Parenteral nutrition in the critically ill patient.
Parenteral nutrition in the critically ill patient.
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DOI：
10.1056/nejmct0806956
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发表时间：
2009-09-10
期刊：
影响因子：
--
通讯作者：
Ziegler TR
中科院分区：
文献类型：
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作者：
Ziegler TR
一位67岁女性2型糖尿病患者，因肠系膜缺血接受小肠和右半结肠广泛切除，空肠造口术和结肠造口术。在外科重症监护病房，严重的全身炎症反应综合征可能与败血症的发展。患者接受容量复苏、血管加压药支持、机械通气、广谱抗生素和静脉胰岛素输注治疗。术后通过鼻胃管开始低剂量管饲。然而，在血管加压药需求增加、腹胀恶化、胃残留量增加以及沿着呕吐发作后，应停止这些喂养。向医院营养支持部门咨询喂养建议。与患者家属的讨论显示，在过去6个月内，患者体重减轻了约15%，并因进食相关腹痛而减少了进食量。她的术前体重为51 kg（112 lb），或理想体重的90%。体格检查显示骨骼肌和脂肪轻度萎缩。血液检查显示低镁血症，低磷血症，肝肾功能正常。推荐使用中心静脉肠外营养。
A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical intensive care unit, severe systemic inflammatory response syndrome with possible sepsis develops. The patient is treated with volume resuscitation, vasopressor support, mechanical ventilation, broad-spectrum antibiotics, and intravenous insulin infusion. Low-dose tube feedings are initiated postoperatively through a nasogastric tube. However, these feedings are discontinued after the development of escalating vasopressor requirements, worsening abdominal distention, and increased gastric residual volume, along with an episode of emesis. The hospital nutritional-support service is consulted for feeding recommendations. A discussion with the patient's family reveals that during the previous 6 months, she lost approximately 15% of her usual body weight and decreased her food intake because of abdominal pain associated with eating. Her preoperative body weight was 51 kg (112 lb), or 90% of her ideal body weight. The physical examination reveals mild wasting of skeletal muscle and fat. Blood tests show hypomagnesemia, hypophosphatemia, and normal hepatic and renal function. Central venous parenteral nutrition is recommended.