O'Keefe Stephen J D, Lee Ronzo B, Anderson Frank P, Gennings Chris, Abou-Assi Souheil, Clore John, Heuman Douglas, Chey William
Medical College of Virginia and Virginia Commonwealth University and McGuire Veterans Administration Hospital, Richmond 23298, USA.
Am J Physiol Gastrointest Liver Physiol. 2003 Jan;284(1):G27-36. doi: 10.1152/ajpgi.00155.2002.
In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and parenteral feeding. Twenty-seven healthy volunteers were studied while receiving either oral drinks or duodenal infusions of a complex formula diet, duodenal or intravenous infusions of elemental (protein as free amino acids, low fat) formulae, or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for protein (1.5 g x kg(-1) x d(-1)) and energy (40 kcal x kg(-1) x d(-1)). Compared with placebo, all oroenteral diets stimulated amylase, lipase, trypsin, and bile acid secretion and increased plasma concentrations of gastrin and cholecystokinin, whereas intravenous feeding did not. The complex formula produced a similar response whether given as drinks or duodenal infusions. Changing the duodenal formula to elemental reduced enzyme secretion by 50%, independently of CCK. Higher increases in plasma insulin, glucose, and amino acids were noted with intravenous feeding. Delivering food directly to the intestine by a feeding tube does not reduce pancreaticobiliary secretion. Enteral "elemental" formulae diminish, but only intravenous feeding avoids pancreatic stimulation. Intravenous administration impairs metabolic clearance.
在消化系统疾病的营养管理中，了解肠内和肠外营养相对的分泌及代谢反应很重要。对27名健康志愿者进行了研究，他们分别接受口服饮料、十二指肠输注复合配方饮食、十二指肠或静脉输注要素（蛋白质为游离氨基酸、低脂）配方饮食或生理盐水。通过鼻十二指肠聚乙二醇灌注和抽吸来测量胰胆分泌反应，同时监测血液中的激素和营养物质水平。各种饮食的蛋白质（1.5 g·kg⁻¹·d⁻¹）和能量（40 kcal·kg⁻¹·d⁻¹）均相匹配。与安慰剂相比，所有经口肠道饮食均刺激淀粉酶、脂肪酶、胰蛋白酶和胆汁酸分泌，并增加胃泌素和胆囊收缩素的血浆浓度，而静脉营养则无此作用。复合配方饮食无论是以饮料形式还是十二指肠输注形式给予，产生的反应相似。将十二指肠配方改为要素配方可使酶分泌减少50%，与胆囊收缩素无关。静脉营养时血浆胰岛素、葡萄糖和氨基酸的升高幅度更大。通过饲管将食物直接输送到肠道并不会减少胰胆分泌。肠内“要素”配方会减少胰胆分泌，但只有静脉营养可避免胰腺受到刺激。静脉给药会损害代谢清除。
