Abou-Assi Souheil G, Khurana Vikash, Schubert Mitchell L
Department of Medicine, Division of Gastroenterology, Virginia Commonwealth University’s Medical College of Virginia and McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
Curr Treat Options Gastroenterol. 2005 Apr;8(2):145-152. doi: 10.1007/s11938-005-0007-y.
The provision and maintenance of good nutrition in patients with acute and chronic illness is a fundamental part of standard medical and surgical care. Recently, there is great interest in using enteral nutritional support to reverse the morbidity and mortality associated with malnutrition. Enteral nutrition is preferred over parenteral nutrition because it is more physiologic, maintains intestinal structure and function, limits bacterial translocation, has less morbidity, has fewer complications, and is less expensive. However, the decision to feed into the stomach or into the small bowel (postpyloric) continues to be a matter of some debate and continued clinical investigation. Although the gastric route of enteral feeding is easier and less expensive, some physicians worry that gastric feeding may predispose to aspiration and pneumonia, especially in critically ill patients who frequently have delayed gastric transit. In these critically ill patients, small bowel function usually remains relatively intact and placement of a postpyloric feeding tube may permit more effective delivery of nutrients. However, it should be noted that placement of postpyloric feeding tubes can be challenging, and this may lead to a delay in initiation of nutritional support.
为急慢性疾病患者提供并维持良好的营养状况是标准内科及外科治疗的基本组成部分。近来，人们对使用肠内营养支持来扭转与营养不良相关的发病率和死亡率产生了浓厚兴趣。与肠外营养相比，肠内营养更受青睐，因为它更符合生理需求，能维持肠道结构和功能，限制细菌移位，发病率更低，并发症更少，且费用更低。然而，选择经胃喂养还是经小肠（幽门后）喂养仍是一个存在一定争议且仍在持续进行临床研究的问题。尽管经胃途径进行肠内喂养更简便且费用更低，但一些医生担心胃内喂养可能易引发误吸和肺炎，尤其是在经常出现胃排空延迟的重症患者中。在这些重症患者中，小肠功能通常相对保持完好，放置幽门后喂养管可能使营养物质的输送更有效。然而，应当注意的是，放置幽门后喂养管可能具有挑战性，这可能导致营养支持开始延迟。
