Wojnar M M, Hawkins W G, Lang C H
Department of Surgery, State University of New York at Stony Brook, USA.
Crit Care Clin. 1995 Jul;11(3):717-33.
Nutrition and metabolic support is just one of many weapons at the clinician's disposal in the battle against infection. Much has been learned in the past several decades concerning the host's response to infection and the competition among substrates during health and disease. Despite these advances, we still are remarkably ineffective at preventing the muscle wasting that accompanies sepsis and other chronic catabolic conditions. This likely is the result of our lack of understanding concerning the molecular mechanisms responsible for changes in protein metabolism. It is anticipated that the optimal or preferred mixture of glucose, fat, and protein will be better defined in the future, and that new supplements (e.g., MCTs, amino acids, growth factors, antioxidants) will prove beneficial, so the protein-catabolic response to sepsis can be ameliorated and patient outcome improved. Until that time, nutritional interventions should be initiated early in the septic episode and be assessed and altered frequently. Specific guidelines for nutritional support are presented in Table 3.
营养和代谢支持只是临床医生在对抗感染的战斗中可使用的众多武器之一。在过去几十年里，我们对宿主对感染的反应以及健康和疾病状态下底物之间的竞争有了很多了解。尽管有这些进展，但在预防脓毒症和其他慢性分解代谢状况所伴随的肌肉萎缩方面，我们仍然成效显著不足。这可能是由于我们对负责蛋白质代谢变化的分子机制缺乏了解。预计未来将更好地确定葡萄糖、脂肪和蛋白质的最佳或优选混合物，并且新的补充剂（如中链甘油三酯、氨基酸、生长因子、抗氧化剂）将被证明是有益的，这样就可以改善对脓毒症的蛋白质分解代谢反应并改善患者预后。在此之前，应在脓毒症发作早期就开始营养干预，并经常进行评估和调整。营养支持的具体指南见表3。
