危重患者急性胃肠损伤与肠康复治疗  

Intestinal rehabilitation in the management of acute gastro-intestinal injury

作　　者：任建安[1] 

机构地区：[1]南京军区南京总医院全军普通外科研究所,210002

出　　处：《中华消化外科杂志》2013年第1期21-24,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81270478）;江苏省自然科学基金创新学者攀登项目（BK2010017）

摘　　要：急性胃肠损伤（AGI）是指危重患者因为急性疾病导致胃肠道功能不正常。AGI按严重程度可分为4级：Ⅰ级，存在发展至胃肠道功能障碍和衰竭的风险；Ⅱ级，胃肠道功能障碍；Ⅲ级，胃肠道功能衰竭；Ⅳ级，胃肠道功能衰竭伴有远隔器官功能障碍。AGI的症状包括呕吐与反流、胃潴留、腹泻、消化道出血、麻痹性肠梗阻、肠扩张和肠鸣音异常。针对目前国内外诊断和治疗AGI的现状，可应用肠康复治疗AGI。肠康复是早年促进短肠综合征患者残存小肠恢复肠内营养与经口饮食的整套方案。肠康复的步骤包括全肠外营养、肠外＋肠内营养、全肠内营养和经口饮食等4个阶段。临床实践中应根据AGI损伤的程度决定肠康复的起始措施，不一定拘泥于前述的4个步骤，同时还应通过肠内或肠外途径提供肠黏膜组织特异营养因子。Acute gastrointestinal injury （AGI） is a malfunctioning of the gastrointestinal tract in intensive care patients due to their acute illness. AGI could be divided into 4 types, including AGI grade Ⅰ： increased risk of developing gastrointestinal dysfunction or failure; AGI grade Ⅱ： gastrointestinal dysfunction; AGI grade Ⅲ： gastrointestinal failure; AGI grade Ⅳ： gastrointestinal failure complicated with distal organ dysfunction. The symptoms of AGI include vomiting and regurgitation, gastric retention, diarrhea, gastrointestinal bleeding, paralytic intestinal obstruction, bowel dilatation and abnormal bowel sounds. Intestinal rehabilitation therapy was used to promote the patients with short bowel syndrome to restore enteral or oral feeding, and it could be used to improve the gastrointestinal function in patients with AGI. The procedure of intestinal rehabilitation therapy include total parenteral nutrition, parenteral and enteral nutrition, total enteral nutrition and oral feeding. The specific therapy could be implemented according to the severity of AGI and early enteral nutrition should be tried frequently. Intestinal tissue specific nutrients should also be provided either through enteral or parenteral approaches.

关 键 词：急性胃肠损伤 肠功能障碍 肠康复 肠内营养 

分 类 号：R45[医药卫生—治疗学]