Shikora S A, Ogawa A M
Nutrition Support Services, USAF Medical Center, Lackland AFB, Texas, USA.
Postgrad Med J. 1996 Jul;72(849):395-402. doi: 10.1136/pgmj.72.849.395.
Critically ill patients invariably require nutritional intervention. Traditionally, enteral nutrition has not been widely employed in this patient population. This is due in part to the success of present-day parenteral nutrition, and to difficulties encountered with enteral feeding. Recent evidence has demonstrated that enteral is preferable to parenteral nutrition in terms of cost, complications, gut mucosal maintenance, and metabolic and immune function. Enterally administered nutritional support can and should be utilised as the preferred route of nourishment for the critically ill. The appropriate choice of access and formula, as well as a rational strategy for implementation, should improve the likelihood of success. This article describes the unique features of critical illness as they pertain to nutritional support, the benefits of enteral nutrition, and the obstacles to success, and offers suggestions which may improve the ability to provide nutrients adequately via the intestinal tract.
重症患者总是需要营养干预。传统上，肠内营养在这类患者群体中并未得到广泛应用。部分原因在于当今肠外营养的成功，以及肠内喂养所遇到的困难。最近的证据表明，在成本、并发症、肠道黏膜维持以及代谢和免疫功能方面，肠内营养优于肠外营养。肠内给予的营养支持能够且应该作为重症患者首选的营养途径。合适的通路和配方选择，以及合理的实施策略，应能提高成功的可能性。本文描述了与营养支持相关的危重症的独特特征、肠内营养的益处以及成功的障碍，并提出了一些建议，这些建议可能会提高通过肠道充分提供营养的能力。
