{"id":19767262,"date":"2023-11-10T14:31:57","date_gmt":"2023-11-10T13:31:57","guid":{"rendered":"https:\/\/www.chu-poitiers.fr\/?p=19767262"},"modified":"2023-11-10T14:31:59","modified_gmt":"2023-11-10T13:31:59","slug":"denutrition-lalimentation-artificielle","status":"publish","type":"post","link":"https:\/\/www.chu-poitiers.fr\/en\/denutrition-lalimentation-artificielle\/","title":{"rendered":"D\u00e9nutrition\u00a0: l\u2019alimentation artificielle"},"content":{"rendered":"\n

Il existe deux modes d\u2019administration pour la nutrition artificielle, la voie ent\u00e9rale et la voie parent\u00e9rale. La nutrition par voie ent\u00e9rale est la m\u00e9thode privil\u00e9gi\u00e9e si le tube digestif est fonctionnel parce qu\u2019elle pr\u00e9sente moins de risques infectieux. Elle est administr\u00e9e soit par une sonde nasogastrique, nasoduod\u00e9nale ou nasoj\u00e9junale, dans le tube digestif si elle est de courte dur\u00e9e ou bien par sonde de gastrotomie ou j\u00e9junostomie, si elle est sup\u00e9rieure \u00e0 un mois. La nutrition par voie parent\u00e9rale, quant \u00e0 elle, est administr\u00e9e par voie intraveineuse centrale ou p\u00e9riph\u00e9rique, les nutriments \u00e9nerg\u00e9tiques (lipides, glucides et prot\u00e9ines) et non \u00e9nerg\u00e9tiques mais essentiels (vitamines, min\u00e9raux et oligo\u00e9l\u00e9ments) \u00e9tant transf\u00e9r\u00e9s directement dans la circulation sanguine. Il existe une grande vari\u00e9t\u00e9 de produits de nutrition ent\u00e9rale et de nutrition parent\u00e9rale ce qui permet de s\u2019adapter aux besoins et capacit\u00e9s digestives de chaque patient. \u00ab La plupart du temps, les maladies chroniques induisent une perte d\u2019app\u00e9tit et\/ou une augmentation de la d\u00e9pense \u00e9nerg\u00e9tique. Les patients se d\u00e9nutrissent ou sont \u00e0 risque de d\u00e9nutrition. Nous mettons alors en place une alimentation parent\u00e9rale si le tube digestif n\u2019est pas fonctionnel ce qui arrive souvent en chirurgie visc\u00e9rale. La nutrition parent\u00e9rale, qui est vraiment la solution de dernier recours, ne se fait que sur prescription m\u00e9dicale <\/em>\u00bb, explique Margaux Nesme, di\u00e9t\u00e9ticienne en chirurgie visc\u00e9rale. En p\u00e9diatrie, la solution nutritive artificielle peut concerner toutes pathologies qu\u2019elles soient aigu\u00ebs avec une incapacit\u00e9 alimentaire sur un temps court ou chroniques comme c\u2019est le cas des patients dans le service d\u2019oncologie-h\u00e9matologie p\u00e9diatrique. Pascale Hermouet, di\u00e9t\u00e9ticienne en p\u00e9diatrie, prend en charge des enfants de 0 \u00e0 16 ans, parfois plus. \u00ab La sp\u00e9cificit\u00e9 du service de p\u00e9diatrie fait que je prends en charge des patients ayant des besoins nutritionnels tr\u00e8s diff\u00e9rents, adapt\u00e9s \u00e0 leur pathologie, \u00e0 leur \u00e2ge et \u00e0 leur poids, avec des besoins allant de 400 kcal \u00e0 plus 3 000 kcal. Les modes d\u2019administration des nutritions ent\u00e9rales ou parent\u00e9rales sont les m\u00eames que chez les adultes. Lorsqu\u2019une nutrition ent\u00e9rale est mise en place pour une p\u00e9riode sup\u00e9rieure \u00e0 trois mois, nous proposons une gastrotomie c\u2019est-\u00e0-dire la pose d\u2019une sonde par un petit trou dans la paroi abdominale qui va jusqu\u2019\u00e0 l\u2019estomac<\/em> \u00bb. Quelle que soit l\u2019alimentation artificielle choisie, le r\u00f4le des di\u00e9t\u00e9ticiens est, dans un premier temps, d\u2019\u00e9valuer l\u2019\u00e9tat nutritionnel du patient, de calculer ses besoins \u00e9nerg\u00e9tiques et de proposer le produit et le volume correspondants. Il s\u2019agit ensuite d\u2019en assurer le suivi puisque l\u2019alimentation artificielle est mise en place progressivement. Elle peut \u00eatre partielle ou totale, en fonction des apports alimentaires per os du patient, avec des volumes qui \u00e9voluent et elle peut \u00eatre administr\u00e9e \u00e0 diff\u00e9rents moments de la journ\u00e9e, en nocturne ou en diurne, en continu ou en bolus. Le suivi peut se poursuivre ensuite \u00e0 domicile lorsque les patients rentrent chez eux. \u00ab Quand ils sont dans le service, c\u2019est bien plus simple pour nous d\u2019adapter le protocole \u00e0 la tol\u00e9rance, nous discutons avec l\u2019\u00e9quipe soignante, les m\u00e9decins et la famille. A domicile, la situation peut \u00e9voluer c\u2019est pourquoi nous restons en contact avec les patients, les soignants lib\u00e9raux, les prestataires de service ou l\u2019hospitalisation \u00e0 domicile s\u2019occupant du patient. Puis, lorsque nous les revoyons en consultation, les modifications de sch\u00e9ma de nutrition leur sont transmises assurant un suivi pour le patient ou les familles en p\u00e9diatrie afin que tout se passe au mieux. L\u2019\u00e9valuation de l\u2019\u00e9tat nutritionnel et des capacit\u00e9s alimentaires orales des patients nous conduisent \u00e0 diminuer voire arr\u00eater la nutrition artificielle lorsqu\u2019elle n\u2019est plus n\u00e9cessaire <\/em>\u00bb.<\/p>\n","protected":false},"excerpt":{"rendered":"

Lorsque l\u2019enrichissement alimentaire est insuffisant ou qu\u2019une alimentation normale est impossible, les patients peuvent se voir administrer une\u2026","protected":false},"author":12,"featured_media":19767292,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[96],"tags":[],"class_list":["post-19767262","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-non-classifiee"],"acf":[],"yoast_head":"\nD\u00e9nutrition\u00a0: l\u2019alimentation artificielle - Site du CHU de Poitiers<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.chu-poitiers.fr\/denutrition-lalimentation-artificielle\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"D\u00e9nutrition\u00a0: l\u2019alimentation artificielle - Site du CHU de Poitiers\" \/>\n<meta property=\"og:description\" content=\"Lorsque l\u2019enrichissement alimentaire est insuffisant ou qu\u2019une alimentation normale est impossible, les patients peuvent se voir administrer une solution nutritive artificielle. 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