Heyland D K, Cook D J, Guyatt G H
Department of Medicine, Division of Critical Care, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Intensive Care Med. 1993;19(8):435-42. doi: 10.1007/BF01711083.
To examine the relationship between enteral nutrition (EN) and infection in the critically ill.
Computerized search of published research and review of relevant reference lists.
151 citations were reviewed and 39 articles met selection criteria. Primary studies were included if they evaluated EN in critically ill humans and its effect on infectious morbidity and mortality.
Relevant data were abstracted on the timing and impact of EN on morbidity, the optimal route of administration, composition and pH of EN, and bacterial contamination of EN. The evidence from human studies that EN, particularly early EN, results in reduced septic morbidity as compared to parenteral nutrition is limited to small, unblinded studies with non-rigorous definitions of pneumonia. There is no evidence to support a preference of feeding into the stomach versus the small bowel. The addition of fish oil, arginine, glutamine and fiber to enteral feeds has a variable impact on survival in animal models; there are no trials in critically ill patients that demonstrate a reduction in infectious morbidity and mortality. Acidification of enteral nutrition results in decreased bacterial colonization of the stomach in critically ill patients. Bacterial contamination of enteral nutrition is an important source of infection.
Evidence from experimental data in critically ill patients suggests that enteral nutrition may have a favourable impact on gastrointestinal immunological function and infectious morbidity.
探讨肠内营养（EN）与危重症患者感染之间的关系。
对已发表的研究进行计算机检索，并查阅相关参考文献列表。
共检索到151篇文献，其中39篇符合入选标准。纳入的主要研究需评估危重症患者的肠内营养及其对感染性发病率和死亡率的影响。
提取了有关肠内营养的时机及其对发病率影响、最佳给药途径、肠内营养的成分和pH值以及肠内营养细菌污染情况的相关数据。人体研究证据表明，与肠外营养相比，肠内营养，尤其是早期肠内营养，可降低脓毒症发病率，但这仅限于一些规模较小、未设盲且对肺炎定义不严格的研究。没有证据支持胃内喂养优于小肠喂养。在肠内营养中添加鱼油、精氨酸、谷氨酰胺和纤维对动物模型的存活率有不同影响；尚无针对危重症患者的试验表明其可降低感染性发病率和死亡率。肠内营养酸化可减少危重症患者胃内的细菌定植。肠内营养的细菌污染是感染的重要来源。
危重症患者的实验数据证据表明，肠内营养可能对胃肠道免疫功能和感染性发病率有积极影响。
