目的: To delineate nutritional support in adult patients with severe burns; to investigate associations between nutritional practice and clinical outcomes.

方法: A prospective, observational multicenter trial was conducted. Intensive care units from seven hospitals participated in the treatment of burn patients injured in a massive factory explosion in Kunshan City, Jiangsu Province, China, on Aug 2, 2014.Data on nutritional support and patient outcomes were collected and analyzed.

结果:  One hundred patients were enrolled from seven hospitals. Most of the patients suffered extremely severe burns; the burn extent was above 70% of total body surface in 90% of the cases. Mean interval from injury to nutrition start for all patients was 2.4±1.1 days. Eleven patients received enteral nutrition (EN) alone. Sixty-seven patients (67%) were initiated with EN with a mean time of 1.7 days from injury to first fed. Within this group, 26 patients (38.8%)were fed by EN initially with PN supplemented afterwards;41 patients were initiated with EN and supplement parenteral nutrition(PN). The remaining 22 patients started with PN, later supplemented with EN. During the study period, 32 patients developed EN intolerance. Patients received an average of about 70% of their prescribed caloric and protein by nutrition support. Patients with calories provided by EN lower than 30%of target had significantly higher 28-day mortality (36.4%) compared with those higher than 30% (P=0.001).Mortality at 28 days was11% (11/100);the median time from diagnosis to death was 16.4days. Multiple regression analysis demonstrated that EN less than 30% and septic shock were independent risk factors of 28-day mortality (odds ratio, 5.2; 95% CI, 1.026-11.682.; P = 0.042; odds ratio, 6.5; 95% CI, 0.848-32.156.; P = 0.031).

结论: EN can be initiated early in the majority of severe burn patients. Nearly 90% of the patients were fed by EN supplemented with PN. Many gastric feeding patients developed EN intolerance; post-pyloric feeding was beneficial to improving the tolerance of enteral nutrition. EN may help to improve the prognosis of severe burn patients.
Many severe burn patients cannot tolerant early total gastric feeding, post-pyloric feeding or and combined earlier SPN were beneficial to improving EN tolerance and nutrition supplying deficiency, therefore improve the outcome of severe burn patients.