嚴重燒燙傷病人的營養照護

The Nutrition Care of Severe Burn Patients

謝玉琇(Yu-Hsiu Hsieh)

《護理雜誌》 63卷1期 (2016/02) Pp. 22-29

https://doi.org/10.6224/JN.63.1.22

摘要

燒燙傷醫療技術的改進，如合宜的調控治療環境溫度、儘早清創和覆蓋敷料的包紮治療、早期餵食增加營養的供給，皆可使得燒燙傷病人經治療後的存活率大為增加。嚴重燒燙傷會引發病人生理上極大的壓力，許多複雜的因素導致燒燙傷後的代謝反應旺盛，如：組織異化作用的加速，身體肌肉的流失，及熱量和蛋白質的貯存大量耗損，這些都是治療的重點。對嚴重燒燙傷的病人治療而言，不只要求存活率的提昇，更希望能將日後職能上的傷害減到最低，因此近年來應用同化作用劑和免疫配方於燒燙傷病人的研究非常多，可是爭議也極大。熱量攝取不足是研究差異的主因之一，許多特殊營養素的補給（如麩醯胺酸），必先考量熱量與蛋白質的攝食足夠與否，才能評估其效果。攝取足夠的熱量與蛋白質，再考慮特殊營養素（如麩醯胺酸）的補充，才能發揮效益，促進病人復原。

關鍵字

嚴重燒燙傷 ； 熱量 ； 蛋白質 ； 麩醯胺酸

並列摘要

In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body’s reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively.

並列關鍵字

severe burn ； calorie ； protein ； glutamine

參考文獻

Abdullahi, A., & Jeschke, M. G. (2014). Nutrition and anabolic pharmacotherapies in the care of burn patients. Nutrition in Clinical Practice, 29(5), 621–630. doi:10.1177/08845336

Cochran, A., Thuet, W., Holt, B., Faraklas, I., Smout, R. J., & Horn, S. D. (2013). The impact of oxandrolone on length of stay following major burn injury: A clinical practice evaluation. Burns, 39(7), 1374–1379. doi:10.1016/j.burns.2013.04.002

Dickerson, R. N., Gervasio, J. M., Riley, M. L., Murrell, J. E., Hickerson, W. L., Kudsk, K. A., & Brown, R. O. (2002). Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients. Journal of Parenteral and Enteral Nutrition, 26(1), 17–29. doi:10.1177/014860710202600117

Gottschlich, M., Jenkins, M. E., Mayes, T., Khoury, J., Kgan, R. J., & Warden, G. D. (2002). An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. Journal of Burn Care Rehabilitation, 23, 401–415. doi:10.1097/00004630-200203002-00140

Guo, G., Bai, X., Cai, C., Zhang, J., Li, X., Zhu, F., & Liang, S. (2010). The protective effect of different enteral nutrition combined with growth hormone on intestinal mucosal damage of scalded rats. Burns 36(8), 1283–1288. doi:10.1016/j.burns.2010.04.003