medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2016-19-150-155medsovet-1645Research ArticleПрактикаPracticeЭНТЕРАЛЬНОЕ ПИТАНИЕ ПОСЛЕ РАСШИРЕННЫХ И КОМБИНИРОВАННЫХ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВ В ОНКОХИРУРГИИENTERAL NUTRITION AFTER ADVADVANCED COMBINED OPERATIVE INTERVENTIONS IN ONCOSURGERYНЕХАЕВИ. В.NECHAEVI. V.

д.м.н., профессор

Москва

MD, Prof.

СЫТОВА. В.SYTOVA. V.

к.м.н.

Москва

PhD in medicine

ЛОМИДЗЕС. В.LOMIDZES. V.

к.м.н.

Москва

PhD in medicine

Российский онкологический научный центр им. Н.Н. Блохина Минздрава РоссииРоссияRussian Cancer Research Center im. N.N. BlohinaRussian Federation201630122016019150155Copyright © НЕХАЕВ И.В., СЫТОВ А.В., ЛОМИДЗЕ С.В., 20162016НЕХАЕВ И.В., СЫТОВ А.В., ЛОМИДЗЕ С.В.NECHAEV I.V., SYTOV A.V., LOMIDZE S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1645

Энтеральное питание (ЭП) – тип лечебного или дополнительного питания специальными смесями, при котором всасывание пищи (при ее поступлении через рот, через зонд в желудке или кишечнике) осуществляется физиологически адекватным путем, то есть через слизистую оболочку желудочно-кишечного тракта. В данном обзоре будут рассмотрены такие аспекты энтерального питания (ЭП) у больных, находящихся в отделениях реанимации и интенсивной терапии (ОРИТ), как состав, компоненты, способы доставки, осложнения ЭП.

Enteral nutrition (EN) – the type of therapeutic or supplementary feeding special mixtures, in which the absorption of food (when it arrives in the mouth through a tube in the stomach or intestines) is performed physiologically appropriate way, that is through the mucous membranes of the gastrointestinal tract. This review will address such aspects of enteral nutrition (EN) in patients who are in intensive care unit (ICU), the composition, components, methods of delivery, complications of EP.

