Dinh dưỡng qua đường tiêu hóa ở bệnh nhân nặng: Một đánh giá quan trọng về bằng chứng

Intensive Care Medicine - Tập 19 - Trang 435-442 - 1993
D. K. Heyland1,2, D. J. Cook1,2, G. H. Guyatt1,2
1Department of Medicine, Division of Critical Care, McMaster University, Faculty of Health Sciences, Hamilton, Canada
2Department of Clinical Epidemiology and Biostatistics, McMaster University, Faculty of Health Sciences, Hamilton, Canada

Tóm tắt

Để xem xét mối quan hệ giữa dinh dưỡng qua đường tiêu hóa (EN) và nhiễm trùng ở bệnh nhân nặng. Thiết lập: Tìm kiếm bằng máy tính các nghiên cứu đã được công bố và xem xét các danh sách tài liệu tham khảo liên quan. Lựa chọn nghiên cứu: 151 tài liệu đã được xem xét, trong đó có 39 bài báo đáp ứng tiêu chí lựa chọn. Các nghiên cứu chính được bao gồm nếu họ đánh giá EN ở người bệnh nặng và ảnh hưởng của nó đến bệnh tật và tử vong do nhiễm trùng. Dữ liệu liên quan đã được trích xuất về thời gian và tác động của EN đối với bệnh tật, cách thức tối ưu để cho ăn, thành phần và độ pH của EN, cũng như sự nhiễm khuẩn của EN. Bằng chứng từ các nghiên cứu trên con người cho thấy EN, đặc biệt là EN sớm, dẫn đến giảm tỷ lệ nhiễm trùng so với dinh dưỡng tĩnh mạch, nhưng giới hạn trong các nghiên cứu nhỏ, không mù và với các định nghĩa không nghiêm ngặt về viêm phổi. Không có bằng chứng nào ủng hộ việc ưu tiên cho ăn vào dạ dày so với ruột non. Việc bổ sung dầu cá, arginine, glutamine và chất xơ vào thức ăn qua đường tiêu hóa có tác động khác nhau đến khả năng sống sót ở các mô hình động vật; không có thử nghiệm nào ở bệnh nhân nặng cho thấy sự giảm tỷ lệ bệnh tật và tử vong do nhiễm trùng. Acid hóa dinh dưỡng qua đường tiêu hóa dẫn đến giảm sự sinh trưởng của vi khuẩn trong dạ dày ở bệnh nhân nặng. Sự nhiễm khuẩn của dinh dưỡng qua đường tiêu hóa là một nguồn quan trọng của nhiễm trùng. Bằng chứng từ dữ liệu thí nghiệm ở bệnh nhân nặng cho thấy dinh dưỡng qua đường tiêu hóa có thể tác động tích cực đến chức năng miễn dịch đường tiêu hóa và bệnh tật do nhiễm trùng.

Từ khóa

#dinh dưỡng qua đường tiêu hóa #bệnh nhân nặng #nhiễm trùng #bệnh tật #tử vong

Tài liệu tham khảo

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