Thibault Ronan, Picot Denis
aNutrition Unit, Department of Endocrinology, Diabetology and Nutrition, Home Parenteral Nutrition Centre, CHU Rennes, Université de Rennes 1, INSERM U991 bDepartment of Nutritional and Digestive Rehabilitation, Clinique Saint Yves, Rennes, France.
Curr Opin Clin Nutr Metab Care. 2016 Sep;19(5):382-387. doi: 10.1097/MCO.0000000000000304.
Patients with double temporary enterostomy or enterocutaneous fistula may suffer from intestinal failure. Parenteral nutrition is the gold standard treatment until surgical re-establishment of intestinal continuity, but serious complications may arise. Chyme reinfusion or enteroclysis are indicated.
Chyme reinfusion corrects the intestinal failure by restoring intestinal absorption, allowing parenteral nutrition weaning in 91% of patients. Chyme reinfusion contributes to improve nutritional status and reduce plasma liver test abnormalities. Chyme reinfusion is feasible at home without any serious complications in selected patients. Mechanisms underlying chyme reinfusion effectiveness on intestinal function, such as restoration of ileal brake, are suggested but most remain to be demonstrated. When the downstream small bowel is exposed, enteroclysis of enteral nutrition or hydration could be helpful to reduce parenteral nutrition needs, or in case of insufficient food intake during chyme reinfusion.
Chyme reinfusion or enteroclysis are less expensive, well tolerated, and easy-to-use nutrition support techniques, which may allow reducing parenteral nutrition-related healthcare costs. The latter remains to be demonstrated in the setting of a prospective randomized controlled trial. This review may contribute to improve the awareness of intensivists, digestive surgeons, and gastroenterologists involved in intestinal failure management to spread the use of chyme reinfusion or enteroclysis.
行双临时肠造口术或肠皮肤瘘的患者可能会出现肠衰竭。在手术重建肠道连续性之前，肠外营养是金标准治疗方法，但可能会出现严重并发症。此时应采用肠内食糜回输或肠内灌注法。
肠内食糜回输可恢复肠道吸收功能，从而纠正肠衰竭，91%的患者可实现肠外营养撤减。肠内食糜回输有助于改善营养状况，降低血浆肝功能检查异常情况。在选定患者中，肠内食糜回输可在家中进行且无严重并发症。虽然有人提出肠内食糜回输对肠道功能有效的潜在机制，如回肠制动的恢复，但大多数机制仍有待证实。当下游小肠暴露时，肠内营养或补液的肠内灌注有助于减少肠外营养需求，或在肠内食糜回输期间食物摄入量不足的情况下发挥作用。
肠内食糜回输或肠内灌注是成本较低、耐受性良好且易于使用的营养支持技术，可能有助于降低与肠外营养相关的医疗费用。这一点仍有待在前瞻性随机对照试验中得到证实。本综述可能有助于提高参与肠衰竭管理的重症监护医生、消化外科医生和胃肠病学家的认识，以推广肠内食糜回输或肠内灌注的应用。
