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1、SCCM/ASPEN成年危重病患者营养支持治疗实施与评估指南(6/6)2016年03月02日 指南导读, 进展交流 暂无评论GuidelinesfortheProvisionandAssessmentofNutritionSupportTherapyintheAdultCriticallyIllPatient:SocietyofCriticalCareMedicine(SCCM)andAmericanSocietyforParenteralandEnteralNutrition(A.S.P.E.N.)成年危重病患
2、者营养支持治疗的实施与评估指南：美国危重病医学会(SCCM)与美国肠外肠内营养学会(ASPEN)TaylorBE,McClaveSA,MartindaleRG,etal.CritCareMed2016;44:390-438翻译：清华大学长庚医院周华许媛P.CHRONICALLYCRITICALLYILL 慢性危重病患者Question: Howshouldthechronicallycriticallyillpatientbemanagedwithnutritiontherapy?问题：如何管理慢性危重病患者的营养治
3、疗？P1.Basedonexpertconsensus,wesuggestthatchronicallycriticallyillpatients(definedasthosewithpersistentorgandysfunctionrequiringICULOS>21days)bemanagedwithaggressivehigh-proteinENtherapyand,whenfeasible,thataresistanceexerciseprogrambeused.根据专家共识，我们建议慢性危重病患者（定义为
4、那些因持续存在器官功能不全需要住ICU>21天的患者）给予积极高蛋白质EN治疗，且如有可能，应制订抗阻力功能锻炼计划。 O.OBESITYINCRITICALILLNESS 肥胖患者的危重病Question: DoobeseICUpatientsbenefitlessfromearlyENinthefirstweekofhospitalization,duetotheirnutritionreserves,thantheirleancounterparts?问题：肥胖的ICU患者因具有营养储备，是否比消瘦患者从住院第
5、一周的早期EN中获益更少？Q1.Basedonexpertconsensus,wesuggestthatearlyENstartwithin24–48hoursofadmissiontotheICUforobesepatientswhocannotsustainvolitionalintake.根据专家共识，肥胖患者不能经口摄食时，我们建议在收入ICU24-48小时内即开始早期EN。 Question: Whatadditionalparametersshouldbeaddressedwithanutritionas
6、sessmentincriticalillnesswhenthepatientisobese?问题：对肥胖的危重病患者进行营养评估时，需要额外考虑哪些指标？Q2.Basedonexpertconsensus,wesuggestthatnutritionassessmentoftheobeseICUpatientfocusonbiomarkersofmetabolicsyndrome,anevaluationofcomorbidities,andadeterminationoflevelofinflammation,i
7、nadditiontothoseparametersdescribedforallICUpatients.根据专家共识，建议对ICU肥胖患者进行营养评估时，除所有ICU患者的常规指标外，我们建议重视代谢综合征的生物标志物，评价合并症，并确定炎症反应状态。 Question: WhatfactorsonassessmentidentifyobesepatientsintheICUtobeathighrisk?问题：哪些评价指标用于确定ICU肥胖症患者存在高营养风险？Q3.Basedonexpertconsensus,w
8、esuggestthatnutritionassessmentoftheobeseICUpatientfocusonevidenceofcentraladiposity,metabolicsyndrome,sarcopenia,BMI>40,SIRS,orothercomorbiditiesthatcorrelatewithhigherobes
