1、8 =!h ! 0 sM1y Z蒋洋洋1, 28 , 许 勤1, 2, 宋燕波2 ,n( 2D Sv,1. ;2.B DICU, 2210029)K1 =! “5 PV V? 3 0 s f ,/! 0 sM1 Q,V%hM1y、h Z T =! L Z y8s,i4n 。1oM =!; ! 0 s; h ms | R459.3 DS A cI| 1007-810X(2011)01-0046-04ProgresoffactorsassociatedwithenteralfeedingintoleranceJIANGYang-yang1, 2 reviewing, XUQin1, 2, SONG
2、Yan-bo2 checking(1.SchoolofNursing;2.DepartmentofICU,theFirstAfiliatedHospitalwithNanjingMedicalUniversity,Nanjing210029, Jiangsu, China)Abstract Thereisagreatdealofintoleranceoccurredintheuseofenteralnutrition.Thepatientstreatmentandtheadministrationofenteralnutritionmayberelatedtothecausesandtheim
3、provement.Keywords Enteralnutrition; Feedintolerance; Criticalilpatients! h Ri5。 =!(EN) 6、 、r “5 R,$T! nZE。 PENV,th C ! 0sC。/EN! 0 s(feedintoler-ance)QC TB8 。1 ! 0 sM1 QMcClave1,! 0 s 4,7 O9 , XL、8_、 (GAV) B ? S。 9、n、 、 |s、Q L ,$ ! 0 s “5VC 2。1.1 喂养不耐受的评估标准 Andrew 3|! 0 slh C/ f B:EN48h=T4Q。y/ i?B(“
4、b _ m )。 |s;1 BQ , (GRV) 250 ml; 55 5 M 7) ? A!A = ;!AF H, V05 。48 h =9GRV2 000ml。|! 0sl!V? 3 |sQ 7 S!6 hGAV250 ml, O 40 ml/h 4-5。7SY PS 12 hGAV1 200 ml、 |s、n、e 6。1.2 喂养不耐受与 EN胃肠道并发症的区别 ! 0 s? 3 i? 3 -4y。h EN 0 s, VCi?, n、 、0 |s。AQ 9 7。 ,! 0 s? 3EN P 7 S , ?Z7r,5i?。2 Y ?ih ,EN$ ! nZE。EN L VC 0 s f ,
5、h a/。Q |s9F k? 3, F B。tC Ph ! “SHW。Herv 8A U,46%(95%CI,38% 54%)h C 0 s,7y 46 =! 2011 M118 1 Parenteral EnteralNutrition, Vol.18, No.1, January, 2011Te: , V 3,V Y S “5 。E-mail:YT: W,E-mail:DOI :10.16151/j.1007-810x.2011.01.020GAV7 ? 。3 ! 0 sYy ! 0 s y# bWS。r50%h ? 3 b,05! 0 s。3.1 疾病相关的因素3.1.1 高血糖 Nam
6、9?C,? 3 0sh 9。YV , ,9F # E=x l , P b。N,) 2 Uhh ? 3! 0 sBi9F, V ?YVO e| h 0 s1 10。3.1.2 高危疾病 ?C, e M-、%h0Y ?y ,“ T 7 h , h? h G bB 8 11 。MQ, 、d h ,? 3 b qKl。 t ? *8AM7 p。 X L Pb 、 。y * s8y9F# A8VV9 = 3Y23。 6,!A 1i i V y, 8 = 1iV,“ ,0、e G7。 P h Br m , =91。ty V ?9F J5Q 、EN 0 s M1kB 26。4 4.1 应用胃肠道促动力药物
7、0 ? h b ? 27 。S,39%h PS 05 。 0iT? P,T e 28。J o YV F-2 s8、d 5-HT3 s8、5-HT4 s89F l 。 VYV9 5 2448 h1Q。!h 148 h = 4h_1Q= ,r! “S Pl g5V 68 h1Q。5 “EN 0 s M ,#n ?Z,EN 6、 、r、 3 T、 TMeL “5 R。EN 0 s MY,i |rn ,h i? 3, ?r! “。【 ID】1 McClave,JamesK, JamesA, etal.Poorvalidityofresidualvol-umesasamarkerforriskofasp
8、irationincriticalyilpatients.CritCareMed, 2005, 33(2):324-330.2 MontejoJC.Enteralnutrition-relatedgastrointestinalcomplica-tionsincriticalyilpatients:amulticenterstudy.Thenutritionalandmetabolicworkinggroupofthespanishsocietyofintensivecaremedicineandcoronaryunits.CritCareMed, 1999, 27(8):1447-1453.
