Bengmark Stig
Institute of Hepatology, University College London Medical School, London, UK.
Curr Opin Clin Nutr Metab Care. 2005 Sep;8(5):557-61. doi: 10.1097/01.mco.0000170758.78737.90.
Increasing knowledge, both experimental and clinical, supports the fact that early and aggressive enteral nutrition has the capacity to reduce superinflammation and prevent infections in severe acute pancreatitis. Clearly, the main role of enteral nutrition is to boost the immune system, and not, at least initially, to provide calories. Whereas enteral nutrition improves, parenteral nutrition reduces immune functions.
The content of enteral nutrition solutions is more important than the route of administration per se. Antioxidants, plant fibres and live lactic acid bacteria are especially important for boosting the immune system. Recent studies support the fact that enteral nutrition and the supply of fibres and live lactic acid bacteria may significantly reduce the rate of infections. So far none of the treatments has been able to reduce the incidence of the systemic inflammatory response syndrome and multiorgan dysfunction syndrome. A recent unpublished study indicates, however, that the systemic inflammatory response syndrome and multiorgan dysfunction syndrome can also be reduced if much higher doses of lactic acid bacteria and a combination of several bioactive lactic acid bacteria are used (synbiotics).
Immunosupporting enteral nutrition with synbiotics is an important tool to control superinflammation and infection, and might also reduce the multiorgan dysfunction syndrome and systemic inflammatory response syndrome. It is essential that it is supplied early, if possible in the emergency room. New autopositioning regurgitation-resistant feeding tubes are available to facilitate such a policy.
越来越多的实验和临床知识支持这样一个事实，即早期积极的肠内营养有能力减轻重症急性胰腺炎中的过度炎症反应并预防感染。显然，肠内营养的主要作用是增强免疫系统，至少在最初并非提供热量。与肠内营养改善免疫功能相反，肠外营养会降低免疫功能。
肠内营养溶液的成分比给药途径本身更重要。抗氧化剂、植物纤维和活性乳酸菌对增强免疫系统尤为重要。最近的研究支持肠内营养以及纤维和活性乳酸菌的供应可能显著降低感染率这一事实。到目前为止，尚无任何治疗方法能够降低全身炎症反应综合征和多器官功能障碍综合征的发生率。然而，一项最近未发表的研究表明，如果使用更高剂量的乳酸菌以及几种生物活性乳酸菌的组合（合生元），全身炎症反应综合征和多器官功能障碍综合征也可以得到减轻。
含合生元的免疫支持性肠内营养是控制过度炎症反应和感染的重要手段，也可能减轻多器官功能障碍综合征和全身炎症反应综合征。如果可能的话，在急诊室尽早提供这种营养至关重要。新型自动定位抗反流喂养管有助于实施这一策略。
