Alexander J W
Transplantation Division, University of Cincinnati College of Medicine, Ohio.
JPEN J Parenter Enteral Nutr. 1990 Sep-Oct;14(5 Suppl):170S-174S. doi: 10.1177/014860719001400505.
It is now clear that atrophy of the intestinal mucosa can occur rapidly after injury and that the degree of atrophy is quantitatively related to the severity of injury. Such atrophy can be associated with translocation of bacteria and endotoxin, which can trigger the hypermetabolic response and induce a septic state, which may ultimately lead to multiple system organ failure. Early enteral feeding following trauma can prevent atrophy of the intestinal mucosa and is associated with a decrease in the hypermetabolic response and the incidence of septic complications and diarrhea. Enteral feeding of complete diets can also improve outcome with other forms of intestinal injury such as gamma irradiation or cytotoxic drugs. In contrast, total parenteral nutrition and elemental enteral diets are associated with atrophy of the intestinal mucosa and increased translocation. The addition of glutamine and/or fiber to elemental diets may decrease translocation in some but not all circumstances. It is now clear that enteral nutrition can influence the incidence and severity of translocation, which in turn can potentially reverse or prevent the adverse effects of injury and inflammation in traumatic injury and serious illness.
现在已经清楚，肠道黏膜萎缩在损伤后可迅速发生，且萎缩程度与损伤严重程度在数量上相关。这种萎缩可能与细菌和内毒素移位有关，而细菌和内毒素移位可引发高代谢反应并导致脓毒症状态，最终可能导致多系统器官衰竭。创伤后早期肠内喂养可预防肠道黏膜萎缩，并与高代谢反应的降低以及脓毒症并发症和腹泻的发生率降低相关。给予完整饮食进行肠内喂养也可改善其他形式肠道损伤（如γ射线照射或细胞毒性药物所致损伤）的预后。相比之下，全胃肠外营养和要素肠内饮食与肠道黏膜萎缩及移位增加有关。在要素饮食中添加谷氨酰胺和/或纤维在某些但并非所有情况下可能会减少移位。现在已经清楚，肠内营养可影响移位的发生率和严重程度，而移位又有可能反过来逆转或预防创伤性损伤和重症疾病中损伤和炎症的不良影响。
