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中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 310 -312. doi: 10.3877/cma.j.issn.2096-1537.2022.04.006

专题笔谈

血流动力学不稳定的重症患者肠内营养的监测与评估
陈传希1, 欧阳彬1,()   
  1. 1. 510080 广州,中山大学附属第一医院重症医学科 广东省急危重症临床医学研究中心
  • 收稿日期:2022-11-01 出版日期:2022-11-28
  • 通信作者: 欧阳彬

Assessment and monitoring enteral nutrition in hemodynamically unstable ICU patients

Chuanxi Chen1, Bin Ouyang1,()   

  1. 1. Department of Critical Care Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2022-11-01 Published:2022-11-28
  • Corresponding author: Bin Ouyang
引用本文:

陈传希, 欧阳彬. 血流动力学不稳定的重症患者肠内营养的监测与评估[J/OL]. 中华重症医学电子杂志, 2022, 08(04): 310-312.

Chuanxi Chen, Bin Ouyang. Assessment and monitoring enteral nutrition in hemodynamically unstable ICU patients[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 310-312.

早期肠内营养(EEN)对重症患者的益处已被证实。在血流动力学不稳定的重症患者中启动营养支持可能存在风险及挑战。在使用血管活性药的重症患者中,EN的实施存在争议。尤其是在血管升压药物下实施EEN是否可能导致急性肠系膜缺血(AMI)和非闭塞性肠坏死(NOBN)的担忧仍然存在。对于这些患者来说,评估和监测循环至关重要。本文讨论了肠内营养实施期间循环的监测,如血管升压药物剂量、灌注指标对胃肠道的影响,提示了循环监测与评估的重要性。

The benefit of enteral nutrition in critically ill patients has been demonstrated by several studies. Initiating nutrition support in hemodynamically unstable ICU patients can be a challenging endeavor. There are many controversies about supplying of EN in critically ill patients with vasopressor. Concerns about early EN (EEN) in patients on vasopressors are still present due to possibility of acute mesenteric ischemia (AMI) and nonocclusive bowel necrosis (NOBN). For these patients, the assessment and monitoring of hemodynamic status are crucial. This paper discusses the monitoring of hemodynamic status during the implementation of enteral nutrition, such as the effect of vasopressor drug dose and perfusion index on gastrointestinal tract, and proposes the importance of monitoring and evaluation of hemodynamic status.

1
Marik PE. Enteral nutrition in the critically ill: myths and misconceptions [J]. Crit Care Med, 2014, 42(4): 962-969.
2
McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of Nutrition Support Therapy in the adult critically ill patient [J]. JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
3
Ceppa EP, Fuh KC, Bulkley GB. Mesenteric hemodynamic response to circulatory shock [J]. Curr Opin Crit Care, 2003, 9(2): 127-132.
4
Ohbe H, Jo T, Matsui H, et al. Differences in effect of early enteral nutrition on mortality among ventilated adults with shock requiring low-, medium-, and high-dose noradrenaline: a propensity-matched analysis [J]. Clin Nutr, 2020, 39(2): 460-467.
5
Mancl EE, Muzevich KM. Tolerability and safety of enteral nutrition in critically ill patients receiving intravenous vasopressor therapy [J]. JPEN J Parenter Enteral Nutr, 2012, 37(5): 641-651.
6
Wang L, Yang H, Cheng Y, et al. Mean arterial pressure/norepinephrine equivalent dose index as an early measure of initiation time for enteral nutrition in patients with shock: a prospective observational study [J]. Nutrition, 2022, 96: 111586.
7
Franzosi OS, Nunes DS, Klanovicz TM, et al. Hemodynamic and skin perfusion is associated with successful enteral nutrition therapy in septic shock patients [J]. Clin Nutr, 2020, 39(12): 3721-3729.
8
Mao Z, Liu G, Yu Q, et al. Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: A retrospective cohort study [J]. Ann Transl Med, 2020, 8(19): 1240-1240.
9
Piton G, Cypriani B, Regnard J, et al. Catecholamine use is associated with enterocyte damage in critically ill patients [J]. Shock, 2015, 43(5): 437-442.
10
Piton G, Le Gouge A, Brulé N, et al. Impact of the route of nutrition on gut mucosa in ventilated adults with shock: An ancillary of the NUTRIREA-2 trial [J]. Intensive Care Med, 2019, 45(7): 948-956.
11
Reignier J, Boisramé-Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: A randomised, controlled, multicentre, open-label, Parallel-Group Study (NUTRIREA-2) [J]. Lancet, 2018, 391(10116): 133-143.
12
Flordelís Lasierra JL, Montejo González JC, López Delgado JC, et al. Enteral nutrition in critically ill patients under vasoactive drug therapy: the NUTRIVAD study [J]. JPEN J Parenter Enteral Nutr, 2022, 46(6): 1420-1430.
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