ASPEN成年危重病患者營養(yǎng)支持治療的實(shí)施與評(píng)估指南

1、 PAGE PAGE 7營養(yǎng)支持ASPEN 成年危重病患者營養(yǎng)支持治療的實(shí)施與評(píng)估指南臨床營養(yǎng)危重病患者營養(yǎng)支持治療的實(shí)施與評(píng)估指南成年危重病患者營養(yǎng)支持治療實(shí)施與評(píng)估指(1/6)翻譯：清華大學(xué)長庚醫(yī)院周華 許媛來源：中國病理生理學(xué)危重病醫(yī)學(xué)專業(yè)委員會(huì)官網(wǎng) 營養(yǎng)評(píng)估Question: oes the use of a nutrition risk inicator ientify patients who willmost likely benefit from nutrition therapy?問題：營養(yǎng)風(fēng)險(xiǎn)篩查工具能否辨別哪些患者最可能從營養(yǎng)治療中獲益？A1. Base on exper

2、t consensus, we suggest a etermination of nutrition risk(forexample,nutritionalscoreNRS-2002,score)beonallpatientsamittetotheICUforwhomvolitionalintakeisanticipateto beinsufficient.Highnutritionientifiesthosepatientsmostlikelytobenefit from 根據(jù)專家共識(shí)，我們建議關(guān)于收入ICU且預(yù)計(jì)攝食不足的患者進(jìn)行營養(yǎng)風(fēng)險(xiǎn)（如營養(yǎng)風(fēng)險(xiǎn)評(píng)分 評(píng)分。高營養(yǎng)風(fēng)險(xiǎn)患者的識(shí)別， 最

3、可能使其從早期腸內(nèi)營養(yǎng)治療中獲益。A2. Base on consensus, suggest that nutritionalassessmentinclueanevaluationofcomorbiconitions,functionofthegastrointestinal(GI) anofaspiration.suggestnotusingtraitionalnutritioninicators or surrogate markers, as they are not valiate in critical care.根據(jù)專家共識(shí)，我們建議營養(yǎng)評(píng)估應(yīng)當(dāng)囊括關(guān)于于合并且癥、胃腸道功能以

4、及誤吸風(fēng)險(xiǎn)的評(píng)估。我們建議不要使用傳統(tǒng)的營養(yǎng)指標(biāo)或其替代指標(biāo)，因?yàn)檫@些指標(biāo)在ICU 的應(yīng)用并且非得到驗(yàn)證。Question:isthebestmethoforneesintheill aultpatient?問題：確定成年危重病患者能量需求的最佳方法是什么？A3a. We suggest that inirect calorimetry (IC) be use to etermine energyavailableanintheabsenceofthataffectthe ofQuality of Evience: Very Low。如果有條件且不影響測(cè)量準(zhǔn)確性的因素時(shí)，建議應(yīng)用間接能量測(cè)熱法

5、，calorimetry，IC) 確定能量需求。證據(jù)質(zhì)量：非常低A3b. Base on expert consensus, in the absence of IC, we suggest that apublisheequationorasimplisticequationkcal/kg/ay)beuseto(seesectionQfor obesityrecommenations.)根據(jù)專家共識(shí)，當(dāng)沒有IC 時(shí)，我們建議使用已發(fā)表的預(yù)測(cè)公式或鑒于體重(2530 kcal/kg/ 確定能量需求（Q部分有關(guān)肥胖患者的推薦意見。）Question: Shoul protein provisio

6、n be monitore inepenently from energy provision in critically ill ault patients?問題：關(guān)于于成年危重病患者，除能量提供外，是否需要單獨(dú)監(jiān)測(cè)提供的蛋白質(zhì)量？A4. Base on consensus, suggest an ongoingevaluation ofaequacy of protein provision be performe.根據(jù)專家共識(shí)，我們建議連續(xù)評(píng)估蛋白質(zhì)供給的充分性。 開始腸內(nèi)營養(yǎng)Question: What is the benefit of early EN in critically

7、ill ault patients compareto withholing or elaying this therapy?問題：關(guān)于于成年危重病患者而言，與不給予或延遲給N 相比，早期有何益處？B1. We recommen that nutrition support therapy in the form of early ENbeinitiatehoursintheillpatientisunableto maintain volitionalintake.Quality of Evience: Very Low關(guān)于于不能維持自主進(jìn)食的危重病患者，我們推薦24 48 小時(shí)內(nèi)經(jīng)過早期E

