Lee Hoo Young, Oh Byung-Mo
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea.
Brain Neurorehabil. 2022 Mar 28;15(1):e4. doi: 10.12786/bn.2022.15.e4. eCollection 2022 Mar.
Traumatic brain injury (TBI) is a major cause of long-term physical and psychological disability and death. In patients with TBI, undernutrition is associated with an increased mortality rate, more infectious complications, and worse neurologic outcomes. Therefore, timely and effective nutritional therapy is particularly crucial in the management of TBI to improve patients' prognoses. This narrative review summarizes the issues encountered in clinical practice for patients with neurotrauma who receive acute and post-acute in-patient rehabilitation services, and it comprehensively incorporates a wide range of studies, including recent clinical practice guidelines (CPGs), with the aim of better understanding the current evidence for optimal nutritional therapy focused on TBI patients. Recent CPGs were reviewed for 6 topics: 1) hypermetabolism and variation in energy expenditure in patients with TBI, 2) delayed gastric emptying and intolerance to enteral nutrition, 3) decision-making on the route and timing of access in patients with TBI who are unable to maintain volitional intake (enteral nutrition versus parenteral nutrition), 4) decision-making on the enteral formula (standard or immune-modulating formulas), 5) glycemic control, and 6) protein support. We also identified areas that need further research in the future.
创伤性脑损伤(TBI)是导致长期身体和心理残疾及死亡的主要原因。在创伤性脑损伤患者中,营养不良与死亡率增加、更多感染并发症以及更差的神经学预后相关。因此,及时有效的营养治疗在创伤性脑损伤的管理中对于改善患者预后尤为关键。本叙述性综述总结了接受急性和急性后住院康复服务的神经创伤患者在临床实践中遇到的问题,并全面纳入了广泛的研究,包括近期的临床实践指南(CPG),旨在更好地了解针对创伤性脑损伤患者的最佳营养治疗的当前证据。对近期的临床实践指南就6个主题进行了综述:1)创伤性脑损伤患者的高代谢和能量消耗变化;2)胃排空延迟和肠内营养不耐受;3)无法维持自主摄入的创伤性脑损伤患者在营养途径和时机选择上的决策(肠内营养与肠外营养);4)肠内配方(标准配方或免疫调节配方)的决策;5)血糖控制;6)蛋白质支持。我们还确定了未来需要进一步研究的领域。