外科重症病人实施肠内营养的难点及对策  

Difficulties and countermeasures in the implementation of enteral nutrition in Surgical critically ill patients

作　　者：马晓春[1] 杜宇荣 朱然[1] MA Xiao-chun;DU Yu-rong;ZHU Ran(Department of Critical Care Medicine,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院重症医学科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2024年第2期148-151,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上科学基金项目(No.82172130)。

摘　　要：几乎所有的外科医生都认识到早期肠内营养支持对于外科病人的益处,但是对于外科重症病人,早期实施肠内营养并达到临床满意的支持效果仍然要面临很大的挑战。首先,将重症预警和治疗的位点提前,能够减少外科重症病人因疾病或手术导致的消化道原发性结构与功能的损伤;其次,优化包括肠内营养在内的重症治疗方案,能够避免出现医源性消化道灌注不足或缺血;再次,在启动肠内营养治疗前,应该对病人的营养状态、营养需求、营养代谢等方面进行充分的个体化评估,在实施肠内营养后,应该对消化道结构和功能、营养耐受性、营养治疗效果等进行充分评估。外科重症病人更容易出现急性胃肠道损伤与喂养不耐受,胃肠道超声的可视化评估结合其他临床评估,可以在临床更好地反馈重症病人的系统性治疗和肠内营养治疗,更有助于改善肠内营养治疗的效率。外科重症病人的营养治疗应该作为重症整体治疗的一部分,其评估和治疗的节奏和理念应该整合到重症的全流程管理中,从而发挥更好的营养治疗效果,改善外科重症病人的预后。Almost all surgeons recognize early enteral nutrition benefits surgical critically ill patients but it is still a huge challenge to provide a fulfilled early enteral nutrition to surgical critically ill patients.First,early risk prediction may help to reduce surgical injury to the gastrointestinal tract in surgical critically ill patients.Second,optimization of enteral nutrition with other critical care management may reduce iatrogenic injury,such as feeding-associated intestinal ischemia or perforation.Third,assessment of nutritional status,nutritional risks,and nutritional requirements should be appropriately applied before enteral nutrition.Assessment of gastrointestinal tract structure,perfusion,function,feeding intolerance,and nutritional effectiveness should be appropriately applied after enteral nutrition.Surgical critically ill patients are frequently complicated with acute gastrointestinal injury and feeding intolerance.Gastrointestinal ultrasound combined with other clinical parameters could help with a better assessment in critical care management and also in providing enteral nutrition,further improving clinical enteral nutrition effectiveness.Enteral nutrition is part of critical care management in surgical critically ill patients.A correct and renewed peri-intensive care management concept will make nutrition therapy improve the prognosis of surgical critically ill patients.

关 键 词：重症医学 肠内营养 急性胃肠道损伤 胃肠超声 喂养不耐受 营养评估 

分 类 号：R6[医药卫生—外科学]