ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology
ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology
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DOI：
10.1016/j.clnu.2009.04.023
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发表时间：
2009-08-01
影响因子：
6.3
通讯作者：
Schols, A. M. W. J.
中科院分区：
文献类型：
--
作者：
Anker, S. D.;Laviano, A.;Schols, A. M. W. J.
营养支持正在成为慢性病患者综合治疗方法的支柱。慢性心力衰竭（CHF）和慢性阻塞性肺病（COPD）通常与营养不良的进展有关，这是由于能量摄入减少、能量消耗增加和食欲受损。营养不良和最终的恶病质已被证明对CHF和COPD的临床过程具有负面影响，并影响患者的生活质量。因此，应考虑对这些患者进行营养支持，特别是防止进行性体重减轻，因为可能无法恢复瘦体重和脂肪体重。在CHF和COPD患者中，胃肠道是正常可及的并且起作用。虽然最近的报道表明心力衰竭与肠道形态学、通透性和吸收的改变有关，但这些改变的临床意义仍不清楚。当心肺患者需要营养支持时，口服补充剂和肠内营养应是首选，特别是考虑到肠外营养的潜在并发症和经济负担。这种适当优先的肠内途径部分解释了缺乏关于肠外营养在CHF和COPD患者中作用的可靠临床试验。根据通过PubMed、Medline和SCOPUS检索收集的现有证据，建议肠外营养保留给记录有吸收不良和肠内营养失败的患者。(C)2009年欧洲临床营养与代谢学会。All rights reserved.
Nutritional support is becoming a mainstay of the comprehensive therapeutic approach to patients with chronic diseases. Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are frequently associated with the progressive development of malnutrition, due to reduced energy intake, increased energy expenditure and impaired anabolism. Malnutrition and eventually cachexia have been shown to have a negative influence on the clinical course of CHF and COPD, and to impinge on patients' quality of life. Nutritional Support in these patients should be therefore considered, particularly to prevent progressive weight loss, since restoration of lean and fat body mass may not be achievable. In CHF and COPD patients, the gastrointestinal tract is normally accessible and functioning. Although recent reports suggest that heart failure is associated with modifications of intestinal morphology, permeability and absorption, the clinical relevance of these are still not clear. Oral supplementation and enteral nutrition should represent the first choices when cardiopulmonary patients need nutritional support, particularly given the potential complications and economic burden of parenteral nutrition. This appropriately preferential enteral approach partly explains the lack of robust clinical trials of the role of parenteral nutrition in CHF and COPD patients. Based on the available evidence collected via PubMed, Medline, and SCOPUS searches, it is recommended that parenteral nutrition is reserved for those patients in whom malabsorption has been documented and in those in whom enteral nutrition has failed. (C) 2009 European Society for Clinical Nutrition and Metabolism. All rights reserved.