Krezalek Monika A, Yeh Andrew, Alverdy John C, Morowitz Michael
aDepartment of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois bDepartment of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Curr Opin Clin Nutr Metab Care. 2017 Mar;20(2):131-137. doi: 10.1097/MCO.0000000000000348.
This review describes the relationship between nutritional therapies and the intestinal microbiome of critically ill patients.
The intestinal microbiome of the critically ill displays a near complete loss of health-promoting microbiota with overgrowth of virulent healthcare-associated pathogens. Early enteral nutrition within 24 h of admission to the ICU has been advocated in medical and surgical patients to avoid derangements of the intestinal epithelium and the microbiome associated with starvation. Contrary to previous dogma, permissive enteral underfeeding has recently been shown to have similar outcomes to full feeding in the critically ill, whereas overfeeding has been shown to be deleterious in those patients who are not malnourished at baseline. Randomized clinical trials suggest that peripheral nutrition can be used safely either as the sole or supplemental source of nutrition even during the early phases of critical care. The use of probiotics has been associated with a significant reduction in infectious complications in the critically ill without a notable mortality benefit.
Focus of research is shifting toward strategies that augment the intestinal environment to facilitate growth of beneficial microorganisms, strengthen colonization resistance, and maintain immune homeostasis.
本综述描述了营养治疗与危重症患者肠道微生物群之间的关系。
危重症患者的肠道微生物群显示出促进健康的微生物群几乎完全丧失，同时与医疗保健相关的致病性微生物过度生长。对于内科和外科患者，提倡在入住重症监护病房（ICU）24小时内尽早进行肠内营养，以避免与饥饿相关的肠上皮和微生物群紊乱。与以往的教条相反，最近的研究表明，在危重症患者中，允许性肠内营养不足与全量喂养具有相似的结果，而对于基线时没有营养不良的患者，过度喂养则被证明是有害的。随机临床试验表明，即使在重症监护的早期阶段，肠外营养也可以安全地作为唯一或补充营养来源使用。使用益生菌与危重症患者感染并发症的显著减少相关，但对死亡率没有明显益处。
研究重点正在转向增强肠道环境以促进有益微生物生长、增强定植抗性和维持免疫稳态的策略。
