目的：通过11年病人住院资料的回顾性队列研究，分析影响严重烧伤病人早期营养的主要因素和伤后72 h内是否实施肠内营养对治疗结局的影响，为严重烧伤病人肠内营养方案提供依据。方法：本回顾性研究对2009年1月到2020年12月间在烧伤后24 h内收治入院烧伤总面积>30%的烧伤成年病人资料进行分析。采用单因素和多元回归分析影响严重烧伤病人尽早实施肠内营养的主要原因，采用非参数Mann-Whitney U检验比较72 h内与72 h后给予实施肠内营养的主要影响因素及对28 d生存率、在院期间生存率等治疗结局的影响。结果：影响严重烧伤病人启动肠内营养时间的单因素分析结果为烧伤总面积、Ⅲ度烧伤面积及烧伤原因、是否有吸入性损伤（P<0.05）。将上述单因素纳入多元回归分析发现，影响病人尽早实施肠内营养的主要影响因素是Ⅲ度烧伤面积（P=0.017）及吸入性损伤(P=0.001)。进一步以烧伤后72 h内是否启动肠内营养作为研究目标分析发现，病人有吸入性损伤和Ⅲ度烧伤面积大是其主要原因。经数据匹配后的受伤情况及伤前情况一致条件下，烧伤后72 h内与72 h后实施肠内营养的病人在院期间生存率、28 d生存率、血培养阳性率等结局差异无统计学意义（P>0.05），但静脉导管培养阳性率较低(P=0.001)、烧伤后7 d内接受肠外营养治疗率较低(P=0.001)。结论：导致严重烧伤病人未能尽早实施肠内营养主要原因是Ⅲ度烧伤面积大及合并吸入性损伤。烧伤后72 h内接受肠内营养降低静脉导管培养阳性率及肠外营养的使用率，从而降低严重烧伤病人救治风险。

Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data, to provide evidence for enteral nutrition regimens for severe burn patients. Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020. Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%. Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn. Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h, as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate. Results The univariate analysis found that total burn area, full-thickness burn area, burn type, and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn (P<0.05). Incorporating the above single factors into multiple regression analysis, we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area (P=0.017) and inhalation injury (P=0.001). To analysis whether enteral nutrition was started within 72 h after burning, we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition. After matching injury situation with pre-injury situation, we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate, 28-day survival rate, and positive blood culture rate （P>0.05），but was associated with the lower incidence of bacteria positive in intravenous catheters (P=0.001) and the lower rate of parenteral nutrition treatment used within 7 d after burning (P=0.001). Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury. Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition, thereby reducing the risk of treatment in patients with severe burn.