欧洲肠外肠内营养学会肠内营养指南

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1、欧洲肠外肠内营养学会肠内营养指南欧洲肠外肠内营养学会（ESPEN）肠内营养指南于2006年刊登在《临床营养》（ClinicalNutrition）杂志上，为临床营养支持的应用提供了科学依据。该指南采用苏格兰学院间指南协作网（SIGN）分级标准，A级推荐的内容为荟萃分析或随机对照研究的结果，B级推荐为描述研究、比较研究的结果，C级推荐为专家意见。适当的营养支持可以帮助重症患者度过严重疾病导致的高分解状态，通过管饲的肠内营养（EN）是目前重症患者摄入营养物质的主要途径。ESPEN指南对营养支持的应用、途径、和营养制剂配方做出了循证推荐。ClinNutr.2006Apr;25(2):21

2、0-23.ESPENGuidelinesonEnteralNutrition:Intensivecare.KreymannKG,BergerMM,DeutzNE,HiesmayrM,JollietP,KazandjievG,NitenbergG,vandenBergheG,WernermanJ;DGEM(GermanSocietyforNutritionalMedicine),EbnerC,HartlW,HeymannC,SpiesC;ESPEN(EuropeanSocietyforParenteralandEnteralNutrition).DepartmentofIntensi

3、veCareMedicine,UniversityHospitalEppendorf,Hamburg,Germany.Enteralnutrition(EN)viatubefeedingis,today,thepreferredwayoffeedingthecriticallyillpatientandanimportantmeansofcounteractingforthecatabolicstateinducedbyseverediseases.Theseguidelinesareintendedtogiveevidence-basedrecommendationsforthe

4、useofENinpatientswhohaveacomplicatedcourseduringtheirICUstay,focusingparticularlyonthosewhodevelopasevereinflammatoryresponse,i.e.patientswhohavefailureofatleastoneorganduringtheirICUstay.Theseguidelinesweredevelopedbyaninterdisciplinaryexpertgroupinaccordancewithofficiallyacceptedstandardsand

5、arebasedonallrelevantpublicationssince1985.Theywerediscussedandacceptedinaconsensusconference.ENshouldbegiventoallICUpatientswhoarenotexpectedtobetakingafulloraldietwithinthreedays.Itshouldhavebegunduringthefirst24husingastandardhigh-proteinformula.Duringtheacuteandinitialphasesofcriticalillne

6、ssanexogenousenergysupplyinexcessof20-25kcal/kgBW/dayshouldbeavoided,whereas,duringrecovery,theaimshouldbetoprovidevaluesof25-30totalkcal/kgBW/day.SupplementaryparenteralnutritionremainsareservetoolandshouldbegivenonlytothosepatientswhodonotreachtheirtargetnutrientintakeonENalone.Thereisnogene

7、ralindicationforimmune-modulatingformulaeinpatientswithsevereillnessorsepsisandanAPACHEIIScore>15.Glutamineshouldbesupplementedinpatientssufferingfromburnsortrauma.营养支持的应用所有3天内无法通过经口进食满足营养需求的重症患者需要接受肠内营养（C级推荐）。没有证据显示重症患者接受早期肠内营养可以改善相关转归