臺灣博碩士論文加值系統

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。

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.

目 錄

中文摘要 I
英文摘要 II
致謝 III
目錄 V
表目錄 VIII
圖目錄 IX
附錄目錄 X
縮寫對照表 XI
第一章 研究背景及動機 1
第二章 文獻回顧 3
第一節 發炎反應 4
第二節 細胞激素 9
第三節 前列腺素及白三烯素（Leukotrienes） 13
第四節 自由基 22
第五節 燒燙傷病患的呼吸功能 25
第三章 研究目的 29
第四章 實驗設計與方法 30
第一節 研究對象 30
第二節 實驗流程 31
第三節 灌食配方之給予方法 33
第四節 細胞激素測定 36
第五節 血液生化檢驗 41
第六節 呼吸功能 42
第七節 預後 43
第八節 統計分析 44
第五章 結果 45
第一節 基本資料分析 45
第二節 營養素攝取量與消化道耐受性 48
第三節 細胞激素 52
第四節 血液生化檢驗 58
第五節 呼吸功能 59
第六節 預後 61
第六章 討論 64
第一節 基本資料分析 64
第二節 營養素攝取量與消化道耐受性 66
第三節 細胞激素 68
第四節 血液生化檢驗 70
第五節 呼吸功能 72
第六節 預後 75
第七章 結論 78
第八章 未來研究方向 79
英文參考文獻 80
中文參考文獻 85
附錄一 86
附錄二 87
















表 目 錄
表一 細胞激素¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼11
表二 對照組及實驗組之灌食配方營養成分分析¼¼¼¼¼¼¼34
表三 受試者之臨床基本資料¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼47
表四 對照組與實驗組第一天至第八天之營養素平均攝取量¼¼49
表五 受試者之臨床基本資料¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼51
表六 控制組、實驗組第一天及第八天之呼吸變異數及動脈血氧
分壓之比較¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼60















圖 目 錄
圖一 嚴重燒燙傷病人的發炎反應及其影響¼¼¼¼¼¼¼¼¼¼¼6
圖二 燒燙傷發炎反應簡明圖示¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼8
圖三 花生四烯酸的連鎖反應 ¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼14
圖四 g-亞麻油酸的新陳代謝¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼17
圖五 重要飽和脂肪酸之鍊加長反應及去飽和反應¼¼¼¼¼¼¼¼21
圖六 對照組與實驗組於入院第一天、第八天及第十五天血液中
TNF-a的濃度變化¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼53
圖七 對照組與實驗組於入院第一天、第八天及第十五天血液中
IL-6的濃度變化¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼55
圖八 對照組與實驗組於入院第一天、第八天及第十五天血液中
IL-10的濃度變化¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼¼57
圖九 對照組與實驗組於住院期間呼吸器之使用天數¼¼¼¼¼¼¼62
圖十 對照組與實驗組每1% 受傷體表面積之住院天數¼¼¼¼¼¼63

附 錄 目 錄
附錄一 Long 修訂之Harris-Benedict公式¼¼¼¼¼¼¼¼¼86
附錄二 燒燙傷嚴重指數（Burn Severity Index） ¼¼¼¼¼¼87

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中 文 參 考 文 獻
蔡坤志 （2002）自由基簡介與其臨床應用，臨床醫學，第四十九卷第二期