<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">中国急诊危重症患者肠内营养治疗专家共识(2022)</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-01</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:全景看重症</em></h2></div><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0OveAhfM4HlZtibW4sM5KdmfD5DF4WAF1d3ts1icta8oPHsq0E5CEbca9w9A/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F662FB82BF950F892A6.jpg" alt="图片" style="text-align: justify; margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box; overflow-wrap: break-word; visibility: visible; width: 396px;"/><br/></p><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><br/></section><section><section><section><section><section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">共识制定前期,在全国范围内进行了“急诊危重患者肠内营养(enteral nutrition, EN)治疗医护知、信、行现状”调查,结果显示急诊医护人员对急诊危重症患者首选EN治疗方面认识一致、接受度高,但是在知识储备、行为实践方面仍存在明显差异。基于此,在多位专家共同努力下,制定《中国急诊危重症患者肠内营养治疗专家共识》,以规范临床实践,进一步提高急诊危重症患者的治疗质量。</span></p><p></p></section></section></section></section></section><section><section><br/></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section><section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">一、急诊危重症患者营养风险筛查</span></section></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见1:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对滞留急诊&gt;48 h 的急诊危重症患者,建议采用营养风险筛查(nutritional risk screening, NRS)- 2002 进行营养风险评估。NRS-2002&nbsp;≥ 3 分提示患者存在营养风险,建议营养治疗。<br/></span></p><p><br/></p><p></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0OveDqoCdXK79TD08WHz3l8FZwG4PQdxSWjuybr3ka8ib8lMkYHBgkxjueQ/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F6630E4D6323DB8E741.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 396px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见2:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对入住急诊重症监护病房(emergency intensive care unit, EICU)的急危重症患者,建议采用危重症患者的营养风险(nutritional risk in critically ill, NUTRIC)评分行营养风险评估。NUTRIC 评分≥ 6 分或者改良版 NUTRIC 评分≥ 5 分提示存在高营养风险,建议营养治疗。</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0Ove8RibXN1yvA9LsAwU3wnJSqj4QNeMwmibJdRwbWIuQA5JZsZoFaDVDSgA/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F66321C12476E2011C0.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box; overflow-wrap: break-word; width: 396px; visibility: visible;"/><br/></p><p><br/></p></section></section></section></section></section></section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">二、EN启动时机</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见3:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于血流动力学稳定的患者[ 平均动脉压(mean arterial pressure, MAP)≥ 65 mmHg(1mmHg=0.133 kPa),去甲肾上腺素≤ 1 μg/(kg · min)并在减量中 ], 24~48 h 内酌情尽早启动 EN。<br/></span></p><section><section><section><section></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见4:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于能经口饮食但吞咽不安全的患者,建议使用 EN。</span></section><section><br/></section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">三、EN的目标能量和蛋白质目标</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见5:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于急诊危重症患者,建议基于标准体重的简单计算公式&nbsp;:25~30&nbsp;Kcal/(kg&nbsp;·&nbsp;d)来确定静息目标能量。如果有条件,可使用间接测热(indirect&nbsp;calorimetry,&nbsp; IC)法确定能量需求。<br/></span></p><section></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见6:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">急性疾病早期(前 3 d)应用低热卡营养支持治疗(低于目标能量的 70%);3 d 后,如胃肠功能耐受,能量摄入可逐步提高至目标能量的80%~100%。</span></section><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见7:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">推荐给予足够的蛋白质 [1.2~2.0 g/ (kg · d)],并对蛋白质摄入量的充分性进行持续评估。</span></section><section><br/></section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">四、EN的途径</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见8:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">推荐盲法留置鼻胃 / 鼻肠管,首选胃内途径;对有高误吸风险,或促动力药物无效的经胃 EN 不耐受患者,建议采用幽门后喂养。<br/></span></p><section></section><p><br/></p><section style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见9:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于鼻胃 / 鼻肠管置管困难的患者,建议在超声或透视引导下放置 , 若仍无法成功,建议在内镜引导下放置。