有营养风险患者首选肠内营养支持

临床营养支持包括肠外营养（parenteral nutrition,PN）与肠内营养（enteral nutrition,EN）支持。20世纪60至80年代初,我国每年接受规范PN、EN支持的病例仅有数十至数千例,常用于有明显营养不良（不足）的患者,所以适应证方面基本不存在问题。1987年以后,接受临床营养支持的人数有了较快增长,2000年后增长更为迅速。根据洲际市场服务（Intercontinental MarketingService,IMS）保健信息系统中用药总量的动态数据,     

肠内营养--外科临床营养支持的首选途径

营养的重要性早为人们所熟知,无论在传统医学与现代医学中都很强调营养的作用,但住院病人中仍有30%～50%属营养不良.在20世纪70年代以前,当胃肠功能有障碍时,常因无有效的方法提供必需的营养,而出现许多病人在富裕中饥饿.     

肠内营养——外科临床营养支持的首选途径

营养是我们生长和生存的根本,是病人抵抗外界伤害维持自己身体各项功能、以及修复身体损伤的基础力量。而肠内营养是在我们无法通过进食摄入所需营养的时候,医生给我们身体提供营养的一种方式。在外科临床上,医生在对病人给予营养支持的首选途径就是肠内营养,那么,肠内营养究竟是什么,它在外科临床上有什么优势呢,下面我们就来了解一下,关于肠内营养的相关知识。     

肠内营养--外科临床营养支持的首选途径

黎介寿院士在《中国实用外科杂志》2003年23卷第2期发表的述评犤文章编号:1005-2208(2003)02-0067-01犦不但论证了肠内营养在外科的临床营养支持中应为首选途径的道理,分析了肠内营养在国内不易推广的具体原因,而且还提出了化解这些困难的方法。其他临床学科(如肾科、呼吸科、老年科等)也应当考虑将肠内营养作为临床营养支持的首选途径。为使本刊读者有机会学习这篇重要述评,经黎介寿院士同意及《中国实用外科杂志》许可,本刊全文转载。     

肠内营养的护理

肠内营养(EN)是经胃肠道提供代谢需要的营养物质及其他各种营养素的营养支持方式。1肠内营养的适应症不能进口摄入足够食物,但能通过鼻饲管将注入胃肠道的营养液消化吸收的患者。如吞咽和咀嚼困难、意识障碍、昏迷等。适用于(1)意识障碍或昏迷;(2)吞咽咀嚼困难;(3)消化道瘘;(4)高代谢状态、营养不良;(5)炎性肠道疾病、短肠综     

肠内营养治疗研究进展

近年来，肠内营养技术因其符合生理条件、吸收好、费用低等诸多优势，在临床工作中得到了广泛应用推广。为更加全面深入地了解肠内营养治疗的内容、技术及注意事项，笔者搜集和总结国内外关于肠内营养治疗的相关文献，系统阐述肠内营养的适应症、内容搭配、给药途径及给药不良反应。     

日本肠内营养进展

Despite plyaing important roles in recovery or maintenance ofnutritional state and immunocompetene in malnourished or surgically injured patients,nutritional care has still controversial problems in view of complications related to administered calory,composition of energy substrates and feeding routes.Present presentation would be focused on Japanese articles of enteral nutrition (EN) care with semi digested formula for surgical patients.We have already revealed experimentally and clinically that every EN of semi digested formula is well utilized as energy sources and also that EN exerts tropic influences on gut structure and integrity.On the other hand,EN should be applied carefully to avoid many untoward gastrointestinal reactions.In retrospective analysis of perioperative nutritional care for patients of upper GI tract malignancies we certified that the early applied and stepwisely increased EN plus peripheral parental nutrition could maintain the postoperative nutritional state as well as TPN.Kakegawa et al.performed a clinical evaluation of enteral nutrition-Harmonic M.which contains lactoalbumin and soy protein,MCT and LCT in postoperative upper GI tract malignancies.In a randomized controlled study by telephone method they revealed that Harmonic M could be feasible for postoperative nutritional care of severely stressed surgical patients without any serious complications.Takagi et al investigated how the antecedent nutritional routes influence systemic IL6 and IL10 reponses and endotoxin translocation after an operation for thoracic esophageal cancer.In spite of retrospective analysis they verified as follows:Perioperative EN provides better regulation of inflammatory cytokine responses and may contribute less to immunosupression after major surgery than parenteral nutrition.The attenuated production of endotoxcin induced by EN may play an important role in these phenomena.In the gastroenterological field we revealed that EN was effective on the supportive care of severe actute pancreatitis.EN with semidigestive formula was also reported to be applied successfully in postoperative patients in cardiovascular surgery,neurosurgery and pediatric surgery.Current concept of EN in Japan would be reviewed from the standpoints of indication,protocol or schedule,and applying methods.     