8、N 開始營養(yǎng)支持治療。證據(jù)質(zhì)量：非常低Question:IsainoutcometheuseoforPNforault illpatients?問題：成年危重病患者使用或PN 關(guān)于預(yù)后的影響有何不同？B2. We suggest the use of EN over PN in critically ill patients who requirenutrition support therapy.Quality of Evience: Low to Very Low關(guān)于于需要營養(yǎng)支持治療的危重病患者而非PN 的營養(yǎng)供給方式。證據(jù)質(zhì)量：低至非常低Question:Istheclinicalev

9、ienceofcontractility(bowelsouns,flatus)priorto initiatinginillaultpatients?問題：在成年危重病患者開始EN 前是否需要有腸道蠕動(dòng)的證據(jù)（腸鳴音，排氣）？B3. Base on expert consensus, we suggest that, in the majority of MICUanSICUpatientpopulations,GIcontractilityfactorsshoulbeevaluate initiatingovertsignsofcontractilityshoulnotbepriorto i

10、nitiation of鑒于專家共識(shí)，我們建議，關(guān)于于多MICU 和SICU 患者，不管啟用時(shí)需要關(guān)于胃腸道蠕動(dòng)情況進(jìn)行評(píng)估，但此前并且不需要有腸道蠕動(dòng)的體征。Question:isthelevelofinfusionoftheGIfor ill patients? How oes the level of infusion of affect patient outcomes?問題：危重病患者胃腸道輸注EN 的最佳速度是多少？EN 輸注速度如何影響患者預(yù)后？B4a. We recommen that the level of infusion be iverte lower in the G

11、Iinthoseillpatientsathighforaspiration(seesection4)or those have shown intolerance to Quality of Evience: Moerate to High關(guān)于于具有誤吸高危因素（4 部分）或不能耐受經(jīng)胃喂養(yǎng)的重癥患者，我們推薦減慢輸注的速度。證據(jù)質(zhì)量：中至高B4b. Base onconsensus suggest that, in most illpatients, it is acceptable to initiate EN in the stomach.鑒于專家的共識(shí)方式。Question: Is

12、EN safe uring perios of hemoynamic instability in ault critically ill patients?問題：關(guān)于于成年危重病患者，血流動(dòng)力學(xué)不穩(wěn)定是否安全？B5.Baseonconsensus,suggestthatinthesettingofhemoynamiccompromiseorinstability,shoulbeuntilthepatient isfullyan/orstable.Initiation/reinitiationofmaybeconsiere cautioninpatientsunergoingofvasopre

13、ssorsupport.根據(jù)專家共識(shí)，我們建議在血流動(dòng)力學(xué)不穩(wěn)定時(shí)，應(yīng)當(dāng)暫停EN 直至患者接受了充分的復(fù)蘇治療和（或）病情穩(wěn)定。關(guān)于于正在撤除升壓藥物的患者，可以考慮謹(jǐn)慎開始或重新開始EN。OSINGOF的劑量Question: What population of patients in the ICU setting oes not requirenutrition support therapy over the first week of hospitalization?問題：哪些患者住ICU 的第一周內(nèi)無需營養(yǎng)支持治療？C1. Base on consensus, suggest t

14、hat patients at lownutritionnormalbaselinenutritionstatusanlowisease(for example,3orscore5)cannotmaintainvolitional intakeoNOTspecializenutritionovertheof hospitalization in theICU.根據(jù)專家共識(shí)，我們建議那些營養(yǎng)風(fēng)險(xiǎn)較低及基礎(chǔ)營養(yǎng)狀況正常、疾病較輕（例如NRS-2002 3 或 NUTRIC 評(píng)分 5）的患者，即使不能自主進(jìn)食，住ICU 的第一周內(nèi)不需要特別給予營養(yǎng)治療。Question:Forpopulationo

15、fpatientsintheICUsettingisitto provietrophicovertheofhospitalization?問題：哪些ICU 患者在住院第一周內(nèi)適合滋養(yǎng)型喂養(yǎng)(trophic EN)？C2.We recommen that either trophic or full nutrition by EN is appropriatefor patients acute synrome (ARS)/acute lung (ALI)anthoseexpectetohaveaurationofmechanicalventilation72hours, astheseoffe

