摘要
重症患者的肠屏障功能损害可导致细菌和毒素移位,是肠源性感染乃至多器官功能衰竭的重要因素。早期肠内营养(early enteral nutrition,EEN)可滋养肠道,养肠固菌,有效地维护肠屏障功能和免疫功能,为机体提供部分代谢底物,从而获得临床受益。重症急性胰腺炎、严重烧伤、严重创伤性脑损伤、腹部大手术等重症患者已有循证证据支持EEN,尚未控制的休克及严重低氧血症和酸中毒患者应延迟使用EEN。重症患者的EEN可口服或鼻胃管饲,启动时推荐不含膳食纤维的整蛋白型制剂,持续性经泵输入可提高EEN胃肠道耐受性。
Intestinal barrier function impairment can lead to bacterial and toxin translocation in critically ill patients and is an important factor in gut-derived infections and even multiple organ failure.Early enteral nutrition(EEN)can nourish the intestine,prevent bacterial translocation,effectively maintain intestinal barrier function and immune function and provide metabolic substrates for the body,bringing clinical benefits.For critically ill patients such as those with severe acute pancreatitis,severe burns and severe traumatic brain injury and those after major abdominal surgery,there is evidence-based proof supporting EEN while in patients with uncontrolled shock and severe hypoxemia and acidosis,the initiation of EEN should be delayed.EEN in critically ill patients can be applied orally or through nasogastric tube.Dietary fiber-free intact protein preparations are recommended at initiation and administration via continuous pumping can improve EEN gastrointestinal tolerability.
作者
刘承宇
陈丽如
朱明炜
Liu Chengyu;Chen Liru;Zhu Mingwei(Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Clinical Nutrition,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华临床营养杂志》
CAS
CSCD
2022年第3期161-166,共6页
Chinese Journal of Clinical Nutrition
基金
中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-B-094)
中国食品科学技术学会食品科技基金(2020-14)。
关键词
重症疾病
早期肠内营养
肠屏障功能
肠源性感染
Critical illness
Early enteral nutrition
Intestinal barrier function
Gut-derived infection
