Braga M, Gianotti L, Di Carlo V
Chirurgia Generale, Ospedale San Raffaele, IRCCS, Università degli Studi di Milano.
Chir Ital. 1994;46(6):11-9.
Artificial nutrition (AN) has become an essential part of traumatised and surgical patient care. The main indications for AN are severe undernutrition and hypermetabolism, which are important causes of immunosuppression. Total parenteral nutrition has proved to be as beneficial in the perioperative period only in malnourished subjects. In contrast, overfeeding may cause detrimental sequelae with an increase in postoperative complications. Experimental and clinical trials have clearly shown that the administration of nutrients via the enteral route versus the parenteral one has several advantages, including improved local and systemic immune response and gut barrier function with the subsequent reduction of septic morbidity. Preliminary data in traumatised and surgical patients have shown further immunological and clinical advantages when the composition of the enteral solutions has been enriched with specific nutrients capable of enhancing the host defence mechanisms. The most important are arginine, n-3 fatty acids, RNA, and glutamine.
人工营养（AN）已成为创伤和外科手术患者护理的重要组成部分。AN的主要适应证是严重营养不良和高代谢，这是免疫抑制的重要原因。事实证明，全胃肠外营养仅对营养不良的患者在围手术期有益。相比之下，过度喂养可能会导致有害后果，增加术后并发症。实验和临床试验清楚地表明，与肠外途径相比，经肠内途径给予营养物质有几个优点，包括改善局部和全身免疫反应以及肠道屏障功能，随后降低脓毒症发病率。创伤和外科手术患者的初步数据显示，当肠内溶液的成分富含能够增强宿主防御机制的特定营养素时，还具有进一步的免疫学和临床优势。其中最重要的是精氨酸、n-3脂肪酸、RNA和谷氨酰胺。