16、einghavesimilarpatientoutcomesovertheweek of hospitalization. Quality of Evience: High關(guān)于于急性呼吸窘迫綜合(ARS)/急性肺損傷患者以及預(yù)期機(jī)械通氣時(shí)間72 小時(shí)的患者，我們推薦給予滋養(yǎng)型或充分的腸內(nèi)營養(yǎng)，這兩種營養(yǎng)補(bǔ)充策略關(guān)于患者住院第一周預(yù)后的影響并且無差異。證據(jù)質(zhì)量：高Question:populationofpatientsintheICUfull(ascloseas possibletonutritiongoals)beginningintheofhospitalization? Howsoons

17、houlnutritiongoalsbeinthesepatients?U 患者住院第一周需要足量（盡可能接近目標(biāo)喂養(yǎng)量？這些患者應(yīng)多長時(shí)間達(dá)到目標(biāo)量？C3. Base on expert consensus, we suggest that patients who are at highnutrition (for example, 5 or score 5, without or malnourishe shoul be avance goal as quicklyastolerateoverhoursmonitoringforsynrome. toprovie80%ofestimate

18、orcalculategoalanprotein 4872hoursshoulbemaeinorertoachievetheclinicalbenefitofover the ofhospitalization.根據(jù)專家共識(shí)，我們建議具有高營養(yǎng)風(fēng)險(xiǎn)患者（25或不考慮IL-6情況下評(píng)分或嚴(yán)重營養(yǎng)不良患者，應(yīng)在 2448小時(shí)達(dá)到并且耐受目標(biāo)喂養(yǎng)量；監(jiān)測(cè)再喂養(yǎng)綜合征。爭取4872 小時(shí)提供預(yù)計(jì)蛋白質(zhì)與能量供給目標(biāo)，從入院第一周中獲益。Question:oestheamountofproteinproviemakeainclinical outcomes of ault illpatients?問題：

19、蛋白質(zhì)供給量關(guān)于成年危重病患者臨床結(jié)局有何不同影響？C4. We suggest that sufficient (high-ose) protein shoul be provie.Proteinexpectetobeintheofactualboy peray,anmaylikelybeevenhigherinormulti-patients (see sections M anP).Quality of Evience: Very Low我們建議充分的（大劑量的）蛋白質(zhì)供給。蛋白質(zhì)需求預(yù)計(jì).2 2.0 g/kg（實(shí)際體重天，燒傷或多發(fā)傷患者關(guān)于蛋白質(zhì)的需求量可能更高P 部分）。證據(jù)質(zhì)量：

20、非常低臨床營養(yǎng)危重病患者營養(yǎng)支持治療的實(shí)施與評(píng)估指南成年危重病患者營養(yǎng)支持治療實(shí)施與評(píng)估指(2/6)翻譯：清華大學(xué)長庚醫(yī)院周華 許媛來源：中國病理生理學(xué)危重病醫(yī)學(xué)專業(yè)委員會(huì)官網(wǎng)ANOF耐受性與充分性的監(jiān)測(cè)Question: How shoul tolerance of EN be monitore in the ault critically illpopulation?問題：如何監(jiān)測(cè)成年危重病患者EN 耐受性？1. Base on expert consensus, we suggest that patients shoul bemonitoreailyfortoleranceofsugg

21、estthatcessationof shoulbeavoie.suggestthatafeeingstatusofnilperos (NPO) for the patient the time of iagnostic tests or shoul be minimize to limit propagation of ileus an to inaequate 根據(jù)專家共識(shí)耐受性。我們建議應(yīng)當(dāng)避免不恰當(dāng)?shù)闹兄?。我們建議，患者在接受診斷性檢查或操作期間，應(yīng)當(dāng)盡可能縮短禁食的醫(yī)囑，以免腸梗阻加重，并且防止?fàn)I養(yǎng)供給不足Question:ShoulGRVsbeuseasaforaspiration

22、tomonitorICU patients on問題：GRV 是否應(yīng)當(dāng)作為接受EN 的 ICU 患者監(jiān)測(cè)誤吸的指標(biāo)？2a. We suggest that GRVs not be use as part of routine care to monitorICU patients on EN.我們建議不應(yīng)當(dāng)把GRV 作為接受的ICU 患者常規(guī)監(jiān)測(cè)的指標(biāo)。2b.suggestthat,forthoseICUsGRVsstillutilize,holing forGRVs500mlintheabsenceofothersignsofintolerance(seesection1) shoul be

