Parenteral Nutrition in Critical Illness: Can it Safely Improve Outcomes?
Parenteral Nutrition in Critical Illness: Can it Safely Improve Outcomes?
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DOI：
10.1016/j.ccc.2010.04.002
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发表时间：
2010-07-01
影响因子：
4.3
通讯作者：
Pichard, Claude
中科院分区：
文献类型：
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作者：
Thibault, Ronan;Pichard, Claude
全肠外营养是在20世纪60年代开发的，此后在重症监护室（ICU）中普遍实施。20世纪80年代和90年代初发表的研究表明，全胃肠外营养的使用与死亡率和感染发病率增加有关。这些不利影响与高血糖症和营养过剩有关，当时未按照一体化原则给予肠外营养。由于其对胃肠道的有益作用，肠内营养在20世纪80年代取代了肠外营养，成为ICU营养护理的黄金标准。然而，单独的肠内营养通常与能量需求的覆盖不足相关，并且随后的蛋白质-能量不足与更差的临床结局相关。最近的证据表明，如果血糖得到控制，避免高营养，全合一肠外营养对ICU患者的死亡率和感染发病率没有显著影响。因此，是时候重新考虑在ICU中使用肠外营养了。当肠内营养不足以满足能量需求时，补充肠外营养可以预防营养缺乏症的发生。临床研究表明，肠外营养和肠内营养的组合可以改善ICU患者的临床结局。
Total parenteral nutrition was developed in the 1960s and has since been implemented commonly in the intensive care unit (ICU). Studies published in the 1980s and early 1990s indicate that the use of total parenteral nutrition is associated with increased mortality and infectious morbidity. These detrimental effects were related to hyperglycemia and overnutrition at a period when parenteral nutrition was not administered according to the all-in-one principle. Because of its beneficial effects on the gastrointestinal tract, enteral nutrition alone replaced parenteral nutrition as the gold standard of nutritional care in the ICU in the 1980s. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequent protein-energy deficit is correlated with a worse clinical outcome. Recent evidence suggests that all-in-one parenteral nutrition has no significant effect on mortality and infectious morbidity in patients in the ICU if a glycemic control is obtained and hyperalimentation avoided. Thus, the time has come to reconsider the use of parenteral nutrition in the ICU. Supplemental parenteral nutrition could prevent onset of nutritional deficiencies when enteral nutrition is insufficient in meeting energy requirements. Clinical studies are warranted to show that the combination of parenteral and enteral nutrition could improve the clinical outcome of patients in the ICU.