A 34-year-old man sustained a severe traumatic brain injury; splenic, multiple right rib fractures; pulmonary contusion; right femoral fracture; and thoracic lumbar fractures. He underwent an emergency craniotomy and splenectomy. He is now intubated on mechanical ventilation, and on enteric nutrition through a post-pyloric feeding tube. On hospital day 3, he is scheduled for femoral fracture internal fixation.
Which of the following is the most appropriate preoperative preparation?
A. Withhold tube feeding at midnight on the day of surgery.
B. Withhold tube feeding six to eight hours before surgery.
C. Withhold tube feeding two hours before surgery and administer metoclopramide on call to the operating room.
D. Continue tube feeding until surgery.
答案解析：
充分的营养被认为是重症监护的重要组成部分，并被认为可改善临床结局。入住ICU的手术患者中有多达68%～83%发生暂时性停止肠管喂养，占潜在喂养时间的32%。口对口状态的目的是防止麻醉诱导期间的胃吸入。但是，对于计划在仰卧位接受手术的机械插管患者，将不进行气道操作。肠内喂养可持续至或甚至在手术过程中。尽管一些中心已经在实施减少口内状态持续时间或提供代偿性营养的实践，但关于该主题的已发表文献很少。重症监护医学学会和美国肠外肠内营养学会建议，应尽量减少围绕诊断检查或程序持续时间的任何口腔状况，以防止营养物质输送不足和长期肠梗阻。
正确答案：D
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