23、avoie.Quality of Evience: Low我們建議，關(guān)于于仍然監(jiān)測(cè)GRV 的 ICU，應(yīng)當(dāng)避免在GRV 60%of an protein by the route alone. Initiating supplementalPNpriortothisperioinillpatientsonsome en oes not improve outcomes an may be to the patient. Quality of Moerate無論低或高營養(yǎng)風(fēng)險(xiǎn)患者，接受腸內(nèi)營7-10天，如果經(jīng)攝入能量與蛋白質(zhì)量仍不足目標(biāo)的60%，我們推薦應(yīng)考慮給予補(bǔ)充型。在開始 天內(nèi)給予補(bǔ)充型，

24、不僅不能改善預(yù)后，甚至可能有害。證據(jù)質(zhì)量：中HOF PN 腸外營養(yǎng)支持最大獲益的適應(yīng)癥Question: PN is neee in the ault ill patient, can be aopte to improve efficacy?問題：成年危重病患者何時(shí)需要PN 支持？提高有效性的策略是什么？H1. Base on expert consensus, we suggest the use of protocols an nutritionsupportteamstohelpincorporatetomaximizeefficacyanassociate ofPN.根據(jù)專家共識(shí)，我

25、們建議使用營養(yǎng)支持實(shí)施方案與營養(yǎng)支持小組，以促進(jìn)營養(yǎng)支持策略的最大化獲益并且降低PN 相關(guān)風(fēng)險(xiǎn)。Question: In the caniate for PN (high or malnourishe),shoultheosebeajusteovertheofhospitalization in theICU?問題：關(guān)于于具有PN 適應(yīng)癥的患者（ICU 第一周應(yīng)如何調(diào)整營養(yǎng)供給量？H2. We suggest that hypocaloricPN osing ( 20 kcal/kg/ay or 80% ofestimatenees)aequateprotein(1.2gprotein/kg/

26、ay)be consiereinpatients(highormalnourishe) PN,initiallyovertheofhospitalizationintheICU. Quality of Low關(guān)于于高營養(yǎng)風(fēng)險(xiǎn)或嚴(yán)重營養(yǎng)不良、需PN支持的患者，我們建議住ICU第一周內(nèi)給予低熱卡PN（20 kcal/kg/ay 或能量需要目標(biāo)的80%），以及充分的蛋白質(zhì)補(bǔ)充1.2g/kg/ay）。證據(jù)質(zhì)量：低Question:Shoulsoy-baseIVfatemulsionsbeprovieintheof ICU stay? Is an avantage to using (i.e., mei

27、um-chainoliveoilOO,ofoils)over traitionalsoybeanoil(SO)-baselipiemulsionsinillaultpatients?問題：成年危重癥患者在收住ICU 第一周內(nèi)是否給予大豆油基礎(chǔ)的靜脈脂肪乳劑(IVFE)？給予新一代的靜脈脂肪乳劑（/長鏈甘油三酯MCT，橄欖油，魚油，混合油類，是否比傳統(tǒng)大豆油基礎(chǔ)的脂肪乳劑更有優(yōu)勢(shì)？H3a. We suggest withholing or limiting SO-base IVFE uring the first weekfollowinginitiationofPNintheillpatien

28、ttoamaximumof100(oftenivieinto2oses/week)ifisconcernforessentialfattyaci eficiency.Quality of Evience: Very Low危重病患者開始PN 輸注，如果考慮必需脂肪酸缺乏，其最大補(bǔ)充劑量100g每周（常分2 次補(bǔ)充）。證據(jù)質(zhì)量：非常低H3b. Alternative IVFE may provie outcome benefit over soy-base IVFE;cannot make a recommenation at this time ue to lack of availabili

29、tyoftheseprouctsintheU.S.theseOOanbecomeavailableintheUniteStates,baseonopinion,suggestthattheirusebeconsiereintheillpatientis an caniate forPN.新一代的比大豆油基礎(chǔ)的關(guān)于預(yù)后具有更好影響類產(chǎn)品的缺乏，故尚不能做出任何推薦意見。根據(jù)專家意見，一旦這類脂肪乳OO在美國上市PN 適應(yīng)癥的重癥患者使用。Question: Is an avantage to using commercially available PN PN) compoune PN 預(yù)混合的

