2016重症营养5..docVIP

SCCM/ASPEN成年危重病患者营养支持治疗实施与评估指南(5/6) 2016年02月29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 张振宇 许媛 M. SURGICAL SUBSETS外科部分 TRAUMA创伤 Question: Does the nutrition therapy approach for the trauma patient differ from that for other critically ill patients? 问题：创伤患者的营养治疗方案与其他危重病患者有何不同？ M1a. We suggest that, similar to other critically ill patients, early enteral feeding with a high protein polymeric diet be initiated in the immediate post-trauma period (within 24 to 48 hours of injury) once the patient is hemodynamically stable. [Quality of Evidence: Very Low] 与其他危重病患者相似，我们建议一旦创伤患者血流动力学稳定，应尽早（创伤后24-48小时）开始高蛋白配方肠内营养。 【证据质量：非常低】 ? Question: Should immune-modulation formulas be used routinely to improve outcomes in a patient with severe trauma? 问题：严重创伤患者是否应常规使用免疫调节配方以改善预后？ M1b. We suggest that immune-modulating formulations containing arginine and FO be considered in patients with severe trauma. [Quality of Evidence: Very Low] 我们建议严重创伤患者给予富含精氨酸与鱼油的免疫调节配方肠内营养。 【证据质量：非常低】 ? TRAUMATIC BRAIN INJURY颅脑创伤 Question: Does the approach for nutrition therapy for the TBI patient differ from that of other critically ill patients or trauma patients without head injury? 问题：TBI患者的营养治疗方案与其他危重病患者或没有颅脑损伤的其他创伤患者有何不同？ M2a. We recommend that, similar to other critically ill patients, early enteral feeding be initiated in the immediate post-trauma period (within 24 to 48 hours of injury) once the patient is hemodynamically stable. [Quality of Evidence: Very Low] 与其他危重病患者相似，我们建议一旦患者血流动力学稳定，在创伤后（损伤24-48小时内）立即开始早期肠内营养。 【证据质量：非常低】 ? Question: Should immune-modulating formulas be used in a patient with TBI? 问题：TBI患者是否应当使用免疫调节配方吗？ M2b: Based on expert consensus, we