Kreymann G, Adolph M, Druml W, Jauch K W
Dept. of Medicine, University of Hamburg, Germany Baxter S.A., Zurich, Switzerland.
Ger Med Sci. 2009 Nov 18;7:Doc14. doi: 10.3205/000073.
In intensive care patients parenteral nutrition (PN) should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of <5 days, do not require full PN but should be given at least a basal supply of glucose. Critically ill patients should be nourished parenterally from the beginning of intensive care if they are unlikely to be adequately nourished orally or enterally even after 5-7 days. Critically ill and malnourished patients should, in addition to a possible partial enteral nutrition, be nourished parenterally. Energy supply should not be constant, but should be adapted to the stage, the disease has reached. Hyperalimentation should be avoided at an acute stage of disease in any case. Critically ill patients should be given, as PN, a mixture consisting of amino acids (between 0.8 and 1.5 g/kg/day), carbohydrates (around 60% of the non-protein energy) and fat (around 40% of the non-protein energy) as well as electrolytes and micronutrients.
在重症监护患者中，若有可能进行充分的口服或肠内营养，则不应进行肠外营养（PN）。对于没有营养不良症状、可能在不到5天的时间内无法通过肠内获得充分营养的重症患者，不需要完全的PN，但应至少给予基础量的葡萄糖。如果重症患者即使在5 - 7天后仍不太可能通过口服或肠内获得充分营养，则应从重症监护开始就进行肠外营养。除了可能进行的部分肠内营养外，重症且营养不良的患者还应进行肠外营养。能量供应不应恒定，而应根据疾病所处阶段进行调整。在疾病的急性期，无论如何都应避免过度营养。作为PN，应为重症患者提供一种混合物，其中包括氨基酸（0.8至1.5克/千克/天）、碳水化合物（约占非蛋白质能量的60%）、脂肪（约占非蛋白质能量的40%）以及电解质和微量营养素。
