Stechmiller Joyce K, Childress Beverly, Porter Tricia
Adult and Elderly Department, University of Florida College of Nursing, Gainesville, Fla., USA.
Am J Crit Care. 2004 Jan;13(1):17-23.
Commercial enteral nutritional formulas for enhancement of the immune system are widely used in critical care. Immunonutrition with arginine can enhance inflammatory and immunologic responses in animal models and in humans. Although clinical improvements in surgical patients have been reported, benefits in critically ill patients with systemic inflammatory response syndrome, sepsis, or organ failure are less clear. Recent meta-analyses on the use of immunonutrition with arginine in critically ill and surgical patients revealed methodological weaknesses in most published studies. Specifically, a meta-analysis indicated that critically ill patients with preexisting severe sepsis may have an increased mortality rate when fed an immunonutritional enteral formula that contains arginine. These findings brought about confusion and controversy over the use of immunonutritional formulas in subsets of critically ill patients. A review of the literature on the function of arginine, its effect on the immune system, its roles in immunonutrition and in the clinical outcomes of critically ill patients, and the implications for nursing practice indicated that the benefits of immunonutrition with arginine in critically ill patients are unproven and warrant further study. Until more information is available, nutritional support should focus primarily on preventing nutritional deficiencies rather than on immunomodulation.
用于增强免疫系统的商业肠内营养配方在重症监护中被广泛使用。含精氨酸的免疫营养可增强动物模型和人类的炎症及免疫反应。尽管已有报道称手术患者的临床状况有所改善，但对于患有全身炎症反应综合征、脓毒症或器官衰竭的重症患者，其益处尚不明确。最近对重症和手术患者使用含精氨酸免疫营养的荟萃分析显示，大多数已发表研究存在方法学缺陷。具体而言，一项荟萃分析表明，预先存在严重脓毒症的重症患者在喂食含精氨酸的免疫营养肠内配方时，死亡率可能会增加。这些发现引发了对重症患者亚组使用免疫营养配方的困惑和争议。对精氨酸功能、其对免疫系统的影响、其在免疫营养及重症患者临床结局中的作用以及对护理实践的影响的文献综述表明，含精氨酸免疫营养对重症患者的益处尚未得到证实，值得进一步研究。在获得更多信息之前，营养支持应主要侧重于预防营养缺乏，而非免疫调节。