30、PN 制劑比配置的PN 混合液更有優(yōu)勢(shì)嗎？H4. Base on expert consensus, use of stanarize commercially available PNcompounePNintheICUpatienthasnoavantageinof clinicaloutcomes.根據(jù)專家共識(shí)，標(biāo)準(zhǔn)商品化的PN 制劑（多腔袋）PN 液相比，未見任何影響ICU 患者臨床結(jié)局的優(yōu)勢(shì)。Question: What is the esire target bloo glucose range in ault ICU patients?問題：成年ICU 患者預(yù)期的血糖控制目標(biāo)是多

31、少？H5. We recommen a target bloo glucose range of 140or 150 180 mg/l forthe general ICU population; ranges for specific patient populations(post-cariovascularheamayifferanbeyonthescope of thisguieline.Quality of Evience: Moerate我們推薦綜合ICU我們推薦綜合ICU 患者的血糖控制目標(biāo)在：140180 或 150180 mg/l；特殊患者（心血管術(shù)后，顱腦損傷）可能有超出指

32、南的不同推薦。證據(jù)質(zhì)量：中Question: Shoul parenteral glutamine be use in the ault ICU patient?問題：成年ICU 患者腸外支持是否應(yīng)補(bǔ)充谷氨酰胺？H6.recommenthatglutaminesupplementationNOTbeuseroutinelyinthesetting. QualityofMoerate我們推薦危重病患者腸外營養(yǎng)期間無需常規(guī)補(bǔ)充谷氨酰胺。證據(jù)質(zhì)量：中Question:Intransitionfeeing,asanvolumeofistoleratebyapatient alreay receivin

33、g PN, at what point shoul the PN be terminate?PN支持的患者向過渡期間量逐漸增加H7BaseonconsensussuggestthatastolerancetoimprovestheamountofPNshoulbeanfinallyiscontinuethe patientis60%offrom根據(jù)專家共識(shí)，當(dāng)EN 耐受性提高，達(dá)到目標(biāo)能量60%以上時(shí)，我們建議經(jīng)PN途徑供給的能量可逐漸減量至終止。成年危重病患者營養(yǎng)支持治療實(shí)施與評(píng)估指(4/6)翻譯：清華大學(xué)長庚醫(yī)院周華 許媛來源：中國病理生理學(xué)危重病醫(yī)學(xué)專業(yè)委員會(huì)官網(wǎng)I. PULMONARY

34、 FAILURE 呼吸衰竭Question: What is the optimal carbohyrate-to-fat ratio for the ault ICUpatient with pulmonary failure?問題：成人ICU 呼吸衰竭患者碳水化合物與脂肪的最佳比例是多少？I1. We suggest that specialty high-fat/low-carbohyrate formulations esigne tothequotientanCO2prouctionNOTbeusemanipulatein ICU patients acute (not to be

35、confuse recommenationQuality of Evience: Very Low某些高脂低碳水化合物特殊配方系根據(jù)呼吸熵與減CO2產(chǎn)生而設(shè)計(jì)，我們不建議將這種配方用于合并且急性呼吸衰竭ICU（不要與推薦意見混淆）【證據(jù)質(zhì)量：非常低】Question:oesuseofformulastofluiaministration benefittheaultICUpatientacute配方制劑限制液體攝入量的ICU 患者獲益？I2. Base on expert consensus, we suggest that flui-restricte energy-ense ENformu

36、lations be consiere for patients with acute respiratory failure (especially if in a state of volume overloa).鑒于專家共識(shí)，我們建議急性呼吸衰竭患者考慮使用限制液體入量的高能量密度腸內(nèi)營養(yǎng)配方（尤其在液體負(fù)荷過多時(shí)）。Question:ShoulphosphateconcentrationsbemonitoreorPN isinitiateintheICUpatient問題：關(guān)于于合并且呼吸衰竭的ICU 患者，開始EN 或 PN 時(shí)是否需要監(jiān)測(cè)血磷濃度？I3. Base on exper

37、t consensus, we suggest that serum phosphate concentrationsshoulbemonitoreclosely,anphosphateneee.鑒于專家共識(shí)，我們建議密切監(jiān)測(cè)血磷濃度，必要時(shí)應(yīng)適當(dāng)給予補(bǔ)充。腎 衰Question: In ault critically ill patients with acute kiney injury (AKI), what aretheinicationsforuseofspecialtyformulations?anproteinrecommenationstomorbiityinAKI?問題：關(guān)于

