危重症患者营养治疗途径的研究进展  

The latest developments in nutritional therapy pathways for patients in critical condition

作　　者：戴罕之 张胜[2] 林荣海 DAI Hanzhi;ZHANG Sheng;LIN Ronghai(School of Medicine,Shaoxing University,Shaoxing 312000,China;不详)

机构地区：[1]绍兴文理学院医学院,浙江绍兴312000 [2]浙江省台州医院重症医学科,浙江台州317000 [3]台州市立医院,浙江台州318000

出　　处：《实用医学杂志》2024年第4期585-590,共6页The Journal of Practical Medicine

基　　金：浙江省自然科学基金项目资助(编号:LY20H150008)。

摘　　要：在ICU中,危重症患者的营养状况与预后密切相关,38%~78%的危重症患者出现了营养不良。推荐对危重症患者进行个体化定制医学营养治疗以改善预后。营养治疗包括肠内营养及肠外营养,肠内营养可通过鼻胃管进行幽门前喂养,操作简单,普遍适用,或通过鼻空肠管进行幽门后喂养,可减少反流误吸风险;肠外营养可通过建立外周静脉通路或中心静脉通路进行喂养,外周静脉通路易于施行,而中心静脉通路可允许高渗透压的营养液。营养治疗途径如何选择,除考虑患者病情外,还需考虑启动时机、能否满足营养需求、喂养相关并发症等问题,目前指南尚未达成统一,研究尚存争议。本文就营养途径相关问题进行综述,以期给临床提供参考。In the ICU,nutritional status is intimately related to the prognosis of critically ill patients and cannot be neglected;nonetheless,between 38%~78%of critically ill patients are malnourished.Individualized nutritional monitoring and therapy is recommended for critically ill patients to improve prognosis.Nutritional treatment includes enteral and parenteral nutrition.Enteral nutrition can be provided by prepyloric feeding through a nasogastric tube,which is simple and generally applicable,or by retropyloric feeding through a nasojejunal tube,which can reduce the risk of reflux aspiration.Parenteral feeding can be administered by creating peripheral venous access for convenient administration or central venous access for the delivery of nutritional solutions with high osmotic pressure.In addition to the patient's condition,the choice of nutrition route should take into account the initiation time,ability to meet nutritional needs,and potential feeding related complications.Current guidelines are not united,and previ⁃ous research has not fully addressed existing conflicts.In this paper,problems associated with each nutrition pathway are reviewed to provide a clinical reference。

关 键 词：危重症 营养不良 肠内营养 肠外营养 

分 类 号：R459.3[医药卫生—治疗学]