日本肠内营养进展

EN in Japan

Despite plyaing important roles in recovery or maintenance ofnutritional state and immunocompetene in malnourished or surgically injured patients,nutritional care has still controversial problems in view of complications related to administered calory,composition of energy substrates and feeding routes.Present presentation would be focused on Japanese articles of enteral nutrition (EN) care with semi digested formula for surgical patients.We have already revealed experimentally and clinically that every EN of semi digested formula is well utilized as energy sources and also that EN exerts tropic influences on gut structure and integrity.On the other hand,EN should be applied carefully to avoid many untoward gastrointestinal reactions.In retrospective analysis of perioperative nutritional care for patients of upper GI tract malignancies we certified that the early applied and stepwisely increased EN plus peripheral parental nutrition could maintain the postoperative nutritional state as well as TPN.Kakegawa et al.performed a clinical evaluation of enteral nutrition-Harmonic M.which contains lactoalbumin and soy protein,MCT and LCT in postoperative upper GI tract malignancies.In a randomized controlled study by telephone method they revealed that Harmonic M could be feasible for postoperative nutritional care of severely stressed surgical patients without any serious complications.Takagi et al investigated how the antecedent nutritional routes influence systemic IL6 and IL10 reponses and endotoxin translocation after an operation for thoracic esophageal cancer.In spite of retrospective analysis they verified as follows:Perioperative EN provides better regulation of inflammatory cytokine responses and may contribute less to immunosupression after major surgery than parenteral nutrition.The attenuated production of endotoxcin induced by EN may play an important role in these phenomena.In the gastroenterological field we revealed that EN was effective on the supportive care of severe actute pancreatitis.EN with semidigestive formula was also reported to be applied successfully in postoperative patients in cardiovascular surgery,neurosurgery and pediatric surgery.Current concept of EN in Japan would be reviewed from the standpoints of indication,protocol or schedule,and applying methods.