家庭肠内营养支持

0引言 家庭营养支持分为家庭肠内营养(home enteral nutrition,HEN)支持和家庭肠外营养支持.由于肠外营养支持的技术要求较高,并发症较严重,因此,家庭营养支持是以HEN为主.在我国已有一些病人在家中接受肠内营养支持,但缺乏系统的监测、随访及指导.因此,有必要进一步规范HEN的开展,以进一步地提高其应用的疗效,减少并发症的发生.     

肠内营养输注泵

背景 肠内营养输注泵(enteral feeding pump)是一种由电脑控制的输液装置,可以精确控制肠内营养液的输注[1, 2].以往管饲或经造瘘进行肠内喂养通常以重力为动力或采用注射器推注.然而,一些因素如很细的输液管、高浓度(黏稠)液体等均能影响液体速度;患者体位的改变、输注管的扭曲受压等随时都可能改变滴速;而滴速及营养液黏稠度又可影响液滴的大小,从而影响输液的速度及总输液量.目前,使用肠内营养输注泵能提供适当压力以克服阻力保证输液速度[2].     

临床与肠内营养

临床营养支持包括肠内营养(EN)和肠外营养(PN)支持,是上世纪中、后叶发展起来的现代治疗学的一个重要组成部分。随着营养支持技术和实践的不断进步与发展,营养支持从肠外营养支持为主转变为在可能的情况下应优先使用肠内营养支持。肠内营养支持以其符合生理状态、应用安全方便、费用低廉等优点,已经越来越多的应用于临床。近年来,早期肠内营养在术后的作用越来越受到重视,它对需要长期进食和高分解代谢状态的     

肠内营养的护理体会

肠内营养是以经口服或管饲提供各种营养素,它符合生理需要,具有简便、安全、有效、经济、并发症少的优点,能促进患者较早康复。当胃肠道允许时,应尽量采用肠道内营养,是临床应遵循的原则,笔者所在科从8月份开始对术中置营养管的患者,术后经空肠营养管进行肠内营养,取得了满意的效果。     

肠内营养的规范化问题

<正>肠内营养(EN)与肠外营养(PN)相比,具有营养全面、使用安全、方便、价格低廉、并发症少等特点。由于营养物质经门静脉途径进入肝,能够促进肠黏膜修复和肠蠕动恢复,具有PN无法比拟的优势,因而,EN的应用越来越普遍,但使用不规范的现象也很常见:如仅凭直觉、感觉或视觉来判断是否给病人使用EN,不进行认真的营养风险筛查或评估;仅满足于病人每天滴入多少EN,不考虑其吸收了多少营养;使用EN的同时还在用生长抑素,或使用EN的同时还在进食等等。若临床医师都能熟悉并正确使用EN,许多疾病的治疗效果会有很大的提升,不过按目前现状,EN的规范化仍是个亟待解决的问题。     

