可溶性纖維控制治療腹瀉的效果

Effect of Soluble Fiber on Diarrhea Control

孫萍(Ping Sun) ； 王果行(Guoo-Shyng W. Hsu) ； 金惠民(Huei-Min Linda Chin)

《北市醫學雜誌》 3卷11期 (2006/11) Pp. 1-9

https://doi.org/10.6200/TCMJ.2006.3.11.01

摘要

「腹瀉」常發生於重症管灌病患，老人及幼童等高危險群。當患者發生腹瀉，將使營養狀況、體液電解質平衡及臨床照顧的問題更加棘手。造成腹瀉的原因很複雜，治療腹瀉的方法很多種；纖維就是其中一種選擇。不可溶性纖維在臨床研究中，無法在短期內改善腹瀉。而可溶性纖維被發酵的程度高，可產生大量的短鏈脂肪酸，促進水分的吸收；並能增加膽囊收縮素分泌，延緩腸道運輸時間，具有降低腹瀉的作用。近幾年，針對重症與腹瀉高危群患者的研究顯示：成人每1000cc配方給予20g以上的部分水解關華豆膠，嬰幼兒每公斤體重給予4g果膠的用量，在實驗期4-7天中可以有效降低腹瀉的發生。然而，管灌病患是否需長期使用含纖配方，到目前為止的科學證據仍缺乏一致的結論。未來仍需大型客觀的研究，針對不同的患者，找出適當有效的「纖維種類」與「纖維劑量」來降低腹瀉的發生率。

關鍵字

可溶性纖維 ； 腹瀉 ； 腸道營養 ； 重症疾病

並列摘要

Diarrhea commonly occurs in tube-feeding of critical illness and high risk group like elder and younger children. When diarrhea develops in these patients, it adversely affects their nutritional status, hydromineral balance and clinical outcomes. Therefore, prevention and treatment of diarrhea are major clinical concerns for healthcare providers. The causative factors about diarrhea are many and the fiber content in the formula is one of treatments. In short term studies of insoluble fiber, there are no significant effect on the incidence of diarrhea. Soluble fibers are fully and rapidly fermented by colonic bacteria and yield more short-chain fatty acids which stimulate water absorption, and increase cholecystokinin level which prolongs colonic transit time, all these may play a role in preventing diarrhea. In recent years, the addition of different type of soluble fibers to enteral feeds decrease the incidence of diarrhea in patients of critical illness, elder and children. During four to seven days of experimental time, the effective dose of diarrhea is over 20g/L partial hydrolysis guar gum for adult, and 4g pectin/kgBw for children younger than 2 years. Although there is currently insufficient evidence to recommend the systematic use of formulas containing fiber in enteral feeding, the administration of soluble fiber is safe and useful for treating diarrhea. In order to establish the optimal types of fiber and effective doses for different patients, it is necessary to design large-scale and high-quality randomized controlled trials in the future.

並列關鍵字

soluble fiber ； diarrhea ； enteral feeding ； critical illness