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Leczenie oparzeń a suplementacja

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Leczenie żywieniowe to ważny aspekt terapii ran trudno gojących się o różnej etiologii. W przypadku pacjentów z rozległymi oparzeniami suplementacja składników odżywczych jest szczególnie istotna, ponieważ zapobiega niedoborom związanym z hipermetabolizmem.

Pacjenci z oparzeniami są narażeni na znaczne straty pierwiastków w procesie gojenia. Niedobory mogą dotyczyć między innymi takich mikroelementów jak miedź, cynk i selen. Przyczyny tego stanu rzeczy to przede wszystkim: wysięk z ran oparzeniowych, działanie wolnych rodników, nasilenie reakcji zapalnych czy wzmożony katabolizm.

Ze względu na to, że standardowe preparaty do żywienia pozajelitowego mogą nie dostarczać potrzebnych mikroelementów w wystarczającej ilości, należy prowadzić ich suplementację. Uzupełnianie tych pierwiastków jest istotne również dlatego, że pozytywnie wpływają one na gojenie ran.

Miedź a leczenie oparzeń

Miedź odpowiada za utrzymanie prawidłowego funkcjonowania wielu tkanek, w tym skóry, naczyń krwionośnych, nabłonka oraz tkanki łącznej. Odgrywa również rolę w produkcji hemoglobiny, mieliny i melaniny, a także w transporcie elektronów i tlenu.

Miedź jest także istotna dla prawidłowego gojenia ran. Pierwiastek ten jest koenzymem oksydaz lizynowych, które biorą udział w tworzeniu wiązań poprzecznych w kolagenie i elastynie. Miedź ma również pozytywny wpływ na proces angiogenezy w środowisku rany. Miedź jest także konieczna do prawidłowego funkcjonowania peptydu miedzianego GHK. Związek ten stymuluje procesy przeciwzapalne i syntezę kolagenu i glikozoaminoglikanów w fibroblastach skóry. Odpowiada także za intensyfikację przyciągania komórek odpornościowych do rany.

Cynk w terapii oparzeń

Cynk jest związany z katalityczną aktywnością anhydrazy węglanowej, karboksypeptydazy, dysmutazy ponadtlenkowej, fosfatazy alkalicznej, oksydoreduktazy, transferazy, ligazy, hydrolazy, liazy i izomerazy. Niedobory cynku zaburzają metabolizm kwasów nukleinowych oraz budowę białek, co może mieć wpływ m.in. na funkcjonowanie układu immunologicznego.

W gojeniu ran cynk bierze udział jako kofaktor enzymów. Ma wpływ na eliminację wolnych rodników i budowę kolagenu, dzięki czemu usprawnia procesy naprawcze.

Selen a oparzenia

Selen pełni w organizmie ważne funkcje strukturalne i enzymatyczne. Jako składnik peroksydazy glutationowej zapobiega utlenianiu fosfolipidów błon komórkowych, odgrywa także rolę w syntezie prostaglandyn i amin katecholowych. Selen wpływa również na funkcjonowanie układu immunologicznego poprzez stymulację produkcji przeciwciał i aktywności komórek immunologicznych. Selen odpowiada za zahamowanie procesów starzenia i wspiera regenerację komórek oraz procesy detoksykacyjne.

W leczeniu oparzeń wczesna suplementacja cynku obniża ryzyko peroksydacji lipidów, wspiera mechanizmy antyoksydacyjne, wzmacnia odporność i przyspiesza proces gojenia ran. Dzięki temu możliwe jest osiągnięcie wyższej przeżywalności i skrócenia pobytu pacjenta na oddziale intensywnej terapii.

Źródło: K. Piorun, A. Krajewski i in., „Rola miedzi, selenu i cynku w leczeniu oparzeń”, „Chirurgia Plastyczna i Oparzenia” 2018, 6(2): 57-60.

Przeczytaj także: Choroby skóry związane z zapaleniem wątroby typu C

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Czynniki etiologiczne respiratorowego zapalenia płuc u pacjentów z oparzeniem dróg oddechowych

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