid, γ-Linolenic Acid and Antioxidants in Burn Patients Using

Mechanical Ventilation

The purpose of this study was to investigate the effect of enteral feeding with Eicosapentaenoic acid (EPA), γ-linolenic acid (GLA) and antioxidants (Vitamin A, C, E) in burn patients using mechanical ventilation. Method: 43 burn patients who were using mechanical ventilation on admission were randomized. The study group was tube fed with EPA, GLA and antioxidants enriched formula and the control group was tube fed with iso-nitrogenic and iso-caloric formula. Blood samples were drawn on admission days 1, 8, and 15 for tumor necrosis factor-α(TNF-α), interleukin 6 (IL-6) and interleukin 10 (IL-10) tests. Cytokines, respiratory function, ventilator setting and outcome were measured. Results: There were 10 patients in the study group and 13 patients in the control group who went through the 8th day study course. Five patients in the study group and 9 patients in the control group complete the 15-day course. There was no significant differences for either calorie or protein intake between the study and control groups. Though the intake of EPA (5.2+1.5g Vs 0g) 、 GLA(5.2+1.5g Vs 0g) 、 vitamin E (362+112 IU Vs 97+115 IU) 、 vitamin C (965+298 mg Vs 478+260 mg) and vitamin A (13727+298 IU Vs 5840+447 IU) were significantly higher in the study group (p < 0.001), there were no significant differences for TNF-α, IL-6, IL-10, respiratory function, ventilator setting and length of hospital stay between the two groups, except minute ventilation in the study group. Conclusion: Except minute ventilation, there was no significant effect on cytokines, ventilatory variables and outcome for enteral feeding with EPA 、 GLA and antioxidants enriched formula in burn patients using mechanical ventilation.