血流动力学不稳定重症患者肠内营养的耐受性与安全性

Tolerability and safety of enteral nutritionin in critical ill patients with hemodynamic instability

肠内营养（EN）是有肠道功能的重症患者营养支持的首选途径，具有预防黏膜萎缩、维持肠道结构完整性及提高免疫力等优点。指南推荐血流动力学不稳定时高剂量儿茶酚胺类药物可降低EN的耐受性，应停止EN。脓毒症休克时内脏灌注减少，不同的血管活性药物对内脏灌注的影响也有差异，既可增加灌注也可减少灌注。胃肠灌注不足时给予EN可增加临床罕见并发症发生的风险。本文总结了血流动力学不稳定的重症患者EN的耐受性和安全性，从而为EN的早期实施提供理论依据。

In patients with a functional gut, enteral nutrition is the preferred route of nutrition support. The favorable effects of enteral nutrition include prevention of mucosal atrophy, maintaining of the integrity of gut flora, and improvement of immunocompetence. The guidlines recommend EN be withheld in patients requiring significant hemodynamie support, because of highdose eatecholamine agents which could reduce EN tolerance. Splanchnic perfusion is reduced in sepsis shock, yet vasoactive agents have demonstrated both improved and diminished perfusion. Inadequate perfusion increases the risk of experiencing rare but serious adverse events. This study summarizes the tolerability and safety of enteral nutritionin in critically ill patients with hemodynamic instability and provides theoretical basis for the early administration of EN.