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Żywność specjalnego przeznaczenia medycznego – w jaki sposób wspiera gojenie ran i kiedy ją stosować?

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Prawidłowe żywienie jest jednym z najważniejszych elementów opieki nad pacjentem z trudno gojącą się raną. Wdrożenie właściwej diety u pacjentów z ranami przewlekłymi może być jednak problematyczne, np. ze względu na występowanie chorób współistniejących, które utrudniają przyjmowanie pokarmów. W takich przypadkach możliwe jest uzupełnienie diety o żywność medyczną, która w łatwy sposób dostarcza odpowiednią liczbę kalorii oraz konkretne składniki pokarmowe.

U pacjentów z trudno gojącymi się ranami często występuje niedobór istotnych składników odżywczych. Rana przewlekła może prowadzić do powikłań ogólnoustrojowych, a toczący się proces zapalny wpływa negatywnie na metabolizm i stan odżywienia organizmu. U chorych z trudno gojącymi się ranami może więc dojść do niedożywienia, co z kolei istotnie spowalnia czas gojenia się rany, obniża funkcje obronne organizmu i zwiększa ryzyko infekcji.

Jaka jest rola diety w procesie leczenia ran?

Pacjenci z trudno gojącymi się ranami, np. odleżynami, owrzodzeniami czy stopą cukrzycową, wymagają odpowiednio zbilansowanej diety, która dostarcza składników niezbędnych do regeneracji uszkodzonych tkanek. W procesie leczenia ran organizm potrzebuje wsparcia w postaci odpowiedniej liczby kalorii, a także optymalnej ilości białka, tłuszczów, węglowodanów, błonnika, soli mineralnych oraz witamin, by skutecznie przeprowadzić procesy naprawcze.

Stosunek kaloryczny białka – tłuszcze – glukoza powinien wynosić około 20 proc. – 30 proc. – 50 proc. Wskazane jest, by produkty wykorzystane do przygotowania diety były naturalne, nieprzetworzone. Nie należy również zapominać o odpowiednim nawodnieniu chorego – pacjent powinien przyjmować 1,5-2 litry płynów na dobę.

Pacjenci z trudno gojącymi się ranami powinni otrzymywać od 5 do 6 posiłków w ciągu doby. W przypadku pacjentów z ranami przewlekłymi zapotrzebowanie na kalorie jest nieco większe niż wśród zdrowych osób – ze względu na toczący się stan zapalny i proces gojenia się rany. W ciągu całego dnia chory powinien zatem przyjmować około 35-40 kcal na kilogram masy ciała. Tak wysoka ilość energii wspiera procesy regeneracyjne w organizmie – sprzyja odbudowie tkanek, tworzeniu się nowych naczyń krwionośnych i formowaniu włókien kolagenowych, a także zapobiega rozwojowi niedożywienia i niedoborów pokarmowych.

Jakie składniki diety są najważniejsze dla pacjentów z trudno gojącymi się ranami?

Żywienie stosowane w procesie leczenia ran powinno być bogate w witaminy i mikroelementy. Dietę należy dostosować do płci pacjenta, jego ogólnego stanu zdrowia i chorób towarzyszących, a także do rodzaju rany. W diecie chorego z trudno gojącą się raną powinny znaleźć się następujące składniki:

  • białko – duże spożycie białka pomaga w odbudowie tkanki w ranie, ponieważ białko jest źródłem aminokwasów, które są materiałem budulcowym dla tkanek. Ponadto aminokwasy uczestniczą w wielu procesach metabolicznych, wspomagają pracę układu odpornościowego, a także biorą udział w krzepnięciu krwi. Białko powinno znaleźć się w niemal każdym posiłku pacjenta z raną przewlekłą. W piśmiennictwie zaleca się, by chory z raną przewlekłą przyjmował około 1,5-2 g białka na kilogram masy ciała dziennie;
  • węglowodany – są źródłem energii dla krwi, mięśni, mózgu i szpiku kostnego, a także wspierają procesy naprawcze;
  • tłuszcze – to źródło energii dla tkanek i narządów oraz materiał budulcowy. W diecie wspierającej gojenie się ran należy ograniczyć spożywanie tłuszczów zwierzęcych (zwłaszcza w połączeniu z cukrami);
  • oleje roślinne – źródło nienasyconych kwasów tłuszczowych (np. omega-3), które wykazują działanie przeciwzapalne;
  • witaminy A, B, C, E i K – wspierają procesy zamykania się ran i kształtowania się blizny, mają właściwości przeciwutleniające, zmniejszają podatność na zakażenia, zapewniają prawidłową krzepliwość krwi i przyspieszają gojenie się ran (zobacz także: Jaką rolę w leczeniu ran odgrywają witaminy?);
  • żelazo, cynk i selen – usprawniają procesy naprawcze skóry i poprawiają utlenienie tkanek, wpływają pozytywnie na funkcjonowanie układu immunologicznego oraz wspierają regenerację komórek;
  • arginina – to źródło tlenku azotu. Rozszerza naczynia krwionośne i poprawia ukrwienie. U pacjentów po urazie stymuluje układ odpornościowy, a także wpływa na rzadsze pojawianie się powikłań infekcyjnych.

Kiedy powinno zostać wdrożone leczenie żywieniowe?

