肠外营养发展的里程碑

Recollections of pioneer in nutrition: landmarks in the development of parenteral nutrition

胃肠外营养(PN)的应用仅仅30年。虽从现代意义上讲,这种疗法的成功发展始于近30年。然而,其历史却应追朔到350多年前,1628年,Willian Harvery描述全身血液循环之时作为第一个里程碑。此后的一个世纪进行的调查研究发现,含有电解质和葡萄糖的液体是能够从人的静脉给予的;蛋白质代谢知识的累积,奠定了关于蛋白质水解产物、肽类以及氨基酸静脉营养研究的基础。30年代Robert Elemn观察到:作为蛋白质水解产物形式的氨基酸,可以安全地用于人。这是迈向PN的重要的第一步。此后的年代,主要致力于寻找含有高能量成分、低渗透压的液体。最有现实意义的选择似乎是以乳剂形式存在的脂肪。不同脂肪乳剂的大量研究是从20年代至50年代进行的,然而,所有这些乳剂均在人身上引起严重的副作用反应。首次安全的脂肪乳剂—英脱利匹特(Intralipid)的应用是在60年代初期;这是迈向PN的重要的第二步;此后,于脂肪乳、氨基酸和葡萄糖溶液中加入维生素、电解质和微量元素已不成问题。几年后,中心静脉插管被证明可用于静脉输液。许多临床研究和报告表明,新生产的营养制剂足以替代普通状况普通饮食。以这种方式维持或保持那些多因无法口服或鼻饲的患者的良好的营养状况是可行的,PN对于预防和治疗常致高并发症及死亡率的饥饿已显示出极?

Parenteral nutrition (PN) has been available for only 30 years. The successful development of this therapy, in a modem sense, was initiated in the late 30s. However, history in this field goes back more than 350 years, with the first landmark being the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides and amino acids. The observation in the late 30s by Robert Elman that amino acids in theform of protein hydrolysate could be administered safely in man was the first major step toward PN. During the following years, major efforts were made to find methods to pr pare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made from the 20s until the end of the 50s. However, all of these emulsions caused severe adverse reactions in man. The first safe fat emulsion, Intralipid, was made available in the early 60s. This was the second major step toward PN. It was then no problem to include vitamins, electrolytes and trace element in the fat emulsions and the solutions of amino acids and glucose. A few years later it was shown that a central venous catheter could be used to administer the infusion fluid intravenously. Many clinical investigations and reports have shown that the newly developed intravenous nutritional regimens are adequate alternatives to the ordinary diet. In this way it has been possible to maintain or obtain a good nutritional condition is most situations when oral or tube feeding can not be used. PN has been shown to be of very great clinical importance to prevent and treat starvation often related to high morbidity and mortality.