нутритивная поддержкаэнтеральное питаниеnutritional supportenteral nutritionReferencesProtein/peptides http://www.criticalcarenutrition. com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on January 30, 2009).Protein/peptides http://www.criticalcarenutrition. com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on January 30, 2009).van den Berg B, Stam H. Metabolic and respiratory effects of enteral nutrition in patients during mechanical ventilation. Intensive Care Med, 1988, 14: 206.van den Berg B, Stam H. Metabolic and respiratory effects of enteral nutrition in patients during mechanical ventilation. Intensive Care Med, 1988, 14: 206.van den Berg B, Bogaard JM, Hop WC. High fat, low carbohydrate, enteral feeding in patients weaning from the ventilator. Intensive Care Med, 1994, 20: 470.van den Berg B, Bogaard JM, Hop WC. High fat, low carbohydrate, enteral feeding in patients weaning from the ventilator. Intensive Care Med, 1994, 20: 470.al-Saady NM, Blackmore CM, Bennett ED. High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med, 1989, 15: 290.al-Saady NM, Blackmore CM, Bennett ED. High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med, 1989, 15: 290.Mesejo A, Acosta JA, Ortega C et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr, 2003, 22: 295.Mesejo A, Acosta JA, Ortega C et al. Comparison of a high-protein disease-specific enteral formula with a high-protein enteral formula in hyperglycemic critically ill patients. Clin Nutr, 2003, 22: 295.Garrel DR, Razi M, Larivière F et al. Improved clinical status and length of care with low- fat nutrition support in burn patients. JPEN J Parenter Enteral Nutr, 1995, 19: 482.Garrel DR, Razi M, Larivière F et al. Improved clinical status and length of care with low- fat nutrition support in burn patients. JPEN J Parenter Enteral Nutr, 1995, 19: 482.McClave SA, Taylor BE, Martindale RG et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40: 159.McClave SA, Taylor BE, Martindale RG et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40: 159.Kreymann KG, Berger MM, Deutz NE, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr, 2006, 25: 210.Kreymann KG, Berger MM, Deutz NE, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr, 2006, 25: 210.Weijs PJ, Stapel SN, de Groot SD, et al. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. JPEN J Parenter Enteral Nutr, 2012, 36: 60.Weijs PJ, Stapel SN, de Groot SD, et al. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. JPEN J Parenter Enteral Nutr, 2012, 36: 60.Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A, et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr, 2012, 31: 462.Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A, et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr, 2012, 31: 462.Clifton GL, Robertson CS, Contant CF. Enteral hyperalimentation in head injury. J Neurosurg, 1985, 62: 186.Clifton GL, Robertson CS, Contant CF. Enteral hyperalimentation in head injury. J Neurosurg, 1985, 62: 186.Scheinkestel CD, Kar L, Marshall K, et al. Prospective randomized trial to assess caloric and protein needs of critically Ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition, 2003, 19: 909.Scheinkestel CD, Kar L, Marshall K, et al. Prospective randomized trial to assess caloric and protein needs of critically Ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition, 2003, 19: 909.Alexander JW. Immunonutrition: the role of omega-3 fatty acids. Nutrition, 1998, 14: 627.Alexander JW. Immunonutrition: the role of omega-3 fatty acids. Nutrition, 1998, 14: 627.Singer P, Theilla M, Fisher H, et al. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med, 2006, 34: 1033.Singer P, Theilla M, Fisher H, et al. Benefit of an enteral diet enriched with eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med, 2006, 34: 1033.Rice TW, Wheeler AP, Thompson BT, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA, 2011, 306: 1574.Rice TW, Wheeler AP, Thompson BT, et al. Enteral omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA, 2011, 306: 1574.Gadek JE, DeMichele SJ, Karlstad MD et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med, 1999, 27: 1409.Gadek JE, DeMichele SJ, Karlstad MD et al. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group. Crit Care Med, 1999, 27: 1409.Pontes-Arruda A, Aragão AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med, 2006, 34: 2325.Pontes-Arruda A, Aragão AM, Albuquerque JD. Effects of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med, 2006, 34: 2325.Stapleton RD, Martin TR, Weiss NS et al. A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med, 2011, 39: 1655.Stapleton RD, Martin TR, Weiss NS et al. A phase II randomized placebo-controlled trial of omega-3 fatty acids for the treatment of acute lung injury. Crit Care Med, 2011, 39: 1655.Zhu D, Zhang Y, Li S, et al. Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med, 2014, 40: 504.Zhu D, Zhang Y, Li S, et al. Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Intensive Care Med, 2014, 40: 504.Buchman AL. Glutamine: commercially essential or conditionally essential? A critical appraisal of the human data. Am J Clin Nutr, 2001, 74: 25.Buchman AL. Glutamine: commercially essential or conditionally essential? A critical appraisal of the human data. Am J Clin Nutr, 2001, 74: 25.Heyland DK, Dhaliwal R, Drover JW et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr, 2003, 27: 355.Heyland DK, Dhaliwal R, Drover JW et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr, 2003, 27: 355.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Journal of Parenteral and Enteral Nutrition, 2016 February, 40(2): 193-194.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Journal of Parenteral and Enteral Nutrition, 2016 February, 40(2): 193-194.Glutamine http://www.criticalcarenutrition.com/index.php? option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Glutamine http://www.criticalcarenutrition.com/index.php? option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Tao KM, Li XQ, Yang LQ, et al. Glutamine supplementation for critically ill adults. Cochrane Database Syst Rev, 2014 :CD010050.Tao KM, Li XQ, Yang LQ, et al. Glutamine supplementation for critically ill adults. Cochrane Database Syst Rev, 2014 :CD010050.Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med, 2013, 368: 1489.Heyland D, Muscedere J, Wischmeyer PE, et al. A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med, 2013, 368: 1489.Ornithine ketoglutarate (OKG) http://www.criticalcarenutrition. com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Ornithine ketoglutarate (OKG) http://www.criticalcarenutrition. com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest, 2013, 143: 646.Barraud D, Bollaert PE, Gibot S. Impact of the administration of probiotics on mortality in critically ill adult patients: a meta-analysis of randomized controlled trials. Chest, 2013, 143: 646.Besselink MG, van Santvoort HC, Buskens E et al. [Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial]. Ned Tijdschr Geneeskd, 2008, 152: 685.Besselink MG, van Santvoort HC, Buskens E et al. [Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial]. Ned Tijdschr Geneeskd, 2008, 152: 685.Hart GK, Dobb GJ. Effect of a fecal bulking agent on diarrhea during enteral feeding in the critically ill. JPEN J Parenter Enteral Nutr, 1988, 12: 465.Hart GK, Dobb GJ. Effect of a fecal bulking agent on diarrhea during enteral feeding in the critically ill. JPEN J Parenter Enteral Nutr, 1988, 12: 465.Dobb GJ, Towler SC. Diarrhoea during enteral feeding in the critically ill: a comparison of feeds with and without fibre. Intensive Care Med, 1990, 16: 252.Dobb GJ, Towler SC. Diarrhoea during enteral feeding in the critically ill: a comparison of feeds with and without fibre. Intensive Care Med, 1990, 16: 252.Heather DJ, Howell L, Montana M et al. Effect of a bulk-forming cathartic on diarrhea in tube-fed patients. Heart Lung, 1991, 20: 409.Heather DJ, Howell L, Montana M et al. Effect of a bulk-forming cathartic on diarrhea in tube-fed patients. Heart Lung, 1991, 20: 409.Schultz AA, Ashby-Hughes B, Taylor R, et al. Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics. Am J Crit Care, 2000, 9: 403.Schultz AA, Ashby-Hughes B, Taylor R, et al. Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics. Am J Crit Care, 2000, 9: 403.Spapen H, Diltoer M, Van Malderen C et al. Soluble fiber reduces the incidence of diarrhea in septic patients receiving total enteral nutrition: a prospective, double-blind, randomized, and controlled trial. Clin Nutr, 2001, 20: 301.Spapen H, Diltoer M, Van Malderen C et al. Soluble fiber reduces the incidence of diarrhea in septic patients receiving total enteral nutrition: a prospective, double-blind, randomized, and controlled trial. Clin Nutr, 2001, 20: 301.Rushdi TA, Pichard C, Khater YH. Control of diarrhea by fiber-enriched diet in ICU patients on enteral nutrition: a prospective randomized controlled trial. Clin Nutr, 2004, 23: 1344.Rushdi TA, Pichard C, Khater YH. Control of diarrhea by fiber-enriched diet in ICU patients on enteral nutrition: a prospective randomized controlled trial. Clin Nutr, 2004, 23: 1344.McIvor AC, Meguid MM, Curtas S, et al. Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings. Nutrition, 1990, 6: 115.McIvor AC, Meguid MM, Curtas S, et al. Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings. Nutrition, 1990, 6: 115.Combined vitamins and trace elements http://www.criticalcarenutrition.com/index.php? option=com_content&task=view&id=17&Itemid=40 (Accessed on March 11, 2009).Combined vitamins and trace elements http://www.criticalcarenutrition.com/index.php? option=com_content&task=view&id=17&Itemid=40 (Accessed on March 11, 2009).Continuous vs other methods of administration http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Continuous vs other methods of administration http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Bonten MJ, Gaillard CA, van der Hulst R, et al. Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated intensivecare- unit patients. Am J Respir Crit Care Med, 1996, 154: 394.Bonten MJ, Gaillard CA, van der Hulst R, et al. Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated intensivecare- unit patients. Am J Respir Crit Care Med, 1996, 154: 394.Steevens EC, Lipscomb AF, Poole GV, Sacks GS. Comparison of continuous vs intermittent naso gastric enteral feeding in trauma patients: perceptions and practice. Nutr Clin Pract, 2002, 17: 118.Steevens EC, Lipscomb AF, Poole GV, Sacks GS. Comparison of continuous vs intermittent naso gastric enteral feeding in trauma patients: perceptions and practice. Nutr Clin Pract, 2002, 17: 118.MacLeod JB, Lefton J, Houghton D et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma, 2007, 63: 57.MacLeod JB, Lefton J, Houghton D et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma, 2007, 63: 57.National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA, 2012, 307: 795.National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA, 2012, 307: 795.Needham DM, Dinglas VD, Morris PE, et al. Physical and cognitive performance of patients with acute lung injury 1 year after initial trop hic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med, 2013, 188: 567.Needham DM, Dinglas VD, Morris PE, et al. Physical and cognitive performance of patients with acute lung injury 1 year after initial trop hic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med, 2013, 188: 567.Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med, 2001, 29: 1955.Mentec H, Dupont H, Bocchetti M, et al. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med, 2001, 29: 1955.McClave SA, Lukan JK, Stefater JA et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med, 2005, 33: 324.McClave SA, Lukan JK, Stefater JA et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med, 2005, 33: 324.Montejo JC, Miñambres E, Bordejé L et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010; 36:1386.Montejo JC, Miñambres E, Bordejé L et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010; 36:1386.Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA, 2013, 309: 249.Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA, 2013, 309: 249.Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care, 2010, 19: 261.Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care, 2010, 19: 261.Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med, 1999, 27: 1447.Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. Crit Care Med, 1999, 27: 1447.Luft VC, Beghetto MG, de Mello ED, Polanczyk CA. Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients. Nutrition, 2008, 24: 528.Luft VC, Beghetto MG, de Mello ED, Polanczyk CA. Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients. Nutrition, 2008, 24: 528.Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ, 2008, 336: 1495.Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ, 2008, 336: 1495.Drakulovic MB, Torres A, Bauer TT et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated pati ents: a randomised trial. Lancet, 1999, 354: 1851.Drakulovic MB, Torres A, Bauer TT et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated pati ents: a randomised trial. Lancet, 1999, 354: 1851.Ho KM, Dobb GJ, Webb SA. A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis. Intensive Care Med, 2006, 32: 639.Ho KM, Dobb GJ, Webb SA. A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis. Intensive Care Med, 2006, 32: 639.Marik PE, Zaloga GP. Gastric versus postpyloric feeding: a systematic review. Crit Care, 2003, 7: R46.Marik PE, Zaloga GP. Gastric versus postpyloric feeding: a systematic review. Crit Care, 2003, 7: R46.Yavagal DR, Karnad DR, Oak JL. Metoclopramide for preventing pneumonia in critically ill pati ents receiving enteral tube feeding: a randomi zed controlled trial. Crit Care Med, 2000, 28: 1408.Yavagal DR, Karnad DR, Oak JL. Metoclopramide for preventing pneumonia in critically ill pati ents receiving enteral tube feeding: a randomi zed controlled trial. Crit Care Med, 2000, 28: 1408.Motility agents http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).Motility agents http://www.criticalcarenutrition.com/index.php?option=com_content&task=view&id=17&Itemid=40 (Accessed on March 03, 2009).

The authors declare that there are no conflicts of interest present.