肠外营养与肠内营养的比较

Summary Inappropriate emphasis has been given to conflictingcamps in the debate over enteral nutrition versus parenteral nutrition.It is not a question of one or the other,but a question of finding the right balance between parenteral and enteral nutrition using both EN and PN to achieve the daily caloric needs of the patient.Not uncommonly,paitents receive inadequate nutrition support during the ramp-up of enteral feedings over several days under the perception that parenteral nutrition carries a high risk of complications,and therefore should be avoided.Properly administered parenteral nutrition is both safe and effective,especially when used with a “background patter”of enteral nutrition.Just a small amount of enteral nutrition significantly reduces the potential complications from parenteral nutrition associated with lack of gut barrier function and inadequate stimulation of the enteral-hepatic circulation.A small amount of background enteral nutrition paves the way for safe administration of apropriate parenteral nutrition to meet the caloric needs and achieve the necessary macro-and micro-nutrient balance to accelerate the recovery of medical and surgical patients otherwise suffering from nutritional compromise.Ⅰ.PN vs.EN Not either-or,but…BOTHⅡ.Risk Factors for EN*Mechanical*Septic*Obtunded patient*Gastroparesis*Frequently occurs for 1-3 days post op*More common and severe with diabetes*Uneven GI function*Stomach-jejunum-ileum-colon*Improperly placed feeding tube*Naso-gastric*Naso-jejunal*Importance of decompressing the stomach*Acquired lactase deficiency*Diarrhea*Constipation*Mechanical-related to insertion and maintenance of IV line*Septic-related to sterile technique,potential for bacterial contamination*Metabolic-issues of fluid balance and nutrition:electrolytes,fat,carbohydrate,protein,vitamins,trace elementsⅢ.Goals *Maintain appropriate level of nutrition support*Avoid complicationsⅣ.Keys to Success *Nutritional Assessment*Keep it simple*Base line*Ongoing*Understand the physiologic state of your patient*If the gut works.use it!*Give a combination of PN and EN*“Mix and Match”*Team approach:*One person in charge*Transition from PN to EN Ⅴ.Transition from PN to EN (see graph)Ⅵ.Pearls for PN *Protocol approach*Sterile technique*Expert line placement*Disciplined line-dressing changes*20-50% of daily calories as fat*Use only 20% lipid emulsion*Use MCT/LCT fat emulsion if available*Always give some ENAs little as 1-2cc/hr provides physiologic protection *Healthy gut with mucous production:minimizes bacterial translocation*Entero-hepatic circulation:minimizes fatty liver and cholestasis*Administer fat and blucose-amino acid solutions together*Add 1 IU/cc heparin to glucose-amino acid solution*Restrict osmolarity to <600 mosm*Ongoing fever work up*Ongoing global assessmentEN and PN *Set nutritional therapy goal*Give “background patter”of EN*Give the balance of calories-electrolytes-vitamins-trace elements as PNⅦ.Keep it Physiologic Keep it Simple     

欧洲肠外肠内营养研讨会关于胰腺疾病肠内营养的指南摘要

2006年,欧洲肠外肠内营养协会(ESPEN)制定了关于急、慢性胰腺炎的EN指南,用以指导胰腺炎病人EN的临床工作.该指南共有19条,其中A级4条,B级2条,C级12条,有1条未列出等级.     

围手术期肠内营养

背景肠内营养与肠外营养相比具有更符合生理、有利于维持肠道黏膜细胞结构与功能完整性、并发症少且价格低廉等优点,因此,只要患者存在部分胃肠道消化吸收功能,应尽可能首先考虑肠内营养支持。严重营养不足是影响外科手术患者结局的重要因素[1~3];而不适当的营养支持同样会给患     

膳食纤维与肠内营养

膳食纤维（ｄｉｅｔａｒｙｆｉｂｅｒ，ＤＦ）一词始见于Ｈｉｐｓｌｅｙ（１９５３）“膳食纤维与妊娠毒血症”一文，其称经流行病学调查，证实妊娠毒血症与膳食中的植物细胞壁（含ＤＦ）有关。当时并未引起人们普遍的关注。以后，陆续发现富含水果与蔬菜的膳食具有降低胆...     

膳食纤维和肠内营养

传统的肠内营养液不含或几乎不含膳食纤维，是一种低渣饮食。因为粘稠度低和不含颗粒物质，很容易管饲。排便量和次数少，结肠处于休息状态被认为是肠内营养的优点。     

胃手术后肠内营养应用

我们对 6 2例行毕氏Ⅰ、Ⅱ式胃切除、全胃切除、近端胃部分切除患者在应用吻合器作胃部手术的同时 ,插入Ｓ型肠内营养管 ,术后早期进行肠内营养 ,可增加手术安全性 ,降低病人住院费用 ,报告如下。1　材料与方法肠内营养管Ｓ1型长 12 5ｃｍ ,由聚氨脂材料组成 ,内径 3.3ｍｍ ,内有金属导丝 ;Ｓ2 型管长 110ｃｍ ,为内径 3.3ｃｍ的硅胶管。肠内营养应用能全力营养液 (荷兰Ｎｕｔｒｉｃｉａ)每 5 0 0ｍＬ含蛋白质 2 0 ｇ、脂肪19ｇ、碳水化合物 6 1.5 ｇ、膳食纤维 7.5 ｇ、矿物质 3ｇ及各种维生素 ,热卡 1ｋｃａｌ/ｍＬ。毕Ⅰ式及近端胃切 31…