目的:强化营养治疗是烧伤治疗的重要组成部分。关于轻微烧伤后的伤害,文学是缺乏的。这项研究的目的是评估轻度和重度烧伤后与国际指南相关的有记录的营养治疗。这项研究的次要目的是评估烧伤后与个体营养目标相比的能量和蛋白质摄入量是否足够。
方法:进行了一项回顾性观察性单中心研究,包括2017年至2019年在瑞典烧伤中心收治的患者。纳入研究的患者年龄≥18岁,烧伤后≥72h需要住院治疗。有关患者人口统计学的信息,营养治疗,收集烧伤的临床特点。根据全身面积烧伤(TBSA%)将患者分为轻度烧伤(TBSA<20%)和重度烧伤(TBSA≥20%)。描述性统计用于分析数据。通过将24种营养治疗建议与已有记录的治疗方法进行比较,建立了对指南的遵守。如果有记录的营养治疗符合指导方针,依从性被认为是高的(≥80%),中等(60-79.9%)或低(<59.9%)。
结果:纳入了一百三十四名患者,轻度烧伤90例,重度烧伤44例。有记录的对营养指南的依从性总体较低。轻度烧伤后,8%(2/24)的营养治疗建议具有较高的依从性(脂肪摄入量<总能量摄入量的35%,肠内营养作为优先喂养途径),17%(4/24)的中度依从性,和75%(18/24)低坚持。在严重烧伤后接受治疗的患者中,有两个建议有记录的高依从性(维生素C和锌);25%(6/24)有中等依从性,67%(16/24)的依从性较低。此外,发现了相当大量的缺失数据。有记录的营养摄入充足,与个人记录的目标相比,轻度烧伤后,能量为78%(±23%),蛋白质为66%(±22%)。严重烧伤后,能量充足性为89%(±21%),蛋白质充足性为78%(±19%),分别。
结论:本研究显示,轻度和重度烧伤患者对营养指南的依从性较低。与严重烧伤相比,在轻度烧伤中,能量和蛋白质的充足性较低。鉴于指南和有记录的营养治疗之间的差异,缺乏针对轻微烧伤的具体指导方针,烧伤后营养治疗不足可能存在相当大的风险.
Intensive nutritional therapy is an essential component of burn care. Regarding post-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documented nutritional therapy in relation to international
guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared to individual nutritional goals post-burn injury.
A retrospective observational single-centre study including patients admitted between 2017 and 2019 at a burn centre in Sweden was performed. The patients included in the study were ≥18 years old and in need of hospital care for ≥72 h post-burn injury. Information about patients\' demographics, nutritional therapy, and clinical characteristics of burn injury was collected. The patients were divided according to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burn injuries (TBSA ≥20%). Descriptive statistics were used to analyse data. Adherence to
guidelines was established by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with
guidelines, adherence was considered high (≥80%), moderate (60-79.9%) or low (<59.9%).
One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44 patients with major burn injuries. Documented adherence to the nutritional
guideline was overall low. After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fat intake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) a moderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury, there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24) had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount of missing data was found. Adequacy of documented nutritional intake, compared to the individual documented goal, was 78% (±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively.
This study revealed low adherence to nutritional guidelines in patients treated for minor and major burn injuries. Compared to major burn injuries, lower documented adequacy for both energy and proteins was found in minor burn injuries. Given the disparity between
guidelines and documented nutritional therapy, and the lack of specific
guidelines for minor burn injuries, there could be a considerable risk of inadequate nutritional therapy post-burn injury.