Rayburn W, Wolk R, Mercer N, Roberts J
Obstet Gynecol Surv. 1986 Apr;41(4):200-14. doi: 10.1097/00006254-198604000-00002.
Parenteral nutrition is required to maintain and restore an anabolic state when oral or enteral routes are not feasible. Despite 16 years of parenteral nutrition availability, reports about parenteral therapy in gynecologic patients or during pregnancy have not been published until relatively recently. Most information is anecdotal but suggests that this mode of therapy is safe, effective, and occasionally life-saving. Parenteral nutrition is used most commonly in women with gynecologic malignancies who are unable to obtain adequate nourishment either during or after surgery, radiation, or chemotherapy. Parenteral alimentation during pregnancy has been used mostly to provide adequate nutrition for those who suffer from prolonged hyperemesis or when there is difficulty in absorption of adequate nutrients. The proper selection and administration of dextrose, fat, protein, vitamins, trace elements, and electrolytes for pregnant women has been associated with apparent favorable perinatal outcomes. Preterm deliveries and intrauterine fetal growth retardation are relatively common and relate to the preexisting or a coexisting medical or obstetric complication. Nutritional assessment before therapy should include a detailed diet history and establishment of baseline clinical and laboratory parameters. Oral or enteral feedings should be attempted beforehand if possible to conserve high costs and potential complications. Parenteral requirements are extrapolated from recommended daily allowances for oral intake, allowing for adjustments in variable absorption. Standardized formulations and fat emulsions are available at pharmacies in many hospitals, making ordering of complex solutions easier, more efficient, and cost effective. Metabolic and septic complications occur infrequently with close monitoring. Few women require intravenous therapy for very long, and home parenteral nutrition is rarely necessary.
当口服或肠内途径不可行时，需要肠外营养来维持和恢复合成代谢状态。尽管肠外营养已有16年的应用历史，但关于妇科患者或孕期肠外治疗的报道直到最近才发表。大多数信息是轶事性的，但表明这种治疗方式是安全、有效的，偶尔还能挽救生命。肠外营养最常用于患有妇科恶性肿瘤的女性，她们在手术、放疗或化疗期间或之后无法获得足够的营养。孕期肠外营养主要用于为患有长期妊娠剧吐或吸收足够营养有困难的孕妇提供足够的营养。为孕妇正确选择和使用葡萄糖、脂肪、蛋白质、维生素、微量元素和电解质与明显良好的围产期结局相关。早产和胎儿宫内生长受限相对常见，与既往存在或并存的内科或产科并发症有关。治疗前的营养评估应包括详细的饮食史以及建立基线临床和实验室参数。如果可能，应事先尝试口服或肠内喂养，以节省高昂的费用和潜在的并发症。肠外营养需求量是根据口服摄入量的推荐每日允许量推算出来的，并根据可变的吸收情况进行调整。许多医院的药房都有标准化配方和脂肪乳剂，使得订购复杂溶液更加容易、高效且具有成本效益。通过密切监测，代谢和感染性并发症很少发生。很少有女性需要长期进行静脉治疗，家庭肠外营养也很少有必要。
