Moore Scott M, Burlew Clay Cothren
Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, Colorado, USA.
Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, Colorado, USA
Nutr Clin Pract. 2016 Feb;31(1):9-13. doi: 10.1177/0884533615620420. Epub 2015 Dec 16.
Early provision of enteral nutrition (EN) in critically ill and injured patients has become standard practice in surgical intensive care units (ICUs) due to its proven role in reducing septic complications. Increasingly, intensivists are confronted with patients with an open abdomen due to the use of damage control surgery and the recognition of the abdominal compartment syndrome; the role and timing of EN in these challenging patients continue to be debated. Patients with an open abdomen are often among the sickest in the ICU and hence could benefit from early nutrition support. However, the exposed abdominal viscera can understandably create anxiety regarding the initiation of EN; there is theoretic concern over exacerbation of bowel distention with resultant inability to close the abdomen and an increased aspiration risk due to paralytic ileus. Recent studies have investigated the utility of EN in the patient with an open abdomen, addressing these clinical concerns. The goal of this clinical review is to provide guidance to physicians caring for these complex patients.
由于早期肠内营养（EN）在降低脓毒症并发症方面已被证实的作用，在外科重症监护病房（ICU）中，为重症和受伤患者早期提供肠内营养已成为标准做法。由于损伤控制手术的应用以及腹腔间隔室综合征的发现，越来越多的重症监护医生面临着有开放性腹部的患者；肠内营养在这些具有挑战性的患者中的作用和时机仍存在争议。有开放性腹部的患者通常是ICU中病情最严重的患者之一，因此可能受益于早期营养支持。然而，暴露的腹腔脏器会引发人们对开始肠内营养的担忧，这是可以理解的；理论上担心肠扩张加剧会导致无法关闭腹部，以及由于麻痹性肠梗阻导致误吸风险增加。最近的研究探讨了肠内营养在有开放性腹部患者中的效用，解决了这些临床问题。本临床综述的目的是为照料这些复杂患者的医生提供指导。
