Ernährung des nicht kritisch kranken Wundpatienten – spezielle Supplemente

 

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Zusammenfassung

Fragestellung Wie ist die Evidenzlage für den Einsatz der Supplemente Arginin, Glutamin, Vitamin A, C, E und Zink zur Förderung der Wundheilung des nicht kritisch kranken Patienten und welche Empfehlungen können zum heutigen Zeitpunkt für die Praxis abgegeben werden? Methodik Literaturrecherche und Durchsicht aller Humanstudien zum Thema, Beurteilung der Studien und daraus folgende Ableitung der Empfehlungen für die klinische Praxis. Ergebnisse Bei keinem der Supplemente existieren überzeugende Evidenzen für den Einsatz in der klinischen Praxis. Für Vitamin A und E sind keine Evidenzen vorhanden. Im Falle von Vitamin C und Glutamin sind sie schwach und für Zink und Arginin existieren moderate Evidenzen. Patienten mit chirurgischen Wunden sowie mit Dekubiti könnten von einer Supplementation mit 2-mal 500 mg Vitamin C / d sowie im Falle von initial tiefen Plasmazinkspiegeln von einer Verabreichung von 40 mg Zink / d über mindestens 2 Wochen profitieren. Zudem weist die Evidenz auf eine Förderung der Wundheilung bei einer Supplementierung von mindestens 17 g Arginin / d hin. Bei oralen Ulzerationen aufgrund von Chemotherapien kann eventuell mit einer Supplementation von mindestens 7,5–8 g Glutamin / d, welche als Gurgel- und Schlucklösung appliziert wird, die Heilung beschleunigt werden. Schlussfolgerung Die heutige Evidenzlage deutet darauf hin, dass die Wundheilung des nicht kritisch kranken Patienten möglicherweise durch gezielte Supplementierungen gefördert werden kann. Weitere Studien in diesem Bereich sind jedoch notwendig, um die Evidenzlage zu verbessern und offene Fragen zu klären.

Abstract

Objective This study determined the strength of the evidence for supplementing non-critically ill patients with arginine, glutamine, vitamins A, C, and E and zinc to improve wound healing, and to develop recommendations for clinical practice. Methods A literature research and review of all studies on human subjects relating to the topic was conducted. The studies were interpreted and recommendations for clinical practice developed. Results To date, there is no strong evidence for any of the supplements in question. Evidence from trials on human subjects are non-existent for vitamins A and E, weak in the case of vitamin C and glutamine and moderate for zinc and arginine. Patients with wounds from surgery as well as patients with pressure sores may benefit from a supplementation of 500 mg vitamin C twice a day and, if patients with these wound categories exhibit low plasma zinc levels at baseline, they may also benefit from a supplementation of 40 mg zinc / d over a period of at least 2 weeks. Furthermore, the evidence suggests an improvement in wound healing in patients supplemented with at least 17 g of arginine / d. Oral ulcerations may heal faster if patients are given at least 7.5 g of glutamine / d as swish and swallow solutions. Conclusion Evidence to date suggests that wound healing may be improved with specific supplementations. However, more studies are needed to improve the data and to deal with unanswered questions.

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Silvia Kurmann

Dipl.-Ernährungsberaterin HF, MSc in Nutrition, Clinical Specialization, Stv. Leiterin Ernährungsberatung Erwachsene, Inselspital, Poliklinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Bern

3010 Bern, Schweiz

Email: silvia.kurmann@insel.ch