Frankenfield D C, Beyer P L
Maryland Institute for Emergency Medical Services Systems, Department of Food and Nutrition Services, University of Maryland Medical Center, Baltimore 21201.
J Am Diet Assoc. 1991 May;91(5):590-6, 599.
In tube-fed patients, dietary fiber is often used to manage constipation/diarrhea. Dietary fiber consists of water-soluble and insoluble plant compounds that are resistant to digestion by small-bowel enzymes but are fermented to varying degrees by colonic bacteria. Many physiologic effects of fiber may be related to the degree of fermentation. Few controlled studies of fiber-containing tube feedings have been performed. These studies have limitations and are nondefinitive as to whether fiber prevents or controls constipation/diarrhea. Constipation in tube-fed patients has not been shown to respond to mixed soluble/insoluble fiber in the few studies performed to date. Likewise, fiber may be of only limited benefit in controlling diarrhea in acute illness because of such factors as stress or medication. Fiber does play a role in maintaining gut integrity in all patients, whether they have diarrhea or not. Fiber may be recommended as part of a standard tube-feeding regimen to help assure gut mucosal integrity but not specifically to treat constipation/diarrhea. Further studies are necessary before the role of fiber in the management of constipation/diarrhea in tube-fed patients is determined.
在管饲患者中，膳食纤维常被用于处理便秘/腹泻。膳食纤维由水溶性和不溶性植物化合物组成，这些化合物对小肠酶的消化具有抗性，但会被结肠细菌不同程度地发酵。纤维的许多生理效应可能与发酵程度有关。关于含纤维管饲的对照研究很少。这些研究存在局限性，对于纤维是否能预防或控制便秘/腹泻尚无定论。在迄今为止进行的少数研究中，尚未显示管饲患者的便秘对混合性可溶/不可溶纤维有反应。同样，由于压力或药物等因素，纤维在控制急性疾病中的腹泻方面可能益处有限。无论患者是否腹泻，纤维在维持所有患者的肠道完整性方面都发挥着作用。可推荐将纤维作为标准管饲方案的一部分，以帮助确保肠道黏膜完整性，但并非专门用于治疗便秘/腹泻。在确定纤维在管饲患者便秘/腹泻管理中的作用之前，还需要进一步研究。
