Nutrition in Burns

Abstract

Enteral nutrition (EN) has followed a long history, and hyperalimentation has had an epoch-making signifi cance since the end of the 1960s. From the 1980s, enterogenous infection and the complications of the catheter, metabolism, infection, etc., have been raised, and gradually much attention has been devoted to EN and especially early feeding. We began to serially study the effect and mechanism of early EN since 1985.Overall, more than 700 rats, guinea pigs, rabbits, minipigs, and 200 burns patient were used to compare early feeding (EF) with delayed feeding (DF). Placing emphasis on 21 cases of severe burns (32.8 ± 10.9 years, total body surface area burned (TBSAB) 45 ± 12.6 %, deep burn 29.8 ± 8.9 %) in 200 burn patients. Feeding was started within PBH 2 (2 h post-burn, in animals) or PBH 12 (patients) in the EF group and after PBH 48 (animal) or PBH 72 (patient) in the DF group. In addition, we created three animal models to study the effect and mechanism of early feeding. 1. The model of gastrostomy and neglecting jejunum in burn rabbit) The jejunum is cut off 5 cm under the ligament of Treitz, close to the distal end of the cut jejunum, end-toside anastomosis between the upper end and the side under the distal end 15 cm from the cut jejunum. The intestine up to 15 cm of anastomotic stoma is the neglecting jejunum; several interrupted sutures are performed just above the anastomotic stoma to form an artifi cial valve to prevent food regurgitation into the neglected jejunum. This model is used to study the effect of early feeding post-burn on protecting intestinal mucosa and the mechanism (Fig. 16.1 ). 2. The model of gastrostomy and central vein, portal vein, and mesenteric vein catheterization in Gui-zhou mini-pigs). This model is used to investigate the effect and its mechanism of early feeding on central and portal vein blood fl ow, intestinal absorption function, barrier function of the intestinal mucosa, and hypermetabolism ( Fig. 16.2 ). 3. The model of gastrostomy and central vein, portal vein, mesenteric vein, iliac vein, and artery catheterization in Gui-zhou mini-pigs One the basis of the model ( Fig. 16.2 ), this mode is used to further study the protection effect of early feeding and glutamine on intestinal structure and function, and understanding substance metabolic changes of muscle in the lower extremities (Fig. 16.3 ). Creation of Three Animal Early Feeding Could Lessen IntestinalAnoxia Injury and Promote Intestine Resuscitation [ 4 -22 ] Early feeding (EF) post-burn could improve portal and intestinal blood fl ow, lessen intestinal ischemia and reperfusion injury, provide better energy metabolism of intestinal mucosa cells, lower depression of mucosa proliferation and reparation, and maintain the intestinal structure and function. 1. Early feeding could lessen intestinal ischemia and anoxia injury (Tables 16.1 , 16.2 , 16.3 , 16.4 , 16.5 , 16.6 , 16.7 , 16.8 , and 16.9 ) Early feeding could improve portal and intestinal blood fl ow and lessen intestinal ischemia and reperfusion injur...