McClave Stephen A, Chang Wei-Kuo
Division of Gastroenterology/Hepatology, 550 S. Jackson St., Louisville, Kentucky 40202, USA.
Nutr Clin Pract. 2005 Oct;20(5):544-50. doi: 10.1177/0115426505020005544.
Whether to provide artificial enteral nutrition therapy to a patient with evidence of gastrointestinal bleeding (GIB) creates a difficult clinical dilemma. Concern that enteral feeding may contribute to the morbidity associated with GIB leads to delays in initiating enteral therapy or to cessation of feeding in the patient in whom artificial nutrition support has already been started. Surprisingly, evidence of GIB is not an automatic contraindication to further enteral feeding. Depending on the etiology of the GIB, enteral nutrition may protect the gut mucosa and reduce further bleeding in some patients, actually increase risk for rebleeding in other patients, or serve as a moot point with no relation to further bleeding or morbidity in still other patients. In many cases, an endoscopic evaluation is needed to distinguish the differential etiology of the GIB. The nutrition support specialist needs a full understanding of the physiology behind the varying diagnoses for GIB to know whether feedings can be initiated or continued or whether enteral feedings need to be withheld for 48-72 hours until risk for rebleeding and further morbidity is minimized.
对于有胃肠道出血（GIB）证据的患者是否给予人工肠内营养治疗，这是一个棘手的临床难题。担心肠内喂养可能会加重与GIB相关的发病率，导致肠内治疗开始延迟，或者使已经开始接受人工营养支持的患者停止喂养。令人惊讶的是，GIB的证据并非进一步肠内喂养的绝对禁忌证。根据GIB的病因，肠内营养在某些患者中可能保护肠黏膜并减少进一步出血，在其他患者中实际上可能增加再出血风险，或者在另外一些患者中与进一步出血或发病率无关，成为一个无实际意义的问题。在许多情况下，需要进行内镜评估以区分GIB的不同病因。营养支持专家需要全面了解GIB不同诊断背后的生理学知识，以确定是否可以开始或继续喂养，或者是否需要暂停肠内喂养48 - 72小时，直到再出血风险和进一步发病率降至最低。
