Leczenie żywieniowe odgrywa istotną rolę w leczeniu ran oparzeniowych. Szczególne znaczenie mają interwencje żywieniowe z zawartością związków immunomodulujących, ponieważ u pacjentów z rozległymi oparzeniami występują zaburzenia reakcji odpornościowej.
Oparzenia a zaburzenia metaboliczne
Rozległe i głębokie rany oparzeniowe wiążą się z nasileniem w organizmie pacjenta procesów katabolicznych. Skutkiem tego dochodzi do utraty masy mięśniowej i zaburzenia ustrojowej równowagi białkowej, a w konsekwencji do niedożywienia, które w znacznym stopniu utrudnia gojenie ran.
Dodatkowo u pacjentów z oparzeniami zaburzeniu ulega równowaga płynowa i rozwija się stan hipermetabolizmu. Z tego powodu leczenie żywieniowe ma w terapii ran oparzeniowych bardzo duże znaczenie.
Żywienie immunomodulujące w leczeniu oparzeń
Szczególnie istotną formą leczenia żywieniowego w przypadku oparzeń jest żywienie immunomodulujące. U pacjentów, u których doszło do rozległych oparzeń, reakcja odpornościowa organizmu jest w znacznym stopniu zaburzona. W wyniku upośledzenia funkcji komórek układu odpornościowego rozwija się stan immunosupresji.
Badania wykazują, że stosowanie u pacjentów oparzeniowych żywienia immunomodulującego wpływa na poprawę reakcji odpornościowych, wzmacnia barierę jelitową, a także ogranicza procesy zapalne i ryzyko powikłań na podłożu infekcyjnym.
Związki immunomodulujące, które wykazują skuteczność i bezpieczeństwo stosowania u pacjentów po oparzeniach, to kwasy tłuszczowe omega-3 i glutaminian. Doustne podawanie tych składników wpływa na skrócenie czasu rekonwalescencji i hospitalizacji, a także zmniejszają śmiertelność z powodu zakażeń w tej grupie pacjentów.
Kwasy omega-3 a oparzenia
Badania wykazują, że podaż nienasyconych kwasów tłuszczowych w odpowiednich proporcjach wspomaga proces gojenia oparzeń, m.in. poprzez stymulację proliferacji komórek uszkodzonej tkanki. Związki te mogą również odwracać negatywne zmiany w lipidomie osocza u pacjentów z oparzeniami poprzez wspieranie metabolizmu białek i kształtowanie odpowiedzi immunologicznej.
Resolwina, związek będący pochodną jednego z kwasów omega-3, zapobiega ponadto powstawaniu zakrzepów w głębokiej sieci naczyniowej skóry, dzięki czemu zmniejsza ryzyko martwicy tkanek. Związek ten wykazuje również u pacjentów z ciężkimi oparzeniami działanie nefro- i hepatoprotekcyjne.
Glutaminian i arginina w leczeniu oparzeń
Glutaminian i arginina są uznawane za aminokwasy niezbędne w diecie pacjentów z hipermetabolizmem, do których należą także pacjenci oparzeniowi.
Związek ten stanowi materiał budulcowy i źródło energii dla komórek, uczestniczy w regulowaniu równowagi kwasowo-zasadowej i wzmacnia barierę jelitową. Glutaminian działa także ochronnie na uszkodzone komórki. Ponadto wykazuje właściwości przeciwzapalne i immunomodulujące.
Dzięki opisanemu działaniu glutaminianu podaż tego związku wpływa na istotne zmniejszenie śmiertelności u pacjentów z ciężkimi oparzeniami. Co istotne, podobnych efektów nie zaobserwowano u osób ze stanami ciężkimi na innym podłożu.
Arginina natomiast może wpływać na poprawę ukrwienia i utlenowania tkanek. Aminokwas ten wykazuje szerokie działanie immunomodulujące i metaboliczne. Dzięki temu pozytywnie wpływa na proces gojenia oparzeń i skraca czas hospitalizacji pacjenta.
Źródło: M. Czerwińska-Rogowska, A. Krajewski et. al., „Żywienie immunomodulujące w kontekście leczenia oparzeń”, Chirurgia Plastyczna i Oparzenia 2018, 6(3): 67-70.
Przeczytaj także: Pierwsza pomoc przy oparzeniach dróg oddechowych
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