{"id":18869,"date":"2020-04-28T05:08:52","date_gmt":"2020-04-27T21:08:52","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18869"},"modified":"2020-07-14T16:17:46","modified_gmt":"2020-07-14T08:17:46","slug":"%e6%ac%a7%e6%b4%b2%e4%b8%b4%e5%ba%8a%e8%90%a5%e5%85%bb%e4%b8%8e%e4%bb%a3%e8%b0%a2%e5%ad%a6%e4%bc%9aespen%e5%85%b3%e4%ba%8e%e6%96%b0%e5%86%a0%e7%97%85%e6%af%92%e6%84%9f%e6%9f%93%e6%82%a3%e8%80%85","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18869","title":{"rendered":"\u6b27\u6d32\u4e34\u5e8a\u8425\u517b\u4e0e\u4ee3\u8c22\u5b66\u4f1a(ESPEN)\u5173\u4e8e\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u60a3\u8005\u8425\u517b\u7ba1\u7406\u5b9e\u8df5\u6307\u5bfc\u4e13\u5bb6\u610f\u89c1"},"content":{"rendered":"\n

ESPEN expert statements and practical guidance for nutritional management of individuals with sars-cov-2 infection.<\/h1>\n\n\n\n

Clinical Nutrition ,\u00a0https:\/\/doi.org\/10.1016\/j.clnu.2020.03.022<\/a><\/h3>\n\n\n\n

\u65b0\u51a0\u80ba\u708e\u4e0d\u826f\u9884\u540e\u4e0e\u9ad8\u75c5\u6b7b\u7387\u4e0e\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u3001\u9ad8\u9f84\u3001\u5408\u5e76\u57fa\u7840\u75be\u75c5\u3001\u80a5\u80d6\u4ee5\u53ca\u8425\u517b\u4e0d\u826f\u5bc6\u5207\u76f8\u5173\uff0c\u708e\u75c7\u53cd\u5e94\u4e0e\u5e76\u53d1\u7684\u5168\u8eab\u611f\u67d3\uff08sepsis\uff09\u4f7f\u75c5\u60c5\u8fdb\u4e00\u6b65\u52a0\u91cd\u3002 ICU\u4f4f\u9662\u65f6\u95f4\u5ef6\u957f\u672c\u8eab\u5c31\u53ef\u5bfc\u81f4\u75c5\u4eba\u83b7\u5f97\u6027\u8425\u517b\u4e0d\u826f\u4e0e\u4e25\u91cd\u7684\u9aa8\u9abc\u808c\u4e27\u5931\u3002\u6700\u8fd1\uff0cESPEN\uff08European Society for Clinical Nutrition and Metabolism\uff0c\uff09\u4e3aCOVID-19 \u75c5\u6bd2\u611f\u67d3\u60a3\u8005\u7684\u8425\u517b\u7ba1\u7406\u63d0\u51fa10\u6761\u7b80\u660e\u7684\u6307\u5bfc\u610f\u89c1\u3002\u7b80\u5355\u4ecb\u7ecd\u5982\u4e0b\uff1a<\/p>\n\n\n\n

Statement 1<\/strong><\/p>\n\n\n\n

Patients at risk for poor outcomes and higher mortality following infection with SARS-COV-2, namely older adults and polymorbid individuals, should be checked for malnutrition through screening and assessment. The check should initially comprise the MUST criteria* or, for hospitalized patients, the NRS-2002 criteria.<\/strong><\/p>\n\n\n\n

*Must criteria: see https:\/\/www.bapen.org.uk\/screening-and-must\/must-calculat<\/em>or<\/p>\n\n\n\n

**NRS-2002 criteria: https:\/\/www.mdcalc.com\/nutrition-risk-screening-2002-nrs-2002<\/em><\/p>\n\n\n\n

\u4e13\u5bb6\u5efa\u8bae1: \u9ad8\u9f84\u3001\u5408\u5e76\u591a\u79cd\u57fa\u7840\u75be\u75c5\u662f<\/strong>SARS-COV-2<\/strong>\u611f<\/strong>\u67d3\u60a3\u8005\u4e0d\u826f\u9884\u540e\u53ca\u9ad8\u75c5\u6b7b\u7387\u7684\u98ce\u9669\u56e0\u7d20\uff0c\u5e94\u5bf9\u6b64\u98ce\u9669\u8fdb\u884c\u7b5b\u67e5\u53ca\u8bc4\u4f30\u8425\u517b\u4e0d\u826f\u3002\u521d\u671f\u53ef\u9009\u62e9 \u201cMUST\u201d\u6216NRS-2002\uff08\u4f4f\u9662\u60a3\u8005\uff09\u7b5b\u67e5\u5de5\u5177\u3002<\/strong><\/p>\n\n\n\n

