Title (croatian) Smjernice za nutritivnu potporu kod kroničnih rana*
Title (english) Guidelines for nutrition support in chronic wounds
Author Miljenko Kovačević
Author Pave Gospodnetić
Author Darija Vranešić Bender
Author Sanja Radanac
Author Aleksandra Munjiza
Author Krešimir Martinac
Author Zdravka Poljaković
Author Ante Kanjer
Author Predrag Pavić
Author Vedran Pažur
Author Tajana Pavić
Author Ana Lamza
Author's institution University of Rijeka Faculty of Medicine (Department of Surgery)
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Surgery
Abstract (croatian) Kroničnim ranama smatraju se rane različitih etiologija koje ne cijele u vremenskom razdoblju od šest do osam tjedana. U bolesnika s kroničnom ranom normalna fiziologija linearnog cijeljenja pretvara se u patološki kronični ciklus „začaranog kruga“, bez jasne krajnje točke zatvaranja rane. Proces cijeljenja rane može biti narušen brojnim čimbenicima sistemnog i lokalnog karaktera. Suvremeni pristup bolesniku s kroničnom ranom zahtijeva interdisciplinarni pristup s obzirom na različitu etiologiju nastanka rane. Malnutricija može usporiti cijeljenje rane i povećati opasnost kroničnog tijeka unatoč modernim lokalnim tehnikama. Štoviše, prisutnost upalnog odgovora povezanog s kroničnom ranom povećava gubitak stanične mase tijela i uzrokuje anaboličku rezistenciju. Nutritivni status bolesnika igra ključnu ulogu u cijeljenju rane, a poseban značaj pridaje se adekvatnom unosu energije, proteina, specifičnih esencijalnih i uvjetno esencijalnih nutrijenata te hidraciji bolesnika. Preporučen energijski unos pothranjenih bolesnika u riziku od kroničnih rana i dekubitalnih ulkusa iznosi 30 – 35 kcal/kg/dan, a pritom
je preporučeni unos proteina 1,2 – 1,5 g/kg/dan. Te preporuke su okvirne i trebaju se prilagođavati za svakog bolesnika, ovisno o dobi, statusu uhranjenosti, komorbiditetima, stupnju, veličini i broju rana te bubrežnoj funkciji. Prepoznati su i neki specifični nutrijenti koji sudjeluju u procesu cijeljenja rane, poglavito proteini, glutamin, arginin, HMB, cink, selen, bakar, željezo te vitamini A, C i D. Cilj je ovih smjernica prikazati preporučeni algoritam probira i praćenja te uvođenja specifične nutritivne terapije u bolesnika s kroničnim ranama. U smjernicama su dodatno prikazane i specifičnosti nutritivne terapije kod opeklina, kirurških rana, dijabetičkog stopala te osobitosti neuroloških i gerijatrijskih bolesnika.
Abstract (english) Chronic wounds are wounds of various etiologies that do not heal within a period of 6–8 weeks. In patients with a chronic wound, the normal physiology of linear healing turns into a pathological chronic cycle of “vicious circle”, without a clear endpoint of wound closure. The wound healing process can be impaired by numerous factors, both systemic and local. The modern approach to the patient with a chronic wound requires an interdisciplinary approach considering the different etiologies of the wound. Malnutrition can slow wound healing
and increase the risk of a chronic course despite modern local techniques. Moreover, the presence of an inflammatory response associated with a chronic wound increases the loss of body cell mass and causes anabolic resistance. The nutritional status of the patient plays a key role in wound healing, and special importance is given to the adequate intake of energy, protein, specific essential and conditionally essential nutrients, and hydration of the patient. The recommended energy intake of malnourished patients at risk of chronic wounds and decubital ulcers is 30–35 kcal/kg/day, while the recommended protein intake is 1.2–1.5 g/kg/day. These recommendations are general and should be adjusted for each patient, depending on age, nutritional status, comorbidities, degree, size and number of wounds and kidney function. Some specific nutrients that participate in the wound healing process have been recognized, especially proteins, glutamine, arginine, HMB, zinc, selenium, copper, iron and vitamins A, C and D. The aim of these guidelines is to present a recommended screening and monitoring algorithm and to introduce a specific nutritional therapy in patients with chronic wounds. The guidelines also show the specifics of nutritional therapy for burns, surgical wounds, diabetic foot, and special approach to neurological and geriatric patients.
Keywords (croatian)
RANE I OZLJEDE – etiologija, liječenje
KRONIČNA BOLEST
CIJELJENJE RANE – fiziologija
NUTRITIVNI STATUS
NUTRITIVNE POTREBE
NURITIVNO LIJEČENJE
DIAJBETIČKO STOPALO – liječenje
VARIKOZNI ULKUS – liječenje
DEKUBITALNI ULKUS – liječenje
OPEKLINE – liječenje
NUTRITIVNA POTPORA
MULTIMODALNO LIJEČENJE
MULTIDISCIPLINARNI ZDRAVSTVENI TIM
SMJERNICE
Keywords (english)
WOUNDS AND INJURIES – etiology, therapy
CHRONIC DISEASE
WOUND HEALING – physiology
NUTRITIONAL STATUS
NUTRITIONAL REQUIREMENTS
NUTRITION THERAPY
DIABETIC FOOT – therapy
VARICOSE ULCER – therapy
PRESSURE UCER – therapy
BURNS – therapy
NUTRITIONAL SUPPORT
COMBINED MODALITY THERAPY
PATIENT CARE TEAM
PRACTICE GUIDELINES AS TOPIC
Language croatian
Language english
Publication type Professional paper - Professional paper
Publication status Published
Peer review Peer review
Publication version Published version
Journal title Liječnički vjesnik
Numbering vol. 146, no. 7-8, pp. 245-263
p-ISSN 0024-3477
e-ISSN 1849-2177
DOI https://doi.org/10.26800/LV-146-7-8-1
URN:NBN urn:nbn:hr:184:713235
Publication 2024
Document URL https://hrcak.srce.hr/320252
Type of resource Text
Access conditions Open access
Terms of use
Created on 2024-08-28 07:07:21