靜脈型生酮飲食於臨床神經疾病的應用

生酮飲食是一種低醣、高脂、適當蛋白質的飲食法，主要是以腸道營養的方式進行。此類飲食可能透過抗氧化、促進興奮性和抑制性神經遞物質之間的平衡，以及調節發炎反應，或改變腸道微生物菌叢的組成，為患有神經系統問題的病人提供治療的益處。目前我們已知生酮飲食對癲癇、抑鬱症、偏頭痛、阿茲海默症和帕金森氏症有潛在的治療功效。但在急性情況下無法由口進食或腸道灌食，可透過腸外方式進行生酮飲食療法，即靜脈型生酮飲食。靜脈型生酮飲食只能在重症加護病房開始，且需要逐步調整，以達到盡可能高的脂肪比例，同時將併發症降至最低。除了傳統的疾病治療外，靜脈型生酮飲食，也可應用於頑固型癲癇重積狀態與後天性嚴重急性腦病變的輔助治療。本篇文章將介紹靜脈型生酮飲食的使用原則、適應症的選擇、併發症的監測與注意事項以及臨床照護經驗。

The ketogenic diet is a low-carbohydrate, high-fat and moderate-protein diet, mostly in the form of enteral nutrition. Currently, the ketogenic diet may provide therapeutic benefits to patients with neurological problems by effectively controlling pro-antioxidant processes and the balance between pro-excitatory and inhibitory neurotransmitters, as well as modulating inflammation or altering the composition of the gut microbiome. We now know that the ketogenic diet may have potential therapeutic benefits for epilepsy, depression, migraines, Alzheimer's disease, and Parkinson's disease. However, in acute situations where food cannot be eaten, ketogenic diet therapy can be performed parenterally, that is, intravenous ketogenic diet. But intravenous ketogenic diet can only be started in the intensive care unit. Intravenous ketogenic diet nutrition needs to be started gradually to achieve the highest possible ratio while minimizing the level of complications. In addition to traditional disease treatment, intravenous ketogenic diet can also be used to treat refractory epileptic seizures and acquired severe acute brain lesions. This article will focus on the principles of using the intravenous ketogenic diet, selection of indications, monitoring of complications, notice and clinical care experience.