Andel H, Rab M, Andel D, Felfernig M, Hörauf K, Felfernig D, Schramm W, Zimpfer M
Department of Anesthesiology and Intensive Care, Vienna Medical School, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Burns. 2001 Jun;27(4):389-93. doi: 10.1016/s0305-4179(00)00134-0.
Early enteral nutrition is recommended in burned patients. Depending on the amount administered, enteral feeding causes an increase of intestinal oxygen-demand. Although early moderate enteral nutrition has been shown to be beneficial, early high calorie enteral nutrition might lead to an imbalance of the O(2)-balance of the gut since intestinal perfusion is decreased after major burns. In 20 severely burned patients during the first 48 h of early high caloric duodenal feeding an assessment of the CO(2)-gap between the arterial and the gastric CO(2), as parameter for the intestinal O(2)-balance, was performed. Time points were prior to starting the enteral nutrition (BASE) subsequently every 30 min after increasing the amount of nutrition administered and from the 11th to the 48th h after beginning of nutrition in intervals of 6 h. In none of the patients was the CO(2)-gap increased during the rapid increase of enteral nutrition. On the contrary the CO(2)-gap decreased significantly. We conclude that high caloric duodenal feeding in the early hypodynamic postburn phase does not have adverse effects on the oxygen balance of the intestine.
建议对烧伤患者进行早期肠内营养。根据给予的量，肠内喂养会导致肠道需氧量增加。虽然早期适度肠内营养已被证明是有益的，但早期高热量肠内营养可能会导致肠道氧平衡失衡，因为严重烧伤后肠道灌注会降低。在20例严重烧伤患者早期高热量十二指肠喂养的头48小时内，对动脉血与胃内二氧化碳之间的二氧化碳差值进行了评估，以此作为肠道氧平衡的参数。时间点包括开始肠内营养之前（基础值），随后在增加营养给予量后每30分钟一次，以及从营养开始后的第11小时至第48小时，每隔6小时一次。在肠内营养快速增加期间，没有一例患者的二氧化碳差值增加。相反，二氧化碳差值显著下降。我们得出结论，烧伤后早期低动力阶段的高热量十二指肠喂养对肠道氧平衡没有不利影响。
