肠外营养在全球及中国的启动与实践

The commencement and practice of parenteral nutrition globally and in China

文章旨在梳理肠外营养(名词编号:01.080,又称静脉营养)的开创历史。1937年,美国外科医师Elman等通过静脉途径将水解纤维蛋白输注到犬体内并观察到正氮平衡,之后在撰写的章节中报道了正氮平衡的示意图。瑞典外科医师Schuberth和内科医师Wretlind在1961年研制出安全的静脉注射用的高能量制剂,是国际上最早的含有葡萄糖、氨基酸和脂肪乳的混合溶液。美国外科医师Dudrick等开展了通过中心静脉途径输注30%葡萄糖、微孔径滤器除菌、硅橡胶导管材料选择和氮平衡监测等实验室工作,验证肠外营养可维持比格犬的生长发育。美国外科医师Wilmore等将肠外营养应用于1例先天性消化道狭窄的女婴,经过18个月的观察验证了肠外营养可维持人类生长发育。以上均是肠外营养开创历程上的里程碑。肠外营养的开创历程崎岖而有趣,蕴含科学研究的一般规律和方法,走过了56年的历程。如今,肠外营养已经到了转化医学T3阶段。在国际同行指导下,中国肠外肠内营养学领域的T3转化初步临床研究也正在开展。希望该文对读者理解肠外肠内营养学需在临床实践中不断优化、不断规范,最终实现营养支持疗法的“合理应用-患者受益”有所帮助。

The aim of this work is to delineate the odyssey of parenteral nutrition(noun number:01.080),which is also called intravenous nutrition.Robert Elman(a surgeon)administered fibrinogen hydrolysate intravenously to dogs and observed the positive nitrogen balance in 1937.Corresponding report about this clinical research was published later on.Oscar Schuberth(a surgeon)and Arvid Wretlind(an internist)developed the soybean oil emulsion with good tolerability and infused a mixture of glucose,amino acids and fat emulsion into patients for the first time.Stanley Dudrick(a surgeon)carried out laboratory studies,such as infusion of 30%glucose through the central vein,selection of materials for silicone rubber catheter,monitoring of nitrogen balance,and so on.He validated that the growth and development of beagle could be supported with parenteral nutrition.Douglas Wilmore(a surgeon)applied parenteral nutrition to a baby girl with congenital stenosis of alimentary tract and thus initially validated the effectiveness of parenteral nutrition in human after 18 months'observation.All mentioned above are landmarks in the history of parenteral nutrition.The development of it is a rugged but interesting journey parenteral nutrition,exemplifying the general principles and methodology of scientific researches.Fifty-six years passing by since the commencement,now,it is time to march into Phase 3 translational(T3)research for parenteral nutrition.T3 clinical researches in parenteral and enteral nutrition is now in the ascendant in China.By looking back at the odyssey,we would like to highlight the necessity of incessant optimization and standardization of parenteral and enteral nutrition practice,to eventually achieve the rational use of nutrition support therapy and bring about patient benefits.