Jeejeebhoy K N
University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada.
Proc Nutr Soc. 2001 Aug;60(3):399-402. doi: 10.1079/pns2001103.
Nutrition support for patients in hospital has become an essential form of therapy. Total parenteral nutrition (TPN) was the preferred way of giving nutrition to hospital patients for many years but enteral nutrition (EN) is now the preferred route. EN is believed to promote gut function and prevent translocation of intestinal bacteria, thus reducing the incidence of sepsis in critically ill patients. In consequence, the use of TPN has been discouraged as a dangerous form of therapy. Critical review of the data suggests that in the human subject TPN does not cause mucosal atrophy or increase translocation of bacteria through the small intestine. However, overfeeding, which is easy with TPN, can explain the results of studies which have shown that TPN increases sepsis. Furthermore, the risks of TPN-induced complications have been exaggerated. When there is risk of malnutrition and EN is not tolerated, or there is gut failure, TPN is an equally effective and safe alternative.
医院患者的营养支持已成为一种重要的治疗方式。多年来，全胃肠外营养（TPN）一直是为住院患者提供营养的首选方式，但现在肠内营养（EN）是首选途径。肠内营养被认为可促进肠道功能并防止肠道细菌移位，从而降低重症患者败血症的发生率。因此，TPN作为一种危险的治疗方式已不被提倡。对数据的批判性审查表明，在人体中，TPN不会导致黏膜萎缩或增加细菌通过小肠的移位。然而，TPN容易导致营养过剩，这可以解释那些表明TPN会增加败血症发生率的研究结果。此外，TPN引发并发症的风险被夸大了。当存在营养不良风险且无法耐受肠内营养，或存在肠道功能衰竭时，TPN是一种同样有效且安全的替代方法。
