Costello Lee-Anne S, Lithander Fiona E, Gruen Russell L, Williams Lauren T
Nutrition and Dietetics, Faculty of Health, The University of Canberra, Bruce, Australian Capital Territory 2601, Australia; Discipline of Acute Care Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia 5000, Australia.
Nutrition and Dietetics, Faculty of Health, The University of Canberra, Bruce, Australian Capital Territory 2601, Australia.
Injury. 2014 Dec;45(12):1834-41. doi: 10.1016/j.injury.2014.06.004. Epub 2014 Jun 13.
Patients who have sustained traumatic brain injury (TBI) have increased nutritional requirements yet are often unable to eat normally, and adequate nutritional therapy is needed to optimise recovery. The aim of the current scoping review was to describe the existing evidence for improved outcomes with optimal nutrition therapy in adult patients with moderate to severe TBI, and to identify gaps in the literature to inform future research.
Using an exploratory scoping study approach, Medline, Cinahl, Embase, CENTRAL, the Neurotrauma reviews in the Global Evidence Mapping (GEM) Initiative, and Evidence Reviews in Acquired Brain Injury (ERABI) were searched from 2003 to 14 November 2013 using variations of the search terms 'traumatic brain injury' and 'nutrition'. Articles were included if they reported mortality, morbidity, or length of stay outcomes, and were classified according to the nature of nutrition intervention and study design.
Twenty relevant articles were identified of which: 12 were original research articles; two were systematic reviews; one a meta-analysis; and five were narrative reviews. Of these, eleven explored timing of feed provision, eight explored route of administration of feeding, nine examined the provision of specific nutrients, and none examined feeding environment. Some explored more than one intervention. Three sets of guidelines which contain feeding recommendations were also identified.
Inconsistency within nutrition intervention methods and outcome measures means that the present evidence base is inadequate for the construction of best practice guidelines for nutrition and TBI. Further research is necessary to elucidate the optimal nutrition therapy for adults with TBI with respect to the timing, route of administration, nutrient provision and feeding environment. A consensus on the ideal outcome measure and the most appropriate method and timing of its measurement is required as a foundation for this evidence base.
创伤性脑损伤（TBI）患者的营养需求增加，但往往无法正常进食，因此需要适当的营养治疗以优化康复效果。本次范围综述的目的是描述现有证据，以说明最佳营养治疗对中重度成年TBI患者预后改善的作用，并找出文献中的空白，为未来研究提供参考。
采用探索性范围研究方法，于2003年至2013年11月14日检索了Medline、Cinahl、Embase、CENTRAL、全球证据图谱（GEM）倡议中的神经创伤综述以及后天性脑损伤证据综述（ERABI），检索词为“创伤性脑损伤”和“营养”的不同变体。如果文章报告了死亡率、发病率或住院时间等结果，并根据营养干预的性质和研究设计进行分类，则纳入研究。
共识别出20篇相关文章，其中：12篇为原创研究文章；2篇为系统综述；1篇为荟萃分析；5篇为叙述性综述。其中，11篇探讨了喂养时机，8篇探讨了喂养途径，9篇研究了特定营养素的供应，没有一篇研究喂养环境。有些文章探讨了不止一种干预措施。还确定了三套包含喂养建议的指南。
营养干预方法和结果测量的不一致意味着目前的证据基础不足以构建TBI营养最佳实践指南。有必要进一步研究，以阐明针对成年TBI患者在喂养时机、给药途径、营养素供应和喂养环境方面的最佳营养治疗方法。需要就理想的结果测量指标以及最合适的测量方法和时机达成共识，作为这一证据基础的基石。
