2016重症营养1.doc

SCCM/ASPEN成年危重病患者营养支持治疗实施与评估指南(1/6) 2016年02月15日???指南导读,?进展交流???暂无评论 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 成年危重病患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) Taylor BE, McClave SA, Martindale RG, et al. Crit Care Med 2016; 44: 390-438 翻译：清华大学长庚医院?周华 许媛 A. NUTRITION ASSESSMENT 营养评估 Question: Does the use of a nutrition risk indicator identify patients who will most likely benefit from nutrition therapy? 问题：营养风险筛查工具能否鉴别哪些患者最可能从营养治疗中获益？ A1. Based on expert consensus, we suggest a determination of nutrition risk (for example, nutritional risk score [NRS-2002], NUTRIC score) be performed on all patients admitted to the ICU for whom volitional intake is anticipated to be insufficient. High nutrition risk identifies those patients most likely to benefit from early EN therapy. 根据专家共识，我们建议对收入ICU且预计摄食不足的患者进行营养风险评估（如营养风险评分NRS-2002，NUTRIC 评分）。高营养风险患者的识别，最可能使其从早期肠内营养治疗中获益。 A2. Based on expert consensus, we suggest that nutritional assessment include an evaluation of comorbid conditions, function of the gastrointestinal (GI) tract, and risk of aspiration. We suggest not using traditional nutrition indicators or surrogate markers, as they are not validated in critical care. 根据专家共识，我们建议营养评估应当包括对于合并症、胃肠道功能以及误吸风险的评估。我们建议不要使用传统的营养指标或其替代指标，因为这些指标在ICU的应用并非得到验证。 ? Question: What is the best method for determining energy needs in the critically ill adult patient? 问题：确定成年危重病患者能量需求的最佳方法是什么？ A3a. We suggest that indirect calorimetry (IC) be used to determine energy requirements, when available and in the absence of variables that affect the accuracy of measurement. [Quality of Evidence: Very Low]。 如果有条件且不影响测量准确性的因素时，建议应用间接能量测定(间接测热法，indirect calorimetry，IC) 确定能量需求。 ［证据质量：非常低］ ? A3b. Based on expert consensus, in the absence of IC, we suggest that a published predictive equation or a simplistic weight-based