Nutrition therapy includes enteral nutrition (EN) therapy and parenteral nutrition (PN) therapy, and the former is divided into diet therapy and tube feeding nutrition therapy. Nutritional therapy for critically ill patients is very important, as the saying goes, “Disease is treated in three parts and nourished in seven parts”, in which nutrition is one of them. At all times, if the gastrointestinal system exists, enteral nutrition should be considered first. Compared with parenteral nutrition, enteral nutrition is economical, safe, convenient and in line with the physiological process.
Enteral nutrition preparations are divided into two main categories according to their protein source: one is amino acid and short peptide type (elemental) preparations; the other is whole protein type (non-elemental) preparations. Within each type of preparation, there are balanced and disease-specific types. Enteral nutrition preparations in foreign countries also include component enteral nutrition preparations.
In order to improve the effect of clinical nutrition treatment and standardize the procedure of clinical nutrition treatment, based on the reference of relevant information at home and abroad, and combined with the experience of experts of Dongze Special Medicine, the nutrition treatment guideline is formulated for clinical application reference.
I. Indications
1.Consciousness disorder, coma and certain neurological diseases: such as brain trauma, cerebrovascular disease, brain tumor, encephalitis and other coma patients, Alzheimer’s disease can not eat through the mouth or mental disorders, severe depression, anorexia nervosa, etc.
2, swallowing difficulties and loss of chewing ability: such as dysphagia, oropharyngeal trauma and post-surgery, those with severe muscle weakness, etc.
3, upper gastrointestinal obstruction or surgery: such as esophageal inflammation, chemical injury, etc. causing difficulty in chewing or swallowing, esophageal stricture obstruction, esophageal cancer, pyloric obstruction, anastomotic edema stricture, gastroparesis, etc.
4, hypermetabolic state: such as severe trauma, large burns, serious infections and other causes of hypermetabolism and negative nitrogen balance of the body.
5, gastrointestinal fistula: usually applied to low-flow fistula or late stage of fistula, such as esophageal fistula, gastric fistula, intestinal fistula, biliary fistula and pancreatic fistula. The best results for low small intestinal fistula, colonic fistula and jejunal feeding gastroduodenal fistula.
6, preoperative preparation and postoperative malnutrition: such as during preoperative intestinal tube preparation, and those with additional nutrient loss during surgery.
7, inflammatory bowel disease: such as ulcerative colitis, Crohns disease, etc.
8, short bowel syndrome: short bowel syndrome intestinal compensatory stage.
9, pancreatic disease: acute pancreatitis intestinal function recovery, chronic pancreatic insufficiency. Note that the feeding tube should be inserted into the proximal jejunum more than 250px, nutritional preparations can only be used small molecule low-fat without digestion can be absorbed elements of the diet, such as Vivo, Irendo, large elements, etc.
10, chronic nutritional deficiencies: such as malignant tumors, radiotherapy, chemotherapy patients and immunodeficiency diseases, etc.
11, organ insufficiency: such as liver, kidney, lung insufficiency or multi-organ failure
12.Some special diseases: acute radiation disease, various organ transplant recipients, including kidney transplant, liver transplant, small intestine transplant, heart transplant, bone marrow transplant, etc.
13, supplementation or transition when parenteral nutrition therapy cannot meet the requirements.
Contraindications
1, complete mechanical intestinal obstruction, gastrointestinal bleeding, serious abdominal infection.
2.Severe stress state early, shock state, continuous paralytic intestinal obstruction.
3, Early stage of short bowel syndrome.
4.High flow jejunal fistula.
5, persistent severe vomiting, intractable diarrhea, severe small bowel inflammation, severe colitis.
6, gastrointestinal dysfunction, or certain conditions that require gastrointestinal rest.
7.The early stage of acute pancreatitis.