Nutritional interventions for preventing and treating pressure ulcers

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Abstract
Pressure ulcers affect 10% of people in hospitals and older people are at highest risk. The correlation between nutritional intake and the development of pressure ulcers is suggested by several studies, but the results are inconsistent. To evaluate the effectiveness of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. The Cochrane Wounds Group Specialised Trials Register and the Cochrane Central register of Controlled Trials were searched in September 2002. An additional search of PubMed and Cinahl and hand search of conference proceedings and journals was performed, bibliographies of relevant articles were examined and experts in the field as well as manufacturers were contacted in order to find additional literature that may be relevant. Randomised controlled trials evaluating the effectiveness of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers by measuring the incidence of new ulcers, ulcer healing or changes in pressure ulcer severity. There were no restrictions on patients, setting, date, publication status or language. Abstracts were independently inspected and full articles were obtained of potentially relevant studies. In case of disagreement advice was sought from a third person (AK). Data extraction and assessment of quality were undertaken by the three authors independently. Only 8 randomised controlled trials out of 16 potentially relevant articles were included. However, most of the 8 trials included are small and of poor methodological quality. PREVENTION: Four studies compared a combination of nutritional supplements, consisting of a minimum of energy and protein in different dosages, for the prevention of pressure ulcers. The largest study found that nutritional supplements reduced the number of new pressure ulcers (Bourdel‐M 2000). The three smaller studies lacked power. TREATMENT: Four studies evaluated the effects of nutritional supplements for the treatment of existing pressure ulcers: one trial examined mixed nutritional supplements, one trial examined zinc, another the effect of proteins, and two studies compared ascorbic acid. The trials included are heterogeneous with regard to participants, interventions and outcomes; therefore it was considered inappropriate to perform a meta‐analysis. It was not possible to draw any firm conclusions on the effect of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. Further trials of high methodological quality are necessary. 以營養介入預防與治療壓瘡 約有10% 的住院病人有壓瘡的問題且老年人有最高罹患壓瘡的風險。數個研究提出營養攝取和壓瘡發展有關聯性，不過這些研究結果未有一致性。 評估腸道暨靜脈營養對預防與治療壓瘡的效果。 在2002年9月搜尋The Cochrane Wounds Group Specialised Trials Register 以及The Cochrane Central register of Controlled Trials。另外還搜尋PubMed和Cinahl，以及人工搜索會議論文和期刊，檢查相關文章的參考書目，同時聯繫相關領域的專家及廠商以便取得額外的相關文獻。 透過測量新生成潰瘍發生率、潰瘍治癒或潰瘍嚴重度變化等指標，以評估腸道暨靜脈營養用於預防和治療壓瘡之效果的隨機對照試驗(Randomised controlled trials；RCTs) 。沒有任何患者、研究地點、日期、發表類型、或語言的限制。 分別檢視摘要，以及取得可能有關的研究全文。萬一發生意見不一致時，則尋求第3者的意見 (AK) 。數據的擷取和研究品質的評估則由3位作 分別進行。 在16項可能有關的文章，僅有8項隨機對照試驗納入，不過這8項被納入的試驗的規模大多較小，且在方法學上的品質不佳。預防：4項研究比較混合的營養補充品，包括各種不同劑量的最低能量和蛋白質用來預防壓瘡的效果。最大的研究發現營養補充品可以降低新壓瘡的發生數 (BourdelM 2000) 。3個較為小型的研究則缺乏考驗力。治療： 4項研究評估營養補充品用於治療已生成之壓瘡的功效：1項試驗檢驗混合式的營養補充品、1項檢驗鋅、另1項檢驗蛋白質的效果，且兩項研究比較維他命C。所納入的研究於參與者、介入和結果衡量指標都不盡相同，所以不適合進行整合分析 (Metaanalysis) 。 針對腸道暨靜脈營養對於預防與治療壓瘡的效果，尚無作出定論的可能。未來需有具高品質的研究方法的試驗。 本摘要由成功大學附設醫院邱曉萱翻譯。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 膳食補充也許可預防急性生病的老年人發生壓瘡 (褥瘡) ，但需要更多研究。壓瘡(又稱為褥瘡)是因壓力或摩擦而在皮膚上產生的潰瘍，發生於無法行動的患者身上承受重量與骨凸的部位(如臀部、足跟及手肘) 。營養不良或脫水使得皮膚脆弱，讓人們易於產生壓瘡。透過提供患者額外的營養介入以及膳食補充(包括鋅和維他命C) 等營養介入，希望藉此預防並治療壓瘡。本份文獻回顧發現雖然有些證據顯示營養介入也許可以減少發生壓瘡的患者人數，但仍需要更多實證以找出最有效的飲食介入方式為何。