Nutrition for optimum wound healing 作者： Alison A Shepherd 出處： Nursing Standard Vol 18(6) October 2003 報告者：陳詩圓

Nutritiote is crucial holistic approach to wound healing. Nurse must to assessment of nutrition risk and enable them to obtain more easily the necessary support for patients to promote optimal wound healing. Nutrition plays a key role in the pathology of wound healing. Need into the different food type on aspects of wound healing.

Wound increase body metabolism. Wound left to progress can percipitate weigh loss. Nutritional intervention should be provided early to prevent this catabolic decline in lean muscle mass, and impairing wound healing.

Nurses involved in wound management need to understand the wound healing process, this knowledge should underpin their care plans. This is a complex process. Factors influencing poor wound healing: poor nutrition, infection and impaired organ.

Energy requlrements nutrition and wound healing. Increased energy demands are made by both inflammation and cellular activity. Glucose is the main substrate used by cells to produce energy, and the main power source

Vit. B1 is an important cofactor for energy production. The same is true manganese. This is identified that older people and this is significant required for optimal wound healing.

Care for patients with DM, it is important to be aware that hyperglycaemia has been show to have severe pathophysiological consequences in these individuals. Maintain stable blood sugar levels will enhanced wound healing.

Would seem prudent to advise people who have diabetes to eat more complex carbohydrates. This physiological response is influenced by the amount of carbohydrate that is present in foods. Foods such as oats, brown rice and wholemeal bread, which are high in fibre and have a low glycaemic index, lead to a slower and gentler rise in corresponding blood glucose. Reduces file incidence of hyperglycaemia and promotes effective wound healing.

The inflammatory response is beneficial to wound healing, as it brings nutrients to the area of the wound, removes debris and bacteria and provides stimuli for chemical wound repair. This pro-inflammatory cascade suppresses the immune system. In individuals who are critically ill, where the metabolic rate is high, this response becomes imbalanced and has the potential to cause the patient to develop septic shock which can progress to multi-system organ failure

Immunonutrition may be defined as the proess whereby nutrients are used to modulate the inflammatory process. That eicosanoids derived from the omega 3 series tend to have less potent infiammatory and immunological effects than those derived from omega 6 Other benefits of omega 3 fatty acids indude lower post-operative infection rates and the enhancement of collagen synthesis.

Dietary protein is required for collagen synthesis and might be used as source of energy when fat and carbohydrate stores are depleted. Protein deficiency contribues to poor healing rates. A diet high in proliferative and remodelling phases of wound healing.

Arginine is the main amino add essntial for collagen depoition. L-arginine supplementation in people with DM enhances wound healing

Glutamine plays an indirect role in wound healing it is known to act as a source of fuel for rapidly dividing cells, such as fibroblasts, glutamine may also attenuate immunosuppression and improve nitrogen blance afterelective surgery.

Iron is also required for the resistance of infection. This emphasises its importance in wound healing. Would seem that the older generation is at risk of poor wound healing, which affects their daily lives. would seem logical that anaemia would result in tissue hypoxia and impaired wound healing. low haemoglobin per se does not have a significant impact on wound healing, provided that adequate tissue perfusion is maintained by cardiac output and gaseous exchange

Zinc has an important role in the econstruction of the wound matrix. Low serum zinc levels have been associated with impaired healing particularly in older women with chronic leg ulcers. Although zinc supplementation has been suggested as necessary in those with deficiency when increased losses are present.

as a result of metabolic stress, the process of wound healing generates production of oxygen molecules that are highly reactive and can impair the process of wound healing. zinc acts as an antioxidant when applied topically to me skin. It may protect against the formation of free radicals, which are known to induce oxidative stress.

Nutritional screening is an important part of the overall clinical assessment of patients. Nurses based in hospitals and in the community have a key role in the identification and monitoring of patients who may be at nutritional risk, thus requiring nutritional support. nutritional screening tool have been developed to guide nurses in basic nutritional screening. Using these tools may identify those patients at risk of malnutrition and enable referral to a dietician for a more detailed nutrition assessment and provision of nutrition support.

If the tools used in clinical practice are not tested for validity, reliability, sensitivity and specificity then this may compromise patient care. Screening should be carried out on admission and then reassessed at regular intervals. This should be dependent on the patient's circumstances as individuals have differing nutritional requirements.

Nutrition plays a key role in the pathology of wound healing. Wound place a high metabolic demand on patients so it is important that they receive adequate calories to redress the balance and prevent malnutrition. It is not the quantity of food that is important, but the quality of what is being ingested. In particular, foods that are rich in omega 3, such as oily fish, have been shown to promote less inflammation and modulate immune function, therebypromoting wound healing.

High-protein diets are beneficial in the proliferative and maturation phases of wound healing. Use of the immune-enhancing amino acid supplements such as glutamine and arginine, especially in the critically ill, is needed. It is better that patients receive their nutrient intake from ingestion of food with upplementation drinks of fortified food.

Nurses have a responsibility to patients to carry out regular nutritional assessments and work in conjunction with dieticians where indicated. This will ensure the patient receives a well-blanced diet, with the nutrients required to promote good wound healing.