Campos Brenno Belazi Nery de Souza, Machado Fabio Santana
Rev Bras Ter Intensiva. 2012 Mar;24(1):97-105.
This article reviews the literature, organizes the major findings, and generates the best evidence-based recommendations on nutrition therapy for head trauma patients. Despite recent advances in head trauma diagnosis and therapy, the mortality associated with this condition remains high. Few therapeutic interventions have been proven to effectively improve this condition. Head trauma causes multiple metabolic and electrolytic disorders; it is characterized by a hypermetabolic state that is associated with intensive catabolism, leading to specific nutritional needs. The current literature lacks specific guidelines for nutrition therapy in severe head trauma patients, although a substantial amount of data has been reported and relevant issues are currently being studied; these data may allow better nutrition therapy guidelines for these patients. In addition to a well-trained multi-disciplinary team, the following recommendations appear to improve outcomes: introducing nutrition therapy early; preferred enteral administration; appropriate energy intake; formulations that are tailored to specific patients, including appropriate nutrients; and strict electrolytic and metabolic monitoring. Understanding the pathophysiology and the consequences of therapy is fundamental.
本文回顾了相关文献，整理了主要研究结果，并针对头部创伤患者的营养治疗提出了基于最佳证据的建议。尽管头部创伤的诊断和治疗最近取得了进展，但与此病症相关的死亡率仍然很高。很少有治疗干预措施被证明能有效改善这种状况。头部创伤会导致多种代谢和电解质紊乱；其特征是与强烈分解代谢相关的高代谢状态，从而产生特定的营养需求。目前的文献缺乏针对重度头部创伤患者营养治疗的具体指南，尽管已经报告了大量数据且相关问题正在研究中；这些数据可能会为这些患者制定出更好的营养治疗指南。除了训练有素的多学科团队外，以下建议似乎能改善治疗效果：早期引入营养治疗；优先采用肠内给药；适当的能量摄入；针对特定患者量身定制的配方，包括适当的营养素；以及严格的电解质和代谢监测。了解病理生理学和治疗后果至关重要。
