Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University Medical Center, Saint Louis, Missouri 63104, USA.
Curr Opin Clin Nutr Metab Care. 2013 Jan;16(1):39-49. doi: 10.1097/MCO.0b013e32835bc0a1.
Skin ulcerations cause significant morbidity and mortality, while driving up healthcare utilization and costs. Interventions to prevent ulcers and improve wound healing times are needed to reduce the burden on patients and healthcare systems. It has been well established that weight loss, protein-calorie malnutrition, and dehydration are risk factors for pressure ulcers. Many nutritional interventions have been studied, with studies being of variable quality and producing mixed results. This review aims to clarify the current evidence and highlights the recent advances in the area of nutrition for the prevention and management of skin ulceration.
Markers for assessing nutritional status will be reviewed first, followed by a discussion on the theoretical benefit of various nutritional interventions on wound healing. Recommendations for nutrient repletion are also included. Finally, the most recent or important literature will be highlighted and the risks and benefits of supplementation are debated. There is mixed evidence for most nutritional interventions, with most studies being of poor quality with variable study designs, lack of control groups, small sample sizes, and short study lengths.
Long-term randomized trials of individual nutrients and clinically relevant endpoints are needed to definitively show the benefit of additional nutritional supplementation over dietary interventions. Until those studies become available, best evidence suggests the importance of screening for malnutrition, calculating resting energy expenditure and caloric needs, and monitoring dietary intake of essential nutrients.
目的综述：皮肤溃疡会导致严重的发病率和死亡率，增加医疗保健的利用和成本。需要干预措施来预防溃疡并缩短伤口愈合时间，以减轻患者和医疗系统的负担。已经充分证实，体重减轻、蛋白质-热量营养不良和脱水是压疮的危险因素。已经研究了许多营养干预措施，这些研究的质量参差不齐，结果也不一致。这篇综述旨在澄清目前的证据，并强调营养在预防和治疗皮肤溃疡方面的最新进展。
最新发现：首先将回顾评估营养状况的标志物，然后讨论各种营养干预措施对伤口愈合的理论益处。还包括营养素补充的建议。最后，将突出显示最新或最重要的文献，并讨论补充的风险和益处。大多数营养干预措施的证据都不一致，大多数研究质量较差，研究设计各不相同，缺乏对照组，样本量小，研究时间短。
总结：需要进行长期的随机对照试验，针对个体营养素和临床相关终点，以明确表明额外的营养补充优于饮食干预。在这些研究结果出来之前，最好的证据表明筛查营养不良、计算静息能量消耗和热量需求以及监测必需营养素的膳食摄入量非常重要。