9、3 AndrewRD,PaulRAF,CraigJ,etal.Frenchrandomizedcompar-isonofnasojejunalandnasogastricfeedingincriticalyilpa-tients.CritCareMed, 2002, 30(3):586-590.4 NguyenNQ,ChapmanM,FraserR,etal.Eythromycinismoreef-fectivethanmetoclopramideinthetreatmentoffeedintoleranceincriticalilness.CritCareMed, 2007, 35(2):4
10、83-489.5 MooreFA, CocanourCS, McKinleyBA,etal.Migratingmotilitycomplexespersistafterseveretraumaticshockinpatientswhotol-erateenteralnutrition.Trauma, 2001, 51(6):1075-1082.6 , , ,. m b/ g5* =!h 0 ss. =!, 2009, 16(2):90-92.7 ,u , .* =!M1i?s.S8 “5, 2004, 20(2):126-127.8 HervM, HervD,MariaB, etal.Uppe
11、rdigestiveintoleranceduringenteralnutritionincriticallyilpatients:Frequency, riskfactors, andcomplications.CritCareMed, 2001, 29(10):1955-1961.48 =! 2011 M118 1 Parenteral EnteralNutrition, Vol.18, No.1, January, 2011 9 NamN,KatrinaC,RobertF,etal.Therelationshipbetweenbloodglucosecontrolandintoleran
12、cetoenteralfeedingduringcriticalilness.IntensiveCareMed, 2007, 33(12):2085-2092. 10 NguyenNQ,LamSW,ChingK,etal.GastricfeedintoleranceisnotincreasedincriticalyilpatientswithtypeIIdiabetesmelli-tus.IntensiveCareMed, 2007, 33(10):1740-1745. 11 NamQN,MeiPN,MarianneC,etal.Theimpactofadmissiondi-agnosison
13、gastricemptyingincriticalyilpatients.CriticalCare,2007, 11(1):R16. 12 ViletS,ChioleroRL,Bolmann,etal.Negativeimpactofhypoca-loricfeedingandenergybalanceonclinicaloutcomeinICUpa-tients.ClinNutr, 2005, 24(4):502-509. 13 KaoCH, ChangLaiSP, ChiengPU, etal.Gastricemptyinginhead-injuredpatients.AmJGastroe
14、nterol, 1998, 93(7):1108-1112. 14 RitzMA,FraserR,EdwardsN,etal.Delayedgastricemptyinginventilatedcriticalyilpatients:measurementby13 C-octanoicacidbreathtest.CritCareMed, 2001, 29(9):1744-1749. 15 KozarRA,HuS,HassounHT,etal.Specificintraluminalnutri-entsaltermucosalbloodflowduringgutischemia/reperfu
15、sion.JPEN, 2002, 26(4):226-229. 16 1 , , ,. -9 * =! 0 sY. +Dv, 2005, 27(10):1016-1019. 17 HammasB, ThornSE,WatwilM.Propofolandgastricefectsofmorphine.ActaAnaesthesiolScand, 2001, 45(8):1023-1027. 18 InadaT,AsaiT,YamadaM,etal.Propofolandmidazolaminhibitgastricemptyingandgastrointestinaltransitinmice.
16、AnesthAnalg, 2004, 99(4):1102-1106. 19 RitzMA, FraserR, TamW, etal.Impactsandpaternsofdis-turbedgastrointestinalfunctionincriticalyilpatients.AmJGas-troenterol, 2000, 95(11):3044-3052. 20 , . =!.: 3, 2002:109-112.21 y W.Y 0s. ZD0, 2001, 31(3):5-7.22 , t, Z,.Y W y). , 2001, 24(5):292-294.23 MarshalAP
17、, WestSH.Enteralfeedinginthecriticalyil:arenursingpracticescontributingtohypocaloricfeeding? IntensiveCritCareNurs, 2006, 22(2):95-105.24 l , j ,g,. Z TY ?Y.D Sv, 2005, 22(6):994-995.25 -, U ,. =! H AF C). “5 , 2009, 8(2):24-25.26 JeanR,NathalieTJ,MaudF,etal.Earlyenteralnutritioninme-chanicalyventil
18、atedpatientsintheproneposition.CritCareMed, 2004, 32(1):94-99.27 NguyenNQ,ChapmanM,FraserRJ,etal.Prokinetictherapyforfeedintoleranceincriticalilness:Onedrugortwo? CritCareMed, 2007, 35(11):2561-2567.28 RohmKD, SchollhornT, BoldtJ, etal.Nutritionsupportandtreatmentofmotilitydisordersincriticalyilpati
19、ents:resultsofasurveyonGermanintensivecareunits.EurJAnaesthesiol, 2008,25(1):58-66.29 CoulieB, TackJ, PeetersT, etal.Involvementoftwodiferentpathwaysinthemotorefectsoferythromycinonthegastrican-truminhumans.Gut, 1998, 43(3):395-400.30 NamQN,KatrinaC,RobertJ.FraserRiskofClostridiumdificilediarheaincr
20、iticalyilpatientstreatedwitherythromycin-basedprokinetictherapyforfeedintolerance.IntensiveCareMed, 2008,34(1):169-173.31 BoivinMA,LevyH.Gastricfeedingwitherythromycinisequiva-lenttotranspyloricfeedinginthecriticalyil.CritCareMed,2001, 29(10):1916-1919.32 DaviesAR,FroomesPRA,FrenchCJ,etal.Randomized
21、compari-sonofnasojejunalandnasogastricfeedingincriticalyilpatients.CritCareMed, 2002, 30(3):586-590.33 :, 7.h =0 b5* =!. =!, 2005, 12(6):332-334.34 BankheadR,BoulataJ, BrantleyS,etal.Enteralnutritionprac-ticerecommendations.JPEN, 2009, 33(2):122-167.(2010-01-20 l; 2010-03-17)临床营养支持的应用与研究继续教育高级学习班招生通
22、知“5! 21 WC S1ZB。11997 M S,S= Y SE、DE p VSEI ?D “ “5!)。 D?Z-, D 、 SB8,4 Q, , Hq, !?,YV 、5V、z 7 p、 l 3、z 7 jp T 17 200Q。85% XS “5! ,vs D !F。F AM:B M4,= M 6, M - M, W,Q“。 , 、QS = S () 55。 ! “5!A,T$ 2005、2009 M 8 8)TB,dA“ “5!” !。2011 MB、= E49sY 2 。FHq:V Y “5!T2 M,D = (cD =), S (c S) 。W f hf。Y: 2 g 305| 2 + u 29D,I210002。 “ : 。:025-80860088。E-mail:49 =! 2011 M118 1 Parenteral EnteralNutrition, Vol.18, No.1, January, 2011
