Nutrition is the basis for biological growth and survival, and is the substrate for patients to resist external aggression, maintain physiological functions, repair tissues, and restore health. There are two types of nutritional support: parenteral (PN) and enteral (EN) nutritional support. Parenteral nutrition has played an important role in the treatment of surgical diseases, and it is now believed that as long as the intestine is functional, enteral nutrition is superior to parenteral nutrition.
Enteral nutrition mechanism of action: 1.
1.Maintain the normal structure of intestinal mucosal cells, intercellular connection and villi height, and maintain the mechanical barrier of mucosa.
2.Maintain the normal growth of intestinal intrinsic flora and maintain the biological barrier of mucosa.
3, contribute to the normal secretion of IgA by intestinal cells and maintain the immune barrier of the mucosa.
4.Stimulating secretion of gastric acid and pepsin to maintain the chemical barrier of the mucosa.
5.Stimulate the secretion of digestive juices and gastrointestinal hormones, promote gallbladder contraction, gastrointestinal peristalsis, increase visceral blood flow, and make the metabolism more in line with the physiological process.
Advantages of enteral nutrition
1.Comprehensive and balanced, in line with physiology
Provide sufficient energy
Provide safe, balanced and complete nutrients and micronutrients
Provide a variety of dietary fiber and glutamine required for normal physiology
Nutrients are absorbed through the portal system, which is conducive to protein synthesis and metabolic regulation
2.Maintain the function of gastrointestinal tract
Maintain the integrity of the structure and function of the gastrointestinal tract
Protect the intestinal mucosal barrier and prevent bacterial translocation
Maintain the secretion of digestive juices and digestive tract hormones to protect liver function
Stimulate and promote the damaged intestinal tract to restore its function as soon as possible
3.Protect liver function
Absorption of nutrients through the portal system, maintaining the normal metabolic process of nutrients
Maintain the normal excretion of bile and normal hepatic and intestinal circulation
Improve the blood supply and nutrition of the liver
Protect the intestinal mucosal barrier to prevent damage to the liver from enteric-derived toxins entering through the blood
4.Improve the immunity of the body
Improve patient’s nutritional status and immunity
Protect the intestinal mucosal barrier to prevent intestinal-derived infection caused by bacteria translocation
Stimulate the secretion of immunoglobulins from the gastrointestinal tract
5.Reduce high catabolism
Reduce intestinal ischemia in stress patients, lower the level of catabolic hormones and cytokines, and relieve high catabolism
Promote the synthesis of protein in the body
Improve nitrogen balance
6Economic and safe
Reduces clinical complications and mortality
Shorten patient’s hospitalization time
Enteral nutrition avoids the metabolic disorders and catheter sepsis that are easily caused by parenteral nutrition
It is convenient to use and easy to manage clinically, and the cost is only about 1/10 of parenteral nutrition.
Indications for enteral nutrition
1.Difficulty in swallowing and chewing
2.Consciousness disorder or coma
3.Gastrointestinal fistula
4.Short bowel syndrome
5.Intestinal inflammatory disease
6.Acute pancreatitis
7.High metabolic state
8.Chronic wasting disease
9, correction and prevention of malnutrition before and after surgery
10.Special diseases
Paralytic and mechanical intestinal obstruction, active gastrointestinal bleeding and shock are all contraindications to enteral nutrition. It should also be used with caution in case of severe diarrhea or extreme malabsorption.
In patients who need nutritional support (critical, trauma, malnutrition, etc.), nutritional support becomes the main treatment for some diseases and should be as important as other treatments. When possible, it is advisable to give timely supplementation in time or in advance, preferably to correct it afterwards.
Clinically, sometimes enteral and parenteral nutrition are combined, but the basic principle is that enteral nutrition should be used as much as possible as long as intestinal function allows. When enteral nutrition is implemented, it should be given orally if it can be given orally; if it cannot be given orally, it can be given by nasogastric/nasoenteric tube or gastrointestinal nutrition stoma tube.