Steinmetz O K, Meakins J L
Department of Surgery, McGill University, Montreal, PQ.
Can J Surg. 1991 Jun;34(3):207-15.
The traditional approach to the care of the gastrointestinal tract in the intensive care unit has been one of neglect. However, recent evidence has linked enteric flora to the generation of clinical sepsis in the absence of other infectious foci. The role of the bowel as an efficient barrier to the invasion of its own flora is addressed in this paper. A variety of insults disrupt the integrity of the barrier function of the gut, allowing the entry of bowel organisms or endotoxins, or both, into the portal and systemic circulatory systems. In animal and early clinical studies, a number of interventions, aimed at altering the enteric flora and enhancing the bowel's barrier function, have been shown to modulate the host's resistance to different insults and may even improve clinical outcome. Such interventions include maintenance of enteral feeding, glutamine supplementation of hyperalimentation solutions and selective bacterial decontamination of the bowel.
重症监护病房对胃肠道的传统护理方式一直是疏于关注。然而，最近有证据表明，在没有其他感染源的情况下，肠道菌群与临床败血症的发生有关。本文探讨了肠道作为抵御自身菌群入侵的有效屏障的作用。多种损伤会破坏肠道屏障功能的完整性，使肠道微生物或内毒素，或两者同时进入门静脉和体循环系统。在动物和早期临床研究中，一些旨在改变肠道菌群并增强肠道屏障功能的干预措施已被证明可以调节宿主对不同损伤的抵抗力，甚至可能改善临床结果。这些干预措施包括维持肠内营养、在全胃肠外营养溶液中补充谷氨酰胺以及肠道选择性去污。
