Auburn University, Harrison School of Pharmacy, Mobile, AL 36688, USA.
Nutr Clin Pract. 2012 Jun;27(3):335-9. doi: 10.1177/0884533612443989. Epub 2012 Apr 13.
Critically ill patients often require specialized nutrition via the enteral route. The benefits of enteral feeding, particularly early in the care of the critically ill patient, are well documented. Controversy exists regarding the provision of enteral nutrition (EN) in critically ill patients with hemodynamic instability who require vasopressors or inotropes. Concerns center on the potential for gut ischemia that may develop in the face of an imbalance between oxygen supply and demand. Current guidelines offer some guidance as to when to it is safe to initiate enteral feeding in patients on vasopressors, but the decision on when to start EN in hemodynamically unstable patients requiring vasoactive substances remains a clinical dilemma for most critical care practitioners. This review focuses on the effects of vasoactive substances such as pressors and inotropes on the gastrointestinal tract, as well as their use in combination with EN.
危重症患者常需通过肠内途径给予专门的营养。肠内喂养的益处，尤其是在危重症患者的早期治疗中，已有充分的文献记载。对于血流动力学不稳定、需要血管加压药或正性肌力药的危重症患者，肠内营养（EN）的提供存在争议。人们关注的是在氧供与氧需失衡的情况下，可能会发生肠道缺血。目前的指南就何时可以在使用血管加压药的患者中安全开始肠内喂养提供了一些指导，但对于需要血管活性物质的血流动力学不稳定患者何时开始 EN 的决策，对大多数重症监护医生来说仍然是一个临床难题。这篇综述重点讨论了血管加压药和正性肌力药等血管活性物质对胃肠道的影响，以及它们与 EN 联合使用的情况。
