Graves Caran, Saffle Jeffrey, Cochran Amalia
Department of Nutrition Care, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.
J Burn Care Res. 2009 Jan-Feb;30(1):77-82. doi: 10.1097/BCR.0b013e3181921f0d.
In 1989, Williamson published a survey of nutrition care practices in burn centers. Nutrition practices have evolved since then; we conducted a study to determine the current scope of nutrition care in burn centers. With IRB approval, a 64 question survey was emailed to 103 burn centers listed in the Burn Care Resources in North America. Follow-up emails were sent to those who did not respond within 2 weeks. Sixty-five centers (63%) responded and included 66% of currently verified burn centers. Due to incomplete surveys, most questions had 45 to 50 responses. The centers averaged 246 annual admissions and all admitted non-burn patients. Eighty percent of dietitians had >5 years burn experience (vs 17% in 1989) and 90% also worked in other intensive care settings. Most dietitians reported advanced training or education (83%). Nutrition assessment, support and monitoring methods have changed though most centers continue to use serum proteins for assessment. Indirect calorimetry use has increased with most centers (78%) adding a 'stress factor' of 10 to 30% above measured energy needs. More centers provided specialized formulas including high-protein (82 vs 8.8%) and immune-enhancing (53 vs 12.3%) than in 1989. All gave a variety of vitamin and mineral supplements. Anabolic steroid and glutamine use was common (92 and 69%). Eighty percent of centers used glucose protocols with 54% having a goal of <or=120 mg/dl; another 42% used 121 to 150 mg/dl as a target. Burn dietitians reported more experience than previously documented but continued to work in other intensive care unit areas. The use of calorimetry and glucose control protocols increased in the past 20 years as did the use of anabolic steroids and supplements. Variability continued in assessment (particularly calorie estimates) and monitoring methods.
1989年，威廉姆森发表了一项关于烧伤中心营养护理实践的调查。自那时起，营养护理实践不断发展；我们开展了一项研究，以确定烧伤中心当前营养护理的范围。经机构审查委员会批准，一份包含64个问题的调查问卷通过电子邮件发送给了北美烧伤护理资源中列出的103家烧伤中心。后续电子邮件被发送给那些在两周内未回复的中心。65家中心（63%）做出了回应，其中包括66%目前已获认证的烧伤中心。由于调查问卷不完整，大多数问题收到了45至50份回复。这些中心平均每年收治246名患者，且都收治非烧伤患者。80%的营养师有超过5年的烧伤护理经验（1989年为17%），90%的营养师还在其他重症监护环境中工作。大多数营养师报告接受过高级培训或教育（83%）。营养评估、支持和监测方法有所变化，不过大多数中心仍继续使用血清蛋白进行评估。间接测热法的使用有所增加，大多数中心（78%）在测量的能量需求基础上增加了10%至30%的“应激系数”。与1989年相比，更多的中心提供了特殊配方，包括高蛋白配方（82%对8.8%）和免疫增强配方（53%对12.3%）。所有中心都提供了多种维生素和矿物质补充剂。合成代谢类固醇和谷氨酰胺的使用很普遍（分别为92%和69%）。80%的中心采用了血糖控制方案，其中54%的目标是血糖水平≤120毫克/分升；另有42%将121至150毫克/分升作为目标。烧伤护理营养师报告的经验比之前记录的更多，但仍在其他重症监护病房领域工作。在过去20年里，测热法和血糖控制方案的使用增加了，合成代谢类固醇和补充剂的使用也是如此。评估（尤其是热量估计）和监测方法仍存在差异。
