Madl C, Holzinger U
4. Medizinische Abteilung mit Gastroenterologie, Hepatologie und Zentralendoskopie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich.
Med Klin Intensivmed Notfmed. 2013 Jun;108(5):396-400. doi: 10.1007/s00063-012-0203-1. Epub 2013 Jun 7.
The functional integrity of the gastrointestinal tract is an essential prerequisite in intensive care patients for the sufficient administration of enteral nutrition. Up to 65% of patients in intensive care units develop symptoms of gastrointestinal dysfunction with high residual gastric volume, vomiting and abdominal distension. The pathophysiological alterations of gastrointestinal intolerance and the subsequent effect on the tolerance of enteral nutrition can affect the whole gastrointestinal tract. Gastroduodenal motility disorders in particular, with increased gastroesophageal reflux lead to intolerance. In more than 90% of intensive care patients with gastrointestinal motility disorders an adequate postpyloric enteral nutrition can be carried out using a jejunal tube. In addition to improved tolerance of enteral nutrition this leads to a reduction of gastroesophageal reflux and the incidence of ventilation-associated pneumonia. Apart from the possibility of endoscopic application of the jejunal tube, alternative techniques were developed which allow a faster positioning of the jejunal tube with less complications. Furthermore, there are therapeutic options for improvement of gastrointestinal motility disorders and apart from general measures, also medicinal options for treatment of gastrointestinal intolerance which allow a sufficient enteral nutrition for intensive care patients.
胃肠道功能的完整性是重症监护患者充分给予肠内营养的必要前提。重症监护病房中高达65%的患者会出现胃肠道功能障碍症状，如胃残余量高、呕吐和腹胀。胃肠道不耐受的病理生理改变以及随后对肠内营养耐受性的影响可累及整个胃肠道。特别是胃十二指肠动力障碍，伴有胃食管反流增加，会导致不耐受。在超过90%的患有胃肠道动力障碍的重症监护患者中，可以使用空肠管进行适当的幽门后肠内营养。除了提高肠内营养耐受性外，这还会减少胃食管反流和呼吸机相关性肺炎的发生率。除了内镜下放置空肠管的可能性外，还开发了替代技术，这些技术能更快地放置空肠管且并发症更少。此外，还有改善胃肠道动力障碍的治疗选择，除了一般措施外，还有治疗胃肠道不耐受的药物选择，这使得重症监护患者能够获得足够的肠内营养。