38、于合并且急性腎損的成年危重癥患者，應(yīng)用特殊腸內(nèi)營養(yǎng)制劑的 指征是什么？為降低AKI患病率，適宜的能量與蛋白質(zhì)補(bǔ)充為多少？J1. Base on expert consensus, we suggest that ICU patients with acute renalorAKIbeplaceonaformulation,anICU recommenations for protein actual boy per ay) an (2530kcal/kg/ay)provisionshoulbefollowe.Ifsignificantelectrolyte abnormalities evel

39、op, a specialty formulation esigne for electrolyteprofile)maybeconsiere.鑒于專家共識(shí)，我們建議患急性腎ICU患者使用標(biāo)準(zhǔn)腸內(nèi)營養(yǎng)配方，并且攝入U(xiǎn)推薦的標(biāo)準(zhǔn)劑量蛋白質(zhì).g實(shí)際體重/ 天）與能量天）。如果發(fā)生電解質(zhì)鮮明異常，應(yīng)考慮應(yīng)用腎衰的 特殊配方制劑（恰當(dāng)?shù)碾娊赓|(zhì)和蛋白比例）。Question:InaultillpatientsAKIhemoialysisor forproteinintaketosupportnitrogenlosses?問題：關(guān)于于接受血液透析或CRRT治療的成年AKI 重癥患者，為補(bǔ)充氮丟失， 合理補(bǔ)

40、充氮的目標(biāo)量是多少？J2. We recommen that patients receiving hemoialysis or CRRT receiveincrease protein, up to a maximum of 2.5g/kg/ay. Protein shoul NOT beinpatientsinsufficiencyasameanstoavoiorelay initiating ialysisQuality of Evience: Very Low我們推薦接受血液透析或CRRT 的患者增加蛋白質(zhì)補(bǔ)充最大劑量可達(dá)2.5 g/kg/天。腎功能不全的患者不應(yīng)為避免或延遲透析治療而

41、限制蛋白質(zhì)攝入量。證據(jù)質(zhì)量：非常低肝 衰Question: Shoul energy an protein requirements be etermine similarly incritically ill patients with hepatic failure as in those without hepatic failure?問題：合并且肝衰與無肝衰的重癥患者，是否供給同等量的能量與蛋白質(zhì)？ K1Baseonconsensussuggestaorusualbeuse insteaofactualinequationstoanproteininpatientsanhepaticu

42、etocomplicationsofascites, volume epletion, eema, portal hypertension, an hypoalbuminemia. suggest nutrition avoi protein in patientsliverusingthesamerecommenationsasforother ill patients (see sectionC4).鑒于專家共識(shí)，由于肝硬化及肝衰患者腹水、血管內(nèi)容量不足、水腫、門靜脈高壓及低蛋白血癥等并且發(fā)癥，我們建議使用能量及蛋白需要量的預(yù)測(cè)公式時(shí)， 應(yīng)采用干重或平時(shí)體重而非實(shí)際體重。與其他危重病患者相

43、同，我們建議肝衰患者不應(yīng)限制蛋白質(zhì)攝入（C4 部分）。Question: What is the appropriate route of nutrition elivery in patients with hepatic failure?問題：肝衰患者恰當(dāng)?shù)臓I養(yǎng)供給途徑是什么？K2. Base on expert consensus, we suggest that EN be use preferentially whenproviingnutritioninICUpatientsacutean/orchronicliver isease.鑒于專家共識(shí)，我們建議罹患急性和（或）慢性肝病I

44、CU 患者優(yōu)先選擇腸內(nèi)營養(yǎng)治療方式。Question: Is a isease-specific enteral formulation neee for critically ill patients with liver isease?問題：合并且肝病的危重病患者是否需要特殊疾病腸內(nèi)營養(yǎng)配方？K3. Base on expert consensus, we suggest that stanar enteral formulations beuseinICUpatientsacuteanchronicliverisease.isnoevienceof benefit of amino ac

45、i formulations (BCAA) on coma intheICUpatientencephalopathyisluminal-actingantibioticsanlactulose.鑒于專家共識(shí)，我們建議罹患急性和慢性肝病ICU 患者選用標(biāo)準(zhǔn)配方腸內(nèi)營養(yǎng)制劑。關(guān)于于已經(jīng)接受腸腔內(nèi)作用抗生素及乳果糖一線治療的肝性腦病患者， 沒有證據(jù)表明支鏈氨基酸）型腸內(nèi)營養(yǎng)配方能夠改善昏迷的嚴(yán)重程度。 急性胰腺炎Question: oes isease severity in acute pancreatitis influence ecisions toprovie specialize nut

