国际烧伤学会最新诊疗实践指南提出营养建议
www.worldburn.org
在资源有限的环境中处理烧伤面临许多挑战。中低收入国家与高收入国家相比，烧伤死亡率高出近6倍，每年与火相关的烧伤约1000万残疾调整生命年损失。
2016年8月，国际烧伤学会官方期刊《烧伤》正式公布旨在帮助医生在资源有限环境中处理烧伤的诊疗实践指南更新，全文共69页。
该学会主席、印度新德里烧伤整形外科专家发表同期评论，称他已经在有超高烧伤发生率的极其贫穷国家工作了三十多年，他认为绝大多数烧伤患者正在由“非经烧伤处理培训专业人士”处理，这是毫无疑问的，在外科的本科或研究生课程中，均无此类培训。
该指南陈述了为改善患者诊疗和结局的最佳诊疗实践建议以及成本考虑。该指南包括一系列主题，包括烧伤诊疗的组织与实施、初步评定与稳定、烟雾吸入性损伤诊治、烧伤休克复苏、焦痂切开术与筋膜切开术、伤口护理、烧伤创面的手术处理、烧伤疤痕的非手术处理、感染预防与控制、抗生素管理、营养、烧伤患者康复的固定与夹板疗法、瘙痒处理、伦理问题、质量改进。
该指南第12章《营养》提出了5条建议：
应在康复早期提供营养支持。
肠内营养支持应优先于肠外营养支持。
应尽快启动常规口服饮食或肠内喂养。
对于烧伤面积超过其体表面积20%的患者，应采用高蛋白质饮食并提供足够热卡以满足能量需求。成人应接受蛋白质1.5～2g/kg/d，儿童应接受3g/kg/d。
能量需求应根据采用烧伤面积大小、年龄、体重等变量的公式进行估算。
Burns. 2016 Aug;42(5):953-1021.
ISBI Practice Guidelines for Burn Care.
ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee.
Highlights
An important component of the goal of education is to be able to communicate a consensus opinion on different aspects of management, one that could serve to benchmark a standard of burn care.
The purpose of setting forth practice guidelines is to define the most effective and efficient methods of evaluation and management of burn injuries.
The ISBI Guidelines for Burn Care has been written to address the needs of burn specialists everywhere in the world.
Practice guidelines (PGs) are recommendations for diagnosis and treatment of diseases and injuries, and are designed to define optimal evaluation and management. The first PGs for burn care addressed the issues encountered in developed countries, lacking consideration for circumstances in resource-limited settings (RLS). Thus, the mission of the 2014-2016 committee established by the International Society for Burn Injury (ISBI) was to create PGs for burn care to improve the care of burn patients in both RLS and resource-abundant settings. An important component of this effort is to communicate a consensus opinion on recommendations for burn care for different aspects of burn management. An additional goal is to reduce costs by outlining effective and efficient recommendations for management of medical problems specific to burn care. These recommendations are supported by the best research evidence, as well as by expert opinion. Although our vision was the creation of clinical guidelines that could be applicable in RLS, the ISBI PGs for Burn Care have been written to address the needs of burn specialists everywhere in the world.
Topics developed in current ISBI practice guidelines.
Organization and delivery of burn care
Initial assessment and stabilization
Smoke inhalation injury: diagnosis and treatment
Burn shock resuscitation
Escharotomy and fasciotomy in burn care
Wound care
Surgical management of the burn wound
Nonsurgical management of burn scars
Infection prevention and control
Antibiotic stewardship
Nutrition
Rehabilitation: positioning of the burn patient
Rehabilitation: splinting of the burn patient
Pruritus management
Ethical issues
Quality improvement
12. Nutrition
Recommendation
Nutritional support should be provided during the acute phase of recovery.
Enteral nutritional support should be used in preference to parenteral nutritional support.
Conventional oral diets or enteral feedings should be initiated as soon as possible.
For patients with burns covering more than 20% of their body surface area, a high protein diet should be used with provision of adequate calories to meet energy needs. Adults should receive 1.5-2 g of protein per kilogram body weight per day (g/kg/d), and children should receive 3 g/kg/d.
Energy requirements should be estimated by formulas that use variables such as burn size and age, and weight.
PMID: 27542292
DOI: 10.1016/j.burns.2016.05.013
Burns. 2016 Aug;42(5):951-2.
ISBI Practice Guidelines for Burn Care: Editorial.
Ahuja RB.
President, International Society for Burn Injuries (ISBI), Department of Burns and Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi 110002, India.
PMID: 27422355
DOI: 10.1016/j.burns.2016.06.020