Molnar Joseph Andrew, Underdown Mary Jane, Clark William Andrew
Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine , Winston-Salem, North Carolina.
James H. Quillen College of Medicine, East Tennessee State University , Johnson City, Tennessee.
Adv Wound Care (New Rochelle). 2014 Nov 1;3(11):663-681. doi: 10.1089/wound.2014.0530.
Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D.
营养是最基本的医学问题之一，但在慢性伤口患者的管理中，它常常被忽视。不幸的是，即使在发达国家的养老院中，营养不良在老年患者中也很普遍。关注基本营养并提供适当的补充剂可能有助于慢性伤口的愈合。最近的研究揭示了发达国家营养不良的流行病学情况、与发展中国家营养不良的相似之处以及该问题的一些生理和社会原因。现在有更多关于营养缺乏的生化影响以及宏量营养素和微量营养素补充的信息。在某些情况下，给予健康个体超出推荐量的单一营养素可能会产生药理作用，有助于伤口愈合。关于慢性伤口营养支持的许多知识是基于从创伤管理中获得的信息。由于患者的人口统计学差异以及急性和慢性伤口生理上的差异，假设这些患者群体的营养支持的所有方面都是相同的是不合理的。在提供特定的营养补充剂之前，必须对患者的一般营养状况和营养不良的原因进行适当评估，否则特定的营养素补充将无法得到有效利用。未来的研究必须集中在急性和慢性伤口的生化和生理差异以及与特定补充剂（如抗氧化剂、维生素A和维生素D）的相互作用上。