46、rition therapy?問題：急性胰腺炎的疾病嚴(yán)重程度是否影響特殊配方營養(yǎng)治療的選擇？ L1aBaseonconsensussuggestthattheinitialnutritionassessment inacuteevaluateiseasetonutritionSinceiseasemaychangequickly,suggestoffeeing toleranceanneeforspecializenutrition鑒于專家共識(shí)，我們建議關(guān)于于急性胰腺炎患者的初始營養(yǎng)評(píng)估應(yīng)考慮疾病的嚴(yán)重程度，以指導(dǎo)營養(yǎng)治療策略。由于病情嚴(yán)重程度可能迅速改變，我們建議關(guān)于于喂養(yǎng)耐受性以及是否需要

47、特殊營養(yǎng)治療進(jìn)行反復(fù)評(píng)估。Question: o patients with mil acute pancreatitis nee specialize nutrition therapy?問題：輕癥急性胰腺炎患者是否需要特殊營養(yǎng)治療？L1b. We suggest NOT proviing specialize nutrition therapy to patients withmilacuteinsteaavancingtoanoralietastolerate.Ifan unexpectecomplicationevelopsoristoavancetooraliet 7ays,then

48、specializenutritionshoulbeconsiere. Quality of Low我們建議輕癥急性胰腺炎患者不使用特殊營養(yǎng)治療，如果能夠耐受，應(yīng)過渡到經(jīng)口進(jìn)食。如果發(fā)生意外并且發(fā)癥或7 天內(nèi)不能過渡到經(jīng)口進(jìn)食，則考慮進(jìn)行特殊營養(yǎng)治療?！咀C據(jù)質(zhì)量：非常低】Question: patients specialize nutrition after amission for acute 問題：哪類急性胰腺炎患者在入院后早起需要特殊營養(yǎng)治療？L1c. We suggest that patients with moerate to severe acute pancreatitis

49、shoulhave a naso-/oroenteric tube place an at a trophic an o ol s oe on s o n 8 os of amission).Quality of Evience: Very Low我們建議中度至重度急性胰腺炎患者留置經(jīng)鼻或經(jīng)口腸內(nèi)營養(yǎng)管，一旦液體復(fù)蘇完成后（入ICU 24-48小時(shí)內(nèi)）即開始滋養(yǎng)型喂養(yǎng)，并且逐步過度到目標(biāo)營養(yǎng)?！咀C據(jù)質(zhì)量：非常低】Question:isthemostformulatouseinitiatinginthepatientmoeratetoacute問題：中重度急性胰腺炎患者開始早時(shí)，選擇哪種配方最適

50、宜？L2. We suggest using a stanar polymeric formula to initiate EN in the patientacuteAlthoughpromising,theatainsufficienttorecommenplacingapatientacuteonan immune-enhancing formulation at thistime.Quality of Evience: Very Low我們建議重癥急性胰腺炎患者開始時(shí)選擇標(biāo)準(zhǔn)聚合物配方制劑然令人鼓舞，但尚不足以推薦重癥急性胰腺炎患者應(yīng)用免疫增強(qiáng)配N?！咀C據(jù)質(zhì)量：非常低】Question

51、: Shoul patients with severe acute pancreatitis receive EN or PN?問題：重癥急性胰腺炎患者應(yīng)當(dāng)接還是L3a. We suggest the use of EN over PN in patients with severe acute pancreatitiswho require nutrition therapy. Quality of Evience: Low我們建議需要營養(yǎng)治療的重癥急性胰腺炎患者優(yōu)先選而非?！咀C據(jù)質(zhì)量：低】Question:Shoulpatientsacutebefeintothestomach or s

52、mallbowel?問題：重癥急性胰腺炎患者應(yīng)給予經(jīng)胃喂養(yǎng)還是經(jīng)小腸喂養(yǎng)？L3b. We suggest that EN be provie to the patient with severe acutebyeithertheorjejunalroute,asisnoin toleranceorclinicaloutcomestheselevelsofinfusion.Quality of Evience: Low我們建議重癥急性胰腺炎患者可經(jīng)胃或經(jīng)空腸接，因?yàn)閮煞N途徑在耐受性與臨床預(yù)后方面并且無差異?！咀C據(jù)質(zhì)量：低】Question:Intheofintolerance,canbeuset

