Department of Gastroenterology, University of Utah Health Sciences, Salt Lake City, Utah, USA.
Am J Gastroenterol. 2011 Jun;106(6):1032-7; quiz 1038. doi: 10.1038/ajg.2011.77. Epub 2011 Apr 5.
Expertise in enteral nutrition (EN) is an important aspect of the skill set of the clinical gastroenterologist. Delivery of adequate EN in critically ill patients is an active therapy that attenuates the metabolic response to stress and favorably modulates the immune system. EN is less expensive than parenteral nutrition and is favored in most cases because of improvement in patient outcomes, including infections and length of stay. Newer endoscopic techniques for placing nasoenteric feeding tubes have been developed, which improve placement success and efficiency. It appears that there is an ideal window period of 24-48 h when enteral feeding should be started in critically ill patients. Most patients can be fed into the stomach, but certain groups may benefit from small bowel feeding. Protocols on how to start and monitor enteral feeding have been developed. Immune-modulating feeding formulations also appear to be beneficial in specific patient populations. The gastroenterologist is a crucial member of the multidisciplinary team for nutritional support in the intensive care unit patient, with his knowledge of gastrointestinal pathophysiology, nutrition, and endoscopic feeding-tube placement.
肠内营养（EN）方面的专业知识是临床胃肠病学家技能的重要组成部分。为危重症患者提供充足的 EN 是一种积极的治疗方法，可减轻应激反应的代谢反应，并有利于调节免疫系统。EN 比肠外营养便宜，在大多数情况下都更受欢迎，因为它可以改善患者的预后，包括感染和住院时间。已经开发出了用于放置鼻肠喂养管的新内镜技术，这提高了放置成功率和效率。似乎存在一个理想的时间段，即危重症患者应在 24-48 小时内开始肠内喂养。大多数患者可以经胃喂养，但某些患者群体可能受益于小肠喂养。已经制定了关于如何开始和监测肠内喂养的方案。免疫调节型喂养配方在特定患者群体中似乎也有益处。胃肠病学家是重症监护病房患者营养支持多学科团队的重要成员，他了解胃肠道病理生理学、营养和内镜喂养管放置。
