Atiyeh B S, Gunn S W A, Dibo S A
General Secretary, Mediterranean Council for Burns and Fire Disasters, Clinical Professor, Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Ann Burns Fire Disasters. 2008 Dec 31;21(4):175-81.
Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society.Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.
重度烧伤患者是最具挑战性的重症患者之一，处于极端的生理应激状态，全身代谢反应强烈。为应对这种损伤而增加的能量消耗，需要从脂肪储备和活跃肌肉中动员大量底物用于修复和供能，从而导致分解代谢。这种高代谢反应在受伤后可持续长达9个月至1年，并与伤口愈合受损、感染风险增加、瘦体重流失、康复受阻以及烧伤幸存者重新融入社会延迟有关。通过给予特定营养素、生长因子或其他药物（通常为药理剂量）来调控患者的生理和生化环境，从而逆转高代谢反应，正逐渐成为重度烧伤治疗先进技术的重要组成部分。早期肠内营养支持、控制高血糖、阻断儿茶酚胺反应以及使用合成代谢类固醇，都已被提议用于减轻高代谢或减轻与重度烧伤相关的分解代谢。本研究是对所提议的营养和代谢治疗措施的文献综述，以确定基于证据的最佳实践。不幸的是，我们目前的知识水平尚无法制定明确的指南。只能概述一些总体趋势，这些趋势肯定会有一些实际应用，但最重要的是将指导该领域未来的研究。
