1. Classification of clinical nutritional support
Enteral nutrition (EN) is a way to provide nutrients needed for metabolism and various other nutrients through the gastrointestinal tract.
Parenteral nutrition (parenteral nutrition, PN) is to provide nutrition from the vein as the nutritional support before and after surgery and critically ill patients. All nutrition supplied from parenteral is called total parenteral nutrition (TPN).
2. The difference between EN and PN
The difference between EN and PN is:
2.1 EN is supplemented by taking orally or nasally feeding into the gastrointestinal tract for digestion and absorption; parenteral nutrition is supplemented by intravenous injection and blood circulation.
2.2 EN is relatively comprehensive and balanced; the nutrients supplemented by PN are relatively simple.
2.3 EN can be used for a long time and continuously; PN can only be used in a specific short-term.
2.4 Long-term use of EN can improve gastrointestinal function, strengthen physical fitness, and improve various physiological functions; long-term use of PN can cause the decline of gastrointestinal function and cause various physiological disorders.
2.5 The cost of EN is low; the cost of PN is relatively high.
2.6 EN has fewer complications and is relatively safe; PN has relatively more complications.
3.the choice of EN and PN
The choice of EN, PN or the combination of the two is largely determined by the patient’s gastrointestinal function and the degree of tolerance to nutrient supply. It usually depends on the nature of the disease, the patient’s condition and the judgment of the doctor in charge. If the patient’s cardiopulmonary function is unstable, most of the gastrointestinal absorption function is lost or nutritional metabolism is imbalanced and urgently needs compensation, PN should be selected.
If the patient’s gastrointestinal tract is functional or partly functional, a safe and effective EN should be selected. EN is a physiologically-compliant way of feeding, which not only avoids the possible risks of central venous intubation, but also helps restore intestinal function. Its advantages are simple, safe, economical and efficient, in line with physiological functions, and there are many different enteral nutrition agents.
In short, the most critical and important principle for selecting EN and PN is to strictly control the application indications, accurately calculate the amount and duration of nutritional support, and reasonably choose the way of nutritional support.
4. The precautions for long-term PN transfer to EN
Long-term PN can lead to the decline of gastrointestinal function. Therefore, the transition from parenteral nutrition to enteral nutrition must be carried out gradually and cannot be stopped abruptly.
When patients with long-term PN begin to tolerate EN, first use low-concentration, slow infusion of elemental enteral nutrition preparations or non-elemental enteral nutrition preparations, monitor water, electrolyte balance and nutrient intake, and then gradually increase the intestines Nutrition infusion amount, and reduce the amount of parenteral nutrition infusion by the same extent, until enteral nutrition can fully meet the metabolic needs, then parenteral nutrition can be completely withdrawn and transition to complete enteral nutrition.
Post time: Jul-16-2021