Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
Nutr Clin Pract. 2019 Oct;34(5):673-680. doi: 10.1002/ncp.10390. Epub 2019 Aug 16.
Severe burn injuries have long been known to have a profound effect on metabolic equilibrium that can persist after resolution of the cutaneous injuries. Following burn injury, metabolism is a dynamic state resulting in the need for frequent interval reassessment over the course of the care continuum. The acute phase of injury transitions to chronic alterations in macronutrient utilization characterized by futile energy cycling and disproportionate catabolism of skeletal muscle. Protein supplementation appears to be preferentially distributed to the burn wound rather than the skeletal muscle pool. Accurate assessment of caloric and protein requirements is extremely difficult in these patients but is an essential step in efforts to attenuate functional impairment. Indirect calorimetry should be utilized to determine caloric requirements, but trophic feeding strategies are preferred in the initial resuscitative phase to prevent overfeeding while maintaining enteric and immune function. Controversy persists regarding optimal protein targets, and weight-based estimates remain the norm. Exogenous protein and caloric provision performed in isolation is insufficient to optimize outcomes and should be incorporated within a multidisciplinary approach to include muscle loading and pharmaceutical adjuncts.
严重烧伤一直被认为对代谢平衡有深远影响，即使皮肤损伤得到解决，这种影响仍可能持续。烧伤后，代谢处于动态状态，需要在整个治疗过程中频繁间隔重新评估。损伤的急性期会转变为以能量循环无效和骨骼肌分解代谢不成比例为特征的宏量营养素利用的慢性改变。蛋白质补充似乎优先分配到烧伤创面，而不是骨骼肌池。在这些患者中，准确评估热量和蛋白质需求极其困难，但这是努力减轻功能障碍的重要步骤。应使用间接测热法来确定热量需求，但在初始复苏阶段，营养喂养策略是首选，以防止过度喂养，同时保持肠道和免疫功能。关于最佳蛋白质目标仍存在争议，体重估计仍然是常规方法。单独进行外源性蛋白质和热量供给不足以优化结果，应纳入多学科方法，包括肌肉负荷和药物辅助。
