Repatriation General Hospital, Daws Road, Daw Park, Adelaide 5041, South Australia.
Nutr Clin Pract. 2010 Feb;25(1):26-31. doi: 10.1177/0884533609357570.
Malnutrition is associated with poor outcomes in critically ill patients, and providing enteral feeding to those who cannot eat is considered best practice. Enteral feeding is often unsuccessful when there is delayed gastric emptying. Recent research has given additional insight into the mechanisms underlying delayed gastric emptying. Pharmacological strategies to improve the success of feeding include prokinetic drugs such as metoclopramide and erythromycin alone or in combination. When drug treatment fails, either parenteral nutrition or direct small intestinal feeding is indicated. Simpler methods to access the duodenum and distal small bowel for feed delivery are under investigation. This review summarizes current understanding of the mechanisms underlying enteral feeding intolerance in critical illness, together with the evidence for current treatment practices. Areas requiring further research are also described.
营养不良与危重症患者的不良结局相关，为无法进食的患者提供肠内营养被认为是最佳实践。当存在胃排空延迟时，肠内喂养往往难以成功。最近的研究为胃排空延迟的机制提供了更多的见解。改善喂养成功率的药物治疗策略包括单独使用或联合使用促动力药物，如甲氧氯普胺和红霉素。当药物治疗失败时，需要给予肠外营养或直接小肠喂养。正在研究更简单的方法来进入十二指肠和远端小肠进行喂养。本综述总结了目前对危重病肠内喂养不耐受机制的理解，以及当前治疗实践的证据。还描述了需要进一步研究的领域。