53、oenhance tolerancetoinpatientsacute問題：關(guān)于于 EN 不耐受的重癥急性胰腺炎患者，有哪些措施可以提高EN 的耐受性？L4. Base on expert consensus, we suggest that, in patients with moerate toacutehaveintolerancetoshoulbetaken to improve tolerance.鑒于專家共識(shí)，我們建議關(guān)于于不能耐受EN 的中重度急性胰腺炎患者，應(yīng)采取相應(yīng)措施改善耐受性。Question: Shoul patients with severe acute pancr

54、eatitis receive probiotics?問題：重癥急性胰腺炎患者是否應(yīng)給予益生菌治療？L5. We suggest that the use of probiotics be consiere in patients with severeacuteQuality of Low我們建議接受早期EN 的重癥急性胰腺炎患者可考慮使用益生菌?！咀C據(jù)質(zhì)量：低】Question: When is it appropriate to use PN in patients with severe acutepancreatitis?問題：重癥急性胰腺炎患者何時(shí)選Question: When i

55、s it appropriate to use PN in patients with severe acutepancreatitis?問題：重癥急性胰腺炎患者何時(shí)選PN 為宜？L6.Baseonconsensus,suggestthat,forthepatientacuteisnotfeasible,useofPMshoulbeconsiereafterone fromtheonsetoftheepisoe.根據(jù)專家共識(shí)一周后應(yīng)考慮使用。成年危重病患者營養(yǎng)支持治療實(shí)施與評(píng)估指(5/6)翻譯：清華大學(xué)長庚醫(yī)院周華 許媛來源：中國病理生理學(xué)危重病醫(yī)學(xué)專業(yè)委員會(huì)官網(wǎng)SURGICAL外科部分創(chuàng)傷Q

56、uestion: oes the nutrition therapy approach for the trauma patient ifferfrom that for otherill patients?問題：創(chuàng)傷患者的營養(yǎng)治療方案與其他危重病患者有何不同？M1a. We suggest that, similar to other critically ill patients, early enteral feeingahighproteinpolymericietbeinitiateintheimmeiatepost-trauma perio24to48hoursofoncethep

57、atientishemoynamically stable.Quality of Evience: Very Low與其他危重病患者相似，我們建議一旦創(chuàng)傷患者血流動(dòng)力學(xué)穩(wěn)定，應(yīng)盡早（創(chuàng)傷后 24-48 小時(shí)）開始高蛋白配方腸內(nèi)營養(yǎng)?！咀C據(jù)質(zhì)量：非常低】Question:Shoulimmune-moulationformulasbeuseroutinelyto improve outcomes in a patient 問題：嚴(yán)重創(chuàng)傷患者是否應(yīng)常規(guī)使用免疫調(diào)節(jié)配方以改善預(yù)后？M1b. We suggest that immune-moulating formulations containing

58、 arginine anbeconsiereinpatientsQualityofLow我們建議嚴(yán)重創(chuàng)傷患者給予富含精氨酸與魚油的免疫調(diào)節(jié)配方腸內(nèi)營養(yǎng)?！咀C據(jù)質(zhì)量：非常低】TRAUMATIC BRAIN INJURY顱腦創(chuàng)傷Question: oes the approach for nutrition for the patient ifferfrom that of other critically ill patients or trauma patients without hea injury?問題：TBI 患者的營養(yǎng)治療方案與其他危重病患者或沒有顱腦損傷的其他創(chuàng)傷患者有何不同？M2

59、a. We recommen that, similar to other critically ill patients, early enteralfeeingbeinitiateintheimmeiatepost-traumaperio24to48hours ofoncethepatientishemoynamicallystable.18 PAGE PAGE 26Quality of Evience: Very Low與其他危重病患者相似，我們建議一旦患者血流動(dòng)力學(xué)穩(wěn)定，在創(chuàng)傷后（損傷24-48 小時(shí)內(nèi)）立即開始早期腸內(nèi)營養(yǎng)?！咀C據(jù)質(zhì)量：非常低】Question: Shoul immu

60、ne-moulating formulas be use in a patient with TBI?問題：TBI 患者是否應(yīng)當(dāng)使用免疫調(diào)節(jié)配方嗎？M2b: Base on expert consensus, we suggest the use of eitherarginine-containing immune-moulating formulations or EPA/HA supplement with stanar enteral formula in patients with TBI.鑒于專家共識(shí)，我們建議患者使用含有精氨酸的免疫調(diào)節(jié)配方，或使用添加的標(biāo)準(zhǔn)配方。 開放腹腔Que