Schlein Kirsten
Baylor Scott & White Health, Dallas, Texas, USA
Nutr Clin Pract. 2016 Aug;31(4):514-22. doi: 10.1177/0884533616629633. Epub 2016 Feb 26.
Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research.
重症患者通常需要肠内营养作为主要营养供给方式。在重症患者群体中，肠内营养（EN）应以胃内喂养还是小肠喂养的方式进行，仍是一个有争议的话题。危重病医学会（SCCM）/美国肠外与肠内营养学会（ASPEN）、欧洲肠外与肠内营养学会（ESPEN）以及加拿大临床实践指南（CCPG）在这个问题上尚未达成共识。迄今为止，尚无研究表明这两种喂养途径在患者死亡率、机械通气天数或重症监护病房（ICU）住院时长方面存在显著差异；然而，研究提供了一些证据，表明在重症患者中使用小肠喂养途径可能有其他益处。本文旨在审视这场辩论的双方观点，回顾小肠和胃内肠内营养途径的优缺点。还讨论了小肠喂养管放置的实际问题和挑战。最后，提供了一些建议，以帮助指导临床医生选择喂养途径，并对未来研究提出了建议。
