Department of Surgery, Medical Sciences School, Federal University of Mato Grosso, Cuiaba, Brazil.
Nutrition. 2012 Sep;28(9):840-3. doi: 10.1016/j.nut.2012.01.013. Epub 2012 May 1.
The early provision of nutrients as part of specialized therapy for critically ill patients admitted for critical medical and surgical conditions is recommended by various international guidelines. Enteral nutrition is the first option and should be initiated 24-48 h after admission to an intensive care unit. Even after gastrointestinal anastomosis, early oral or enteral feeding is not only safe but also associated with enhanced recovery and fewer complications. Recent studies showed that the use of an enteral diet or parenteral nutrition that contains immune nutrients enhances the recovery of critically ill patients. Although the precise caloric target remains controversial, the general consensus advocates the avoidance of prolonged hypocaloric or hypercaloric feeding. However, there is still debate about the timing of the initiation of parenteral nutrition when enteral nutrition either is impossible or does not meet the nutritional goals. Although controversy remains, two recent studies showed that when enteral feeding is not feasible the early initiation of parenteral nutrition was not associated with palpable benefit.
各种国际指南都建议，将营养作为重症患者特殊治疗的一部分，尽早提供给因严重医学和外科病症而住院的患者。肠内营养是首选方法，应在入住重症监护病房后 24-48 小时内开始。即使在胃肠道吻合术后，早期口服或肠内喂养不仅安全，而且还与恢复更快和并发症更少相关。最近的研究表明，使用含有免疫营养素的肠内饮食或肠外营养可以促进重症患者的康复。虽然精确的热量目标仍存在争议，但普遍共识是避免长时间给予低热量或高热量喂养。然而，当肠内营养不可行或无法满足营养目标时，何时开始肠外营养仍存在争议。尽管存在争议，但最近的两项研究表明，当肠内喂养不可行时，早期开始肠外营养并没有带来明显的益处。
