32 王先生 54 歲因最近半年來漸進性吞嚥困難、體重急遽下降 20 公斤，入院時身高 170 公分，體重50 公斤，有明顯脫水現象，無法放置鼻胃管餵食。經檢查確定為食道癌病人，預定接受手術切除並以空腸造口灌食。下列敘述何者正確？①應儘快手術治療，術後開始全靜脈營養支持 ②應延 後手術，先給予 10-14 天的靜脈營養支持 ③術後應繼續給予全靜脈營養支持、加上足量的維生 素及微量元素 ④術後不必等待腸音，即可開始腸道營養支持
(A)①③
(B)②③
(C)①④
(D)②④

2019 ESPEN

Recommendation 40

Early EN should be performed

1. in patients receiving ECMO(接受ECMO)

2. in patients with traumatic brain injury(有腦傷手術)

3. in patients with stroke (ischemic or hemorrhagic)(缺血性或出血性中風)

4. in patients with spinal cord injury(脊柱損傷)

5. in patients with severe acute pancreatitis(嚴重的急性胰臟炎)

6. in patients after GI surgery(腸胃道術後)

7. in patients after abdominal aortic surgery(腹部的動脈術後)

8. in patients with abdominal trauma when the continuity of the GI tract is confirmed/restored

9. in patients receiving neuromuscular blocking agents

10. in patients managed in prone position

11. in patients with open abdomen(開放性腹部)

12. regardless of the presence of bowel sounds unless bowel ischemia or obstruction is suspected in patients with diarrhea

第12點，無論是否有腸音，都可以進行EN，除非腹瀉的患者有腸缺血或是腸阻塞