重视重症病人代谢、免疫和器官功能的营养调理治疗

Nutrition regulation therapy in metabolism,immunity and organ function of critical ill patients:current thinking and future directions

重症病人常伴有程度不一的高分解代谢、免疫炎性反应失衡以及器官功能障碍,单纯的营养支持并不能改善危重病人的营养状态。目前,危重病人的临床营养支持的目的已从单纯的"供给细胞代谢所需要的能量与营养底物,维持组织器官结构与功能",拓展到调控应激状态下的炎症、免疫与内分泌状态以及高分解代谢,改善和保护器官功能等,即由"营养支持"向"营养治疗"发展。近年来,在重症病人的营养支持治疗中,调理应激分解代谢和促进合成代谢的作用得到部分肯定,随之出现的营养药理学和营养免疫学,使营养调理治疗的概念和内容又有了新的拓展。对于重症病人,熟悉病人代谢、免疫炎性反应以及器官功能的变化,适时采用合理而积极的代谢、免疫调理治疗,改善和保护器官功能,应该成为重症病人综合治疗策略中的一个重要组成部分。

Critical ill patients who undergoing hypercatabolism, immunity inflammatory reaction disordered and organ dysfunction, could not be improved by exclusively nutriment supply. Current conception of clinical nutritional support in the intensive care unit （ICU） has been evolved. The purpose that used to be filling cellular metabolic need including enough energy and nutrition elements for metabolism, has now expanded into modifying inflammation and hypercatabolism, improving immune and endocrine status, and protecting organ function. And, it is the change from ＇nutritional support＇ to ＇nutritional therapy＇. Recent investigations of nutrition support in the ICU have relatively conformed regulation of stress atabolism and promotion anabolic in clinical practice. Follow- ing pharmacology ald immunology nutrition developed, the current conception and content of nutrition regulation therapy have new expanded from ＇nutrition support＇. For critical ill patients, it is necessary to familiar with the changes of metabolism, immunity inflammatory reaction and organ-function of patients. At the right moment, to adopt reasonable, active and immunity regulation therapy has hopeful to amend and protect organ-function of patients. The regulation therapy of metabolism and immunity makes an important ingredient in the combined therapy strategy of critical ill patients.