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39.16 结语 经肠营养的重新发展已近20年。,由于膳食制备、输注系统(包括喂养管)、生理作用、临床应用、造口术的改进以及家庭经肠营养的应用等方面均有很多进展。在营养支持上的地位,经肠营养与TPN同样重要,其效果亦与TPN相似。且更具符合生理状态、费用节省、护理较简及使用安全的优点。此外,对胃肠道功能与结构的恢复,更为TPN所不及。所以,营养支持的原则是“只要胃肠道允许,应尽量采用经肠营养”。在胃肠功能较为欠佳时,采用要素膳;否则采用以整蛋白为氮源的非要素膳。利用组件或在固定组成的膳食中加入组件,可以配制适合不同需要的膳食。 参考文献 1.Randall,H.T:Enternal nutrition:Tube feeding in acute and chronic illness.JPEN8(2):113,1984 2.邵继智等:静脉营养,第16,23及25章,上海科技出版社,1984 3.邵继智:经肠营养用要素膳的氮源,药学通报19(10):42,1984 4.青岛生化制药厂:复方营养要素鉴定会资料汇编,第17页,1983 5.邵继智等:国产要素膳的临床应用及疗效观察,营养学报6(4):317,1984 6.Koretz,R.L.et al:Elemental diets-facts and fantasies,Gastroent.78(2):393,1980 7.Traverso,W.et al.:The effect of TPN or elemental diet on pancreatic proteolytic activity and ultrastru-cture,JPEN 5(6):496,1981 8.Young,E.A.et al.:Gastrointestinal response to nutrient variation of defined formula diets,JPEN 5(6):478,1981 9.Grant,A.et al.:Enternal and Parenteral Nutrition.P.127,Blackwell Scientific Publications,Oxford,1982 10.Grant,J.P.et al.:Fluoroscopic placement of nasojejunal feeding tubes with immediate feeding using a nonelemental diet,JPEN 7(3):299,1983 11.Ponsky,J.L.et al.:Percutaneous approaches to enteral alimentation,Am.J.Surg.149:102,1985 12.Salky,B.et al.:Nonoperative conversion of tube gastrostomy to feeding jejunostomy,Am.J.Surg,143.387,1982 13.Moss,G.:Efficent gasotroduodenal decompression with simultaneous full enteral nutrition:A new gastro-stomy catheter technique,JPEN8(2):203,1984 14.Ryan,J.A.et al.:Intrajejunal feeding:Development and current status,JPEN8(2):187,1984 15.Bennegard,K.et al.A comparative study of the efficiency of intragastric and parenteral nutrition in man,Am.J.Clin.Nutr.40:952,1984 16.Adams,M;M.et al.:Guidelines for planning home enteral feedings,J.Am.Diet.Ass.84(1):68,1984 17.Kein,C.L.:Employment of a mobile infusion system for continuous ambulatory tube feeding,JPEN 5(6):526,1981 18.邵继智:经肠营养,第九章,韶关生化制药厂,1984 19.Torosian,M.et al.,Feeding by tube enterostomy,S.G.O.150:918,1980 20.邵继智:要素膳的临床应用,实用外科杂志5(1):48,1985 21.Matsueda,K.et al.:Inedications and technique of home enteral hyperalimentation(日文),JJPEN7(5)789,1986 22.特集:Home hyperalimentation,JJPEN7(5),1986 23.Kerner,J.A.Jr.:Manual of Pediatric Parenteral Nutrition,P.285,John Wiley & Sons,New York,1983 24.Skipper,A.:Specialized formulas for enteral nutrition support,J.Am Diet.Assoc.86:654,1986 25.Salisbry,R.E.et al:Manual of Burn Therapeutics,Chapt.6,Little,Brown and Co.,Boston,1983 26.Smith,J.L.et al:Enteral nutrition support:Formula Preparation from modular ingredients,JPEN7(3):280,1983 27.邵继智:应激状态下的营养支持,实用外科杂志8(9):458,1988 28.Rombeau,J.L.et al:Enteral and Tube Feeding,W.B.Co.Philadelphia,1984 |