</span></section><section><br/></section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">五、EN制剂</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见10:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">推荐胃肠功能完整或胃肠功能康复的患者,选择整蛋白配方;存在胃肠功能损伤的患者,选择短肽配方。现有EN药品能够基本满足临床需求,应作为首选。不推荐首选特殊医学用途食品。<br/></span></p><p><br/></p><section></section><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0OveYFODjwAXmjeiblH4Zsg2iaSEichnTb33dE19MMpIhfOUfWldd4hJkHFxA/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F66334FDB0B67C63557.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 396px ; visibility: visible ;"/></p></section><section><br/></section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">六、EN的实施</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见11:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于急诊危重症患者,使用持续输注 EN,而不是间歇性单次大量输注 EN。<br/></span></p><section><section></section><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见12:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">输注速度建议 10~20 mL/h 起始,如胃肠功能耐受,可逐渐增加速度。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见13:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">所有接受 EN 的机械通气患者应将床头抬高 30~45°,以减少误吸。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见14:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">血糖大于 10 mmol/L 的患者 , 推荐首选静脉滴注胰岛素控制血糖。当血糖难以控制,可采用低血糖指数配方。</span></p><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">七、常见急诊危重症患者 EN 治疗策略</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见15:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">急性呼吸衰竭的患者,不推荐高脂肪 / 低碳水化合物配方。也不常规推荐使用含有 omega-3 脂肪酸的配方。<br/></span></p><p></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见16:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">重症急性胰腺炎患者建议经鼻胃管 EEN。如患者无法耐受经胃喂养,可采用幽门后喂养。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见17:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">接受目标体温管理 (target temperature management, TTM) 的患者,推荐低剂量 EEN 治疗,在复温后增加剂量。</span></p><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">八、EN 的耐受性评估</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见18:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">推荐采用急性胃肠功能损伤(Acute gastrointestinal function injury, AGI)标准对患者进行胃肠功能评估,若 AGI Ⅰ ~ Ⅲ级,仍应积极启动 EN,若 AGI IV 级应暂缓 EN。EN 过程中应对 AGI 实施动态评估。<br/></span></p><p><br/></p><p></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0OvecEicM7QW3lXwhQ0YiciaI9Ucazl7d3c0FqNiaybTfuDj5jAxC3fiamZ8RPA/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F6634A52C5E46E3EB0D.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 396px ; visibility: visible ;"/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见19:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">推荐对误吸高风险的急诊危重症患者进行GRV 监测,连续 2 次 GRV&gt;250 mL 时,如促胃动力药无效,推荐使用幽门后喂养。</span></p><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">九、EN 的并发症处理</span></section><section><br/></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见20:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于存在腹泻、肠鸣音减弱或消失(排除肠缺血或肠梗阻)的患者,建议评估其原因、予适当治疗的同时继续 EN。<br/></span></p><p></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见21:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">当腹腔内压(intra-abdominal pressure,IAP)增高时,应谨慎实施 EN。IAP 12~15 mmHg 时,可以继续常规实施;IAP 16~20 mmHg 时,应采用滋养型喂养;当 IAP&gt;20 mmHg 时,则应暂停 EN。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-two" style="font-size: 16px; line-height: 22.5px; font-weight: bold; color: rgb(0, 0, 0); list-style-type: decimal; text-align: left;">推荐意见22:</span><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对存在再喂养综合征风险患者,营养启动时最大目标为目标热卡的 40%~50%。</span></p><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">十、急诊危重症患者 EN 的流程推荐</span></section><section><br/></section></section><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/AMTPy8ayVcWgibP5Q4Rnp1zDeRdgM0Ove8OBCc75mjBEns51ibia9ibU6vzAGicR4n9w6weHhkLGEBNXSxnDaqLSSeg/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B11601807F66371BA30B4882701D.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 396px ; visibility: visible ;"/></p></section></section></section><!--auditorInfo-->

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