Blissitt P A
Crit Care Nurs Clin North Am. 1990 Sep;2(3):375-84.
Nutrition in acute spinal cord injury is complicated. Not every aspect of nutrition as it relates to the acutely injured spinal cord patient is known. The stress response to injury, fever, infection, sepsis, and surgery alter nutritional needs, as does the spinal cord injury itself. The sequelae of spinal cord injury, including denervation atrophy and paralysis, glucose intolerance, skin and wound breakdown, poikilothermy, anemia, respiratory paralysis, pneumonia, paralytic ileus, gastrointestinal ulcers and hemorrhage, neurogenic bowel and bladder, and depression, all affect the nutritional needs of the patient. Orthopedic appliances, pharmacologic agents, and other injuries can also alter nutritional requirements. Nutritional assessment in acute spinal cord injury is also complex. It should include medical and diet history, physical examination, intake and output measurements, prediction of energy expenditure and protein requirements, or--even better--measurements of energy expenditure with indirect methodology, using the metabolic cart or pulmonary artery catheter. Application of computerized tomography and radioisotope studies may prove valuable in the future. Finally, the direct relationship between nutrition and physiologic alterations of acute spinal cord injury necessitates that the critical care nurse incorporate nutrition-focused thinking into many aspects of the acute spinal cord--injured patient's care.
急性脊髓损伤的营养问题较为复杂。与急性脊髓损伤患者相关的营养问题，并非每个方面都为人所知。对损伤、发热、感染、脓毒症及手术的应激反应会改变营养需求，脊髓损伤本身也会如此。脊髓损伤的后遗症，包括去神经萎缩和瘫痪、葡萄糖不耐受、皮肤及伤口破溃、体温随环境变化、贫血、呼吸麻痹、肺炎、麻痹性肠梗阻、胃肠道溃疡和出血、神经源性肠道和膀胱功能障碍以及抑郁等，都会影响患者的营养需求。矫形器械、药物及其他损伤也会改变营养需求。急性脊髓损伤的营养评估同样复杂。评估应包括病史和饮食史、体格检查、摄入量和排出量测量、能量消耗及蛋白质需求预测，或者——甚至更好的是——采用间接方法，使用代谢车或肺动脉导管测量能量消耗。计算机断层扫描和放射性同位素研究的应用在未来可能会被证明具有价值。最后，营养与急性脊髓损伤生理改变之间的直接关系，使得重症护理护士必须将以营养为重点的思维纳入急性脊髓损伤患者护理的诸多方面。
