Ney L, Annecke T
Chirurgische Klinik Innenstadt, Klinikum der Universität München, München, Deutschland.
Unfallchirurg. 2011 Nov;114(11):973-80. doi: 10.1007/s00113-011-2032-8.
Severe trauma triggers endocrine and inflammatory responses, leading to hyperglycaemia, insulin resistance and protein catabolism. Pharmacological and nutritional interventions cannot counteract these metabolic disturbances. However, adequate supply of energy and proteins may reduce excessive catabolism.Available guidelines recommend early use of enteral nutrition with energetic supply of about 25 kcal/kg and additional protein supply of 1.5 g/kg/day. These aims will be missed frequently by solely providing enteral nutrition in severely injured patients. Early supplemental parenteral nutrition should be used in these cases. Concomitantly, gastric paresis and paralytic ileus hampering enteral nutrition should be treated by propulsive and prokinetic drugs and by use of duodenal or jejunal site of application in selected cases.Euphoric hopes linked with intensified insulin therapy (IIT), targeting blood glucose levels <110 mg/dl in intensive care patients, had to be widely abandoned in recent years. The goal for blood glucose levels should be set at 180 mg/dl as the upper limit according to current knowledge, which promises to optimize the balance between efficacy and safety.
严重创伤会引发内分泌和炎症反应，导致高血糖、胰岛素抵抗和蛋白质分解代谢。药物和营养干预无法抵消这些代谢紊乱。然而，充足的能量和蛋白质供应可能会减少过度的分解代谢。现有指南建议早期使用肠内营养，能量供应约为25千卡/千克，额外蛋白质供应为1.5克/千克/天。在严重受伤的患者中，仅提供肠内营养常常无法实现这些目标。在这些情况下应早期补充肠外营养。同时，对于妨碍肠内营养的胃轻瘫和麻痹性肠梗阻，应使用促动力药进行治疗，并在特定情况下采用十二指肠或空肠给药部位。近年来，针对重症监护患者将血糖水平控制在<110毫克/分升的强化胰岛素治疗（IIT）所带来的美好期望不得不被广泛摒弃。根据目前的知识，血糖水平的目标应设定为180毫克/分升作为上限，这有望优化疗效和安全性之间的平衡。
