Graves Caran, Saffle Jeffrey, Morris Stephen, Stauffer Theresa, Edelman Linda
Intermountain Burn Center, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
Burns. 2005 Feb;31(1):55-9. doi: 10.1016/j.burns.2004.07.008.
Patients with necrotizing fasciitis (NF) and other soft tissue infections are often treated in burn centers due to the extent of wound care and surgical intervention needed. Sepsis and surgery increase metabolic needs and may limit oral intake and necessitate enteral (TEN) or parenteral (TPN) nutrition. We reviewed the records of patients admitted with necrotizing fasciitis or surgical soft tissue infections from January 1993 to June 1998 who had indirect calorimetry (IC) measurements performed. Records were also reviewed for surgical/medical management and nutritional intervention. Twenty-six patients were admitted with 17 of these having IC measurements (133 total IC measurements). The IC group had more surgeries (mean 4.9 versus 2.7) and 82% required mechanical ventilation (mean 17.9 days). Energy expenditure showed a moderate but significant increase in energy needs (mean 23.8 kcal/kg/day, 124% BEE) with large variations (10.7-42.4 kcal/kg/day, 60%-199% BEE) in individual energy requirements. Caloric intake averaged 73% of needs based on IC (range 53%-104%). Nearly all patients (94%) required TEN (82%) and/or TPN (41%) nutrition for a mean of 24 days (range 1-68 days). NF presents a broad range of metabolic and surgical needs. Our data indicates patients with NF have increased energy requirements and suggests provision of calories at 124% basal or 25 kcal/kg actual wt/d; but due to the large individual variation, routine assessment using IC is recommended. Clinicians need to recognize the likely need for nutritional support and possibly lengthy clinical course for these patients.
由于所需伤口护理和手术干预的程度，坏死性筋膜炎（NF）患者和其他软组织感染患者通常在烧伤中心接受治疗。脓毒症和手术会增加代谢需求，可能会限制经口摄入量，因此需要肠内营养（TEN）或肠外营养（TPN）。我们回顾了1993年1月至1998年6月收治的坏死性筋膜炎或手术性软组织感染患者的记录，这些患者均进行了间接测热法（IC）测量。还回顾了手术/医疗管理和营养干预的记录。26例患者入院，其中17例进行了IC测量（共133次IC测量）。IC组进行的手术更多（平均4.9次对2.7次），82%的患者需要机械通气（平均17.9天）。能量消耗显示能量需求有适度但显著的增加（平均23.8千卡/千克/天，基础能量消耗的124%），个体能量需求差异很大（10.7 - 42.4千卡/千克/天，基础能量消耗的60% - 199%）。基于IC的热量摄入量平均为需求的73%（范围为53% - 104%）。几乎所有患者（94%）需要TEN（82%）和/或TPN（41%）营养，平均24天（范围为1 - 68天）。NF呈现出广泛的代谢和手术需求。我们的数据表明，NF患者的能量需求增加，建议按基础能量的124%或25千卡/千克实际体重/天提供热量；但由于个体差异较大，建议使用IC进行常规评估。临床医生需要认识到这些患者可能需要营养支持以及可能漫长的临床病程。
