富含精氨酸、锌和抗氧化剂的营养配方治疗压疮的效果：一项随机试验。

A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial.

出版信息

Ann Intern Med. 2015 Feb 3;162(3):167-74. doi: 10.7326/M14-0696.

Abstract

BACKGROUND

Trials on specific nutritional supplements for the treatment of pressure ulcers (PUs) have been small, inconsistent in their formulations, or unsuccessful in controlling for total supplement calorie or protein content.

OBJECTIVE

To evaluate whether supplementation with arginine, zinc, and antioxidants within a high-calorie, high-protein formula improves PU healing.

DESIGN

Multicenter, randomized, controlled, blinded trial. (ClinicalTrials.gov: NCT01107197).

SETTING

Long-term care and home care services.

PATIENTS

200 adult malnourished patients with stage II, III, and IV PUs.

INTERVENTIONS

An energy-dense, protein-rich oral formula enriched with arginine, zinc, and antioxidants (400 mL/d) or an equal volume of an isocaloric, isonitrogenous formula for 8 weeks.

MEASUREMENTS

The primary end point was the percentage of change in PU area at 8 weeks. Secondary end points included complete healing, reduction in the PU area of 40% or greater, incidence of wound infections, the total number of dressings at 8 weeks, and the percentage of change in area at 4 weeks.

RESULTS

Supplementation with the enriched formula (n = 101) resulted in a greater reduction in PU area (mean reduction, 60.9% [95% CI, 54.3% to 67.5%]) than with the control formula (n = 99) (45.2% [CI, 38.4% to 52.0%]) (adjusted mean difference, 18.7% [CI, 5.7% to 31.8%]; P = 0.017). A more frequent reduction in area of 40% or greater at 8 weeks was also seen (odds ratio, 1.98 [CI, 1.12 to 3.48]; P = 0.018). No difference was found in terms of the other secondary end points.

LIMITATION

Participation was restricted to patients who were malnourished, were able to drink oral supplements, and were living in long-term care institutions or receiving home care services.

CONCLUSION

Among malnourished patients with PU, 8 weeks of supplementation with an oral nutritional formula enriched with arginine, zinc, and antioxidants improved PU healing.

PRIMARY FUNDING SOURCE

Azienda Ospedaliera Universitaria Maggiore della Carità.

摘要

背景

针对压疮（PU）治疗的特定营养补充剂的试验规模较小，配方不一致，或未能控制总补充剂热量或蛋白质含量。

目的

评估富含高热量、高蛋白配方的精氨酸、锌和抗氧化剂补充剂是否能改善 PU 愈合。

设计

多中心、随机、对照、盲法试验。（ClinicalTrials.gov：NCT01107197）。

地点

长期护理和家庭护理服务。

患者

200 名患有 II 期、III 期和 IV 期 PU 的成年营养不良患者。

干预措施

能量密集、富含蛋白质的口服配方，富含精氨酸、锌和抗氧化剂（400 mL/d）或等热量、等氮配方 8 周。

测量

主要终点为 8 周时 PU 面积的变化百分比。次要终点包括完全愈合、PU 面积减少 40%或更多、伤口感染发生率、8 周时的总敷料数以及 4 周时面积的变化百分比。

结果

与对照组（n=99）相比，补充富含配方（n=101）的 PU 面积减少更大（平均减少 60.9%[95%CI，54.3%至 67.5%]）（调整后的平均差异，18.7%[CI，5.7%至 31.8%]；P=0.017）。8 周时也更频繁地观察到面积减少 40%或更多（优势比，1.98[CI，1.12 至 3.48]；P=0.018）。其他次要终点没有差异。