欧洲ESPEN关于危重症患者的肠内营养指南VIP免费

ESPENGuidelinesonEnteralNutrition:Intensivecare程俊峰程俊峰普外科普外科GeriatricsGeriatricsLiverdiseaseLiverdiseaseSurgeryincludingorgantransplantationSurgeryincludingorgantransplantationWastinginHIVandotherchronicinfectiousdiseasesWastinginHIVandotherchronicinfectiousdiseasesAdultrenalfailureAdultrenalfailureGastroenterologyGastroenterologyPancreasPancreasCardiologyandpulmonologyCardiologyandpulmonologyNon-surgicaloncologyNon-surgicaloncologyIntensivecareIntensivecareESPENESPENGuidelinesGuidelinesononEN:EN:ESPENESPENGuidelinesGuidelinesononPN:PN:GeriatricsGeriatricsHepatologyHepatologysurgerysurgeryCardiologyandpneumologyCardiologyandpneumologyAdultrenalfailureAdultrenalfailureGastroenterologyGastroenterologyPancreasPancreashomeparenteralnutrition(HPN)inadultpatientshomeparenteralnutrition(HPN)inadultpatientsSummarySummaryEnteralnutrition(EN)的定义及目的：1、ENisthepreferredwayoffeedingthecriticallyillpatientandcounteractingforthecatabolicstateinducedbyseverediseases.2、Intendedtogiveevidence-basedrecommendationsfortheICUpatient,focusingparticularlyonthosewhodevelopasevereinflammatoryresponse,i.e.patientswhohavefailureofatleastoneorganduringtheirICUstay.EN的时机及要求：1、ENshouldbegiventoallICUpatientswhoarenotexpectedtobetakingafulloraldietwithinthreedays.2、thefirst24husingastandardhigh-proteinformula.theacuteandinitialphases≤20–25kcal/kg/d（exogenousenergy）.Recovery,25–30kcal/kg/d.3、Glutamineshouldbesupplementedinpatientssufferingfromburnsortrauma.SubjectSubjectRecommendationsGradeGradeindicationindicationAllpatientswhoarenotexpectedtobeonafulloraldietwithin3daysCCApplicationTherearenodatasupportusingearlyENcanimprovetheirPrognosis，butthecommitteestillrecommendtheearly（<24h）appropriateamountoffeeding,oncethepatienthaveahaemo-dynamicallystableandafunctioninggastrointestinaltract.CCExogenousenergysupply:theacuteandinitialphase:≥25kcal/kg/dlessfavourableRecovery：≥25kcal/kg/dCCsevereunder-nutrition：theENenergysupplyshouldupto25kcal/kg/d，ifnotreached，pleaseaddPNCCIfthepatientintolerance(suchashighgastricresiduals)toEN,metoclopramide（胃复安）orErythromycin（红霉素）shouldbeconsidered.CCRouteRouteUseENinpatientswhocanbefedviatheenteralroute.CCViajejunalversusgastricfeeding,thereisnosignificantdifference.CCIfthepatientstolerateENandcanreachthetargetenergyvalue,PNshouldbeavoid.AAViaENcannotbefedsufficiently,PNShouldsupplementCCTypeofformulaWholeproteinformulaearesuperiortothepeptide-basedformulaeCCImmune-modulatingformulae(formulaeenrichedwitharginine(精氨酸),nucleotides（核苷酸）andw-3fattyacids)aresuperiortostandardenteralformulae:InelectiveupperGIsurgicalpatients;inpatientswithamildsepsis(APACHE≤15);inpatientswithseveresepsis,maybeharmfulandarenotRecommended;inpatientswithtrauma;inpatientswithARDS(formulaecontainingo-3fattyacidsandantioxidants).AABBBBAABBDuetoinsufficientdata,norecommendationsupporttheImmune-modulatingformulaeapplytotheburnedpatients,butthetraceelements(Cu,SeandZn)shouldbesupplementedinahigherthanstandarddoseAAthesevereillnessICUpatients,shouldnotreceiveanimmune-modulatingformulaenrichedwitharginine,nucleotidesandw-3fattyacidsiftheEN≤700ml/d.BBGlutamineshouldbeaddedtostandardenteralformulainburnedpatientsandtraumapatientsAA1.1EN-when?1.1EN-when?Allpatients（cannotbeonafulloraldietwithin3days）shouldreceiveEN（C）a.Itisunethicaltoin...