Niedobory żywieniowe u pacjentów, w praktyce klinicznej, potwierdzane są za pomocą specjalnych skali oceniających stan odżywienia, a także poprzez poszerzony wywiad u lekarza lub dietetyka. Wskazania do leczenia żywieniowego to m.in.: niedojadanie, niemożność włączenia diety doustnej przez ponad 7 dni, niedożywienie lub zagrożenie niedożywieniem, niedobory pokarmowe, brak możliwości utrzymania dziennego spożycia pokarmów powyżej 60 proc. zalecanej normy przez 10 dni. W piśmiennictwie zaleca się, by interwencję żywieniową wprowadzać w następującej kolejności: żywienie doustne, żywienie doustne + doustne suplementy pokarmowe, żywienie dojelitowe (dostęp sztuczny), żywienie pozajelitowe. U pacjentów, u których sama dieta nie jest skuteczna, konieczne jest wdrożenie żywności specjalnego przeznaczenia medycznego – ONS (ang. oral nutritional supplements).

Żywienie medyczne – wsparcie dla naturalnej diety

Żywność specjalnego przeznaczenia medycznego wskazana jest jako element wspierający naturalną dietę. Składniki odżywcze dostarczane są w zmodyfikowanej formie, tak by były łatwe do spożycia i dostarczały odpowiednią ilość energii oraz konkretnych składników pokarmowych. Na rynku dostępne są preparaty do żywienia pozajelitowego i doustnego. W tej drugiej formie najczęściej można je spotkać w postaci preparatów do picia.

Żywność medyczna w szczególności przeznaczona jest dla pacjentów, którzy m.in. na skutek różnych chorób współistniejących nie są w stanie pokryć swojego dziennego zapotrzebowania na składniki odżywcze za pomocą posiłków. ONS mogą być stosowane w przypadku brak apetytu, jadłowstrętu, schorzeń gardła, przełyku lub żołądka, które mogą utrudniać przełykanie i gryzienie pokarmów, a także w sytuacjach zaburzonej zdolności przyjmowania, trawienia, wchłaniania lub metabolizowania zwykłych posiłków oraz u seniorów i pacjentów okołooperacyjnych.

ONS powinny być dobrane do indywidualnych potrzeb pacjenta, tak by dostarczać nie tylko podstawowych makro- i mikroelementów, ale także substratów (arginina, cynk, witamina C, antyoksydanty), które poprawiają funkcjonowanie układu odpornościowego i stymulują proces gojenia.

Nutridrink Skin Repair wspiera gojenie owrzodzeń i odleżyn

Nutridrink Skin Repair jest jedynym produktem ONS, który spełnia wymagania wytycznych European Pressure Ulcer Advisory Panel (EPUAP) – organu, który wspiera kraje europejskie w działaniach na rzecz zapobiegania i leczenia odleżyn.

Nutridrink Skin Repair to produkt przeznaczony do postępowania dietetycznego w przypadku owrzodzeń goleni (żylnych, tętniczych, mieszanych), owrzodzeń w przebiegu zespołu stopy cukrzycowej oraz odleżyn. Napój jest wysoko energetyczny, wysokobiałkowy i posiada niski indeks glikemiczny. Zawartość argininy i specyficznych mikroskładników odżywczych skutecznie wspiera proces regeneracji trudno gojących się ran. Wszystkie niezbędne składniki skoncentrowane zostały w małej objętości, a płynna postać produktu ułatwia chorym spożywanie posiłku. Produkt dostępny jest w trzech wariantach smakowych – czekoladowym, truskawkowym, waniliowym.

Nutridrink Skin Repair należy przyjmować w liczbie 1-3 butelek na dobę przez minimum 21 dni, zgodnie z zaleceniami lekarza. Istotne jest właściwe dawkowanie, które powinno być dostosowane do stanu rany. Nutridrink należy także przyjmować w określonym czasie, regularnie, gdyż sporadyczne przyjmowanie nie przynosi oczekiwanych efektów.

Bibliografia:

S. Kłęk, „Rola leczenia żywieniowego w procesie gojenia ran”, „Leczenie Ran” 2013;10(4):95-99

Interdyscyplinarna grupa ekspertów, M. Bartoszewicz, T. Banasiewicz, K. Bielecki i wsp., „Zasady postępowania miejscowego i ogólnego w ranach/owrzodzeniach przewlekłych objętych procesem infekcji”, „Forum Zakażeń” 2019; 10 (1):1-30

M. T. Szewczyk, M. Kózka, K. Cierzniakowska i wsp., „Profilaktyka odleżyn – zalecenia Polskiego Towarzystwa Leczenia Ran. Część I”, „Leczenie Ran” 2020; 17 (3): 112-146

M. T. Szewczyk, J. Cwajda-Białasik, P. Mościcka, „Leczenie odleżyn – Zalecenia Polskiego Towarzystwa Leczenia Ran. Część II”, „Leczenie Ran” 2020; 17 (4): 151-184

M. Klimek, W. Szaraniec, E. Rojczyk i wsp., „Rola argininy w procesie gojenia ran”, „Leczenie Ran” 2017; 14 (3):97-101

EPUAP, „Prevention and Treatment Pressure of Ulcers/Injuries: Clinical Practice Guideline”, The International Guideline 2019, Clinical Practice Guideline

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