Department of Surgery, The Methodist Hospital, Houston, Texas, USA.
J Surg Res. 2010 Jun 15;161(2):288-94. doi: 10.1016/j.jss.2009.06.024. Epub 2009 Jul 17.
Nutritional supplementation has become the standard of care for management of critically ill patients. Traditionally, nutritional support in this patient population was intended to replete substrate deficiencies secondary to stress-induced catabolism. Recognition of the influence of certain nutrients on the immune and inflammatory response of the critically ill has led to the evolution of more sophisticated nutritional strategies and concepts. Administration of immune-enhancing formulas supplemented with a combination of glutamine, arginine, omega-3 fatty acids (omega-3 FA), and nucleotides have been shown in most studies to reduce infectious outcomes. More recently, the separation of nutritional support from the provision of key nutrients has led to a further appreciation of the immunomodulatory and anti-inflammatory benefits of isolated nutrients, such as glutamine and antioxidants. The purpose of this article is to review the molecular mechanisms that are unique to each class of frequently utilized nutrients. A better understanding of the specific molecular targets of immunonutrients will facilitate application of more refined nutritional therapies in critically ill patients.
营养补充已成为危重症患者治疗的常规手段。传统上，营养支持旨在补充因应激引起的分解代谢而导致的底物缺乏。对某些营养素对危重症患者免疫和炎症反应的影响的认识，促使更复杂的营养策略和概念不断发展。在大多数研究中，给予免疫增强配方并补充谷氨酰胺、精氨酸、ω-3 脂肪酸（ω-3 FA）和核苷酸，已被证明可降低感染发生率。最近，将营养支持与关键营养素的提供分开，进一步认识到了孤立营养素（如谷氨酰胺和抗氧化剂）的免疫调节和抗炎作用。本文旨在综述经常使用的各类营养素所具有的独特分子机制。更好地了解免疫营养素的特定分子靶点将有助于在危重症患者中应用更精细的营养治疗。
