- 學位論文
以病例回溯法分析探討針對燒燙傷之病人在營養控制時的相關代謝與傷口改善
Related metabolic and improvement wound healing in burn patients with nutritional control: a retrospective case control analysis.
摘要
背景:當有感染、創傷、手術或燒傷等嚴重的生理壓力時，體內代謝會出現異常反應。而燒燙傷病人若有營養不良時將增加其死亡率，而早期腸內營養介入已被證明是有益的。目的:燒燙傷導致體內代謝改變除熱量及三大營養素須因應提高需求量，探討營養介入應視不同代謝期別決定介入時間點並予以不同建議量。研究方法:本研究以病例回溯法收集入住燒燙傷加護病房，年齡大於等於 20歲者，隨機抽取 101例受試者資料，分析探討在：燒燙傷之種類、燒燙傷深度、手術、住院期間營養攝取狀況以及是否聆聽營養師飲食衛教等相關因子，探討其傷口癒合程度、住院天數及出院方式，觀察在不同因素下的變化。結果:接受營養師衛教部分，在住院天數、燒燙傷面積、癒合面積、傷後就醫、手術次數、攝入熱量、攝入蛋白質以及達到建議之熱量與蛋白質攝取量部分皆見有顯著差異(P<0.05)。同時分析罹患糖尿病、燒燙傷型態、水療、手術、傷口深度、飲食種類、其他營養補充、以及非蛋白質與含氮量之比率之部份，皆見有顯著差異(P<0.05)。分析在糖尿病因子存在下是否影響受試者燒燙傷面積、癒合面積、攝取蛋白質以及達到建議之熱量與蛋白質攝取量部分分析具有顯著差異。結論:接受營養衛教能達到充足的營養攝取，有助於燒燙傷照護，像是在加快傷口癒合面積、減少施行手術次數、縮短住院天數，並有助於傷口癒合增加1.118%之癒合面積。
並列摘要
Background:When the body is subjected to severe stress infection, trauma, surgery, or burns can cause abnormal metabolic reactions of the body. Malnutrition is known to increase in burn patients if their mortality, and the benefits of early enteral nutrition intervention and security, has been proven in many studies. Aim:Burns alter the metabolism of the body, which increases demand for calories and macronutrients.The timing of early nutritional intervention to provide the recommended quantity of macronutrients depends on the stage of metabolism. Methods:This study,a retrospective case control analysis examined burn type, burn depth, surgery, nutritional intake during hospitalization, and compliance with nutritionist recommendations as well as their influence on the extent of healing, length of hospitalization, and means of hospital discharge among 101 random burn intensive care unit patients over the age of 20. Result:These results demonstrate significant differences between the groups that did or did not receive health education (P<0.05) with regard to the length of hospitalization, the proportion of burn area, the extent of healing, the number of days between being injured and seeking medical treatment, the number of surgeries, the caloric and protein intake, and percentages of recommended caloric and protein intake achieved. Analysis of diabetes, burn type, hydrotherapy, surgery, burn depth, dietary habits, other nutritional supplements, and the proportions of non-protein calories and nitrogen also presented significant differences (P<0.05). Diabetes was found to have significant influence on the proportion of burn area, the extent of heating, protein intake, and the percentages of suggested caloric and protein intake achieved. Conclusion:Receiving health education to achieve adequate nutritional intake, helps burn care, such as accelerating the wound healing area, reduce the number of times an operation to shorten the length of hospital stay, and increased 1.118% to healing the healing area.