Grant J P
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Ann Surg. 1994 Nov;220(5):610-6. doi: 10.1097/00000658-199411000-00003.
The author reviews the newer nutritional substrates in use or under investigation for enteral and parenteral nutrition. Management of the critically ill patient remains a significant challenge to clinicians, and it is hoped that dietary manipulations, such as those outlined, may augment host barriers and immune function and improve survival.
The role of nutrition in patient well-being has long been recognized, but until the past 25 years, the technology to artificially provide nutrients when patients could not eat was not developed. With current, new methods for enteral and vascular access, patients can be fed nonvolitionally with little difficulty. Continued efforts have been directed toward identifying optimal feeding formulations, which have resulted in a multitude of commercially available products. In the past several years, attention has been turned to evaluation of four specialized nutrients and the use of other substrates as pharmacologic agents.
Pertinent laboratory and clinical data were reviewed to present the pros and cons for each nutritive substrate.
Medium-chain fatty acids, branched-chain amino acids, and glutamine have been shown to be of clinical benefit and should be in common use in the near future. Short-chain fatty acids still are under investigation. Albumin, vitamins E and C, arginine, glutamine, and omega-3 fatty acids show great promise as pharmacologic agents to manipulate the stress response. Nucleotides remain investigational. CONTENTS SUMMARY: The application of some new nutritional substrates for use in critically ill patients, both as caloric sources and as pharmacologic agents, are reviewed.
作者回顾了正在用于或正在研究用于肠内和肠外营养的新型营养底物。对重症患者的管理仍然是临床医生面临的一项重大挑战，人们希望诸如本文所述的饮食干预措施能够增强宿主屏障和免疫功能并提高生存率。
营养在患者健康中的作用早已得到认可，但直到过去25年，当患者无法进食时人工提供营养的技术才得以发展。有了当前新的肠内和血管通路方法，给患者非自愿喂食几乎没有困难。人们持续致力于确定最佳喂养配方，这已产生了众多市售产品。在过去几年中，注意力已转向对四种特殊营养素的评估以及将其他底物用作药物。
回顾相关实验室和临床数据以阐述每种营养底物的优缺点。
中链脂肪酸、支链氨基酸和谷氨酰胺已显示出临床益处，在不久的将来应得到广泛应用。短链脂肪酸仍在研究中。白蛋白、维生素E和C、精氨酸、谷氨酰胺和ω-3脂肪酸作为调节应激反应的药物显示出巨大潜力。核苷酸仍在研究中。内容总结：本文回顾了一些新型营养底物在重症患者中的应用，这些底物既作为热量来源，也作为药物。