\u5efa\u8bae\u5728\u60a3\u75c5\u65e9\u671f\u8bc4\u4f30\u8be5\u75c5\u4eba\u8bf4\u670d\u5b58\u5728\u8425\u517b\u4e0d\u826f\u98ce\u9669\uff0c\u9664\u4e86\u4f4e\u4f53\u91cd\uff0c\u8fd8\u9700\u5173\u6ce8\u808c\u8089\u542b\u91cf\u3002\u591a\u4e2a\u8425\u517b\u5b66\u4f1a\u5021\u8bae\u548c\u63a8\u8350\uff1a\u9996\u5148\u4f7f\u7528\u98ce\u9669\u7b5b\u67e5\u5de5\u5177\uff0c\u7136\u540e\u5224\u65ad\u8425\u517b\u4e0d\u826f\u53ca\u5176\u7a0b\u5ea6\uff08\u89c1\u88681\uff09\uff0c\u7ef4\u6301\u8425\u517b\u72b6\u6001\u4e0e\u6cbb\u7597\u8425\u517b\u4e0d\u826f\u5bf9\u4e8e\u964d\u4f4eCOVID-19\u611f\u67d3\u6f5c\u5728\u5e76\u53d1\u75c7\u4e0e\u4e0d\u826f\u9884\u540e\u540c\u6837\u91cd\u8981\u3002<\/p>\n\n\n\n

Table 1. Phenotypic and etiologic criteria for the diagnosis of malnutrition<\/p>\n\n\n\n

Phenotypic Criteria<\/td> <\/td>Etiologic Criteria<\/td> <\/td><\/tr>
Weight loss (%)<\/td>>5% within past 6months or >10% beyond 6 months<\/td>Reduced food intake or assimilation**<\/td>50% of ER > 1 week, or any reduction for >2 weeks, or any chronic GI condition that adversely impacts food assimilation or absorption<\/td><\/tr>
Low body mass index(kg\/m2)<\/td><20 if < 70 years, or <22 if >70 yrsAsia: <18.5 if < 70 yrs or <20 if >70 yrs<\/td>inflammation***<\/td>Acute disease\/ injury, or chronic disease related<\/td><\/tr>
Reduced musclemass<\/td>Reduced by validated body composition measuring techniques*<\/td> <\/td> <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Statement 2<\/strong>\uff1a<\/strong><\/strong><\/p>\n\n\n\n

Subjects with malnutrition should try to optimize their nutritional status, ideally by diet counseling from an experienced professionals (registered dieticians, experienced nutritional scientists, clinical nutritionists and specialized physicians).<\/strong><\/p>\n\n\n\n

\u4e13\u5bb6\u5efa\u8bae2<\/strong> \u5e94\u5c3d\u91cf\u6539\u5584\u8425\u517b\u4e0d\u826f\u60a3\u8005\u7684\u8425\u517b\u72b6\u6001\uff0c\u6709\u7ecf\u9a8c\u7684\u4e13\u5bb6\uff08\u6ce8\u518c\u8425\u517b\u5e08\uff0c\u4e34\u5e8a\u8425\u517b\u4e13\u5bb6\u4e0e\u533b\u751f\uff09\u53ef\u63d0\u4f9b\u6307\u5bfc\u3002<\/strong><\/p>\n\n\n\n

\u75c5\u6bd2\u6d41\u884c\u671f\u95f4\u65f6\u6211\u4eec\u5c06\u9762\u4e34\u53cc\u91cd\u8425\u517b\u4e0d\u826f\u7684\u6311\u6218\uff1a\u8425\u517b\u4e0d\u8db3\u4e0e\u8425\u517b\u8fc7\u5ea6\uff0c\u8fd9\u4e24\u65b9\u9762\u90fd\u5c06\u4fc3\u8fdb\u75c5\u60c5\u5411\u4e25\u91cd\u53d1\u5c55\u3002\u6709\u5173\u6d41\u611f\u7814\u7a76\u663e\u793a\uff0c\u80a5\u80d6\u53ef\u6291\u5236\u75c5\u6bd2\u7279\u5f02\u6027CD8+T\u7ec6\u80de\u7684\u53cd\u5e94\u6027\u4e0e\u6297\u4f53\u7684\u53cd\u5e94\u3002\u56e0\u6b64\uff0c\u672a\u6765\u75c5\u6bd2\u611f\u67d3\u6cbb\u7597\u4e2d\u4e0d\u4ec5\u662f\u8981\u6ce8\u610f\u8425\u517b\u72b6\u51b5\u4f4e\u4e0b\uff0c\u8fd8\u6709\u6ce8\u610f\u65e5\u76ca\u589e\u957f\u7684\u80a5\u80d6\u4eba\u7fa4\u6bd4\u4f8b\uff08\u6b27\u6d32\uff0c\u5360\u4eba\u53e330\uff5e70%\uff09\u3002\u8fd1\u671f\u65e5\u672c\u5b66\u8005\u6709\u5173\u6d41\u611f\u7814\u7a76\uff1a\u5e94\u7528Cox\u6bd4\u4f8b\u98ce\u9669\u6a21\u578b\u663e\u793a\uff0c\u7537\u6027\u3001\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u8bc4\u5206\u3001\u8840\u6e05ALB\u6c34\u5e73\u4e0e\u53d1\u751f\u80ba\u708e\u662f\u5f71\u54cd\u6d41\u611f\u60a3\u800530\u5929\u751f\u5b58\u7387\u7684\u72ec\u7acb\u53d8\u91cf\u3002\u800c\u4e0e\u9ad8\u9f84\u76f8\u5173\u7684\u4e0d\u826f\u5f71\u54cd\u6e90\u4e8e\u808c\u8089\u542b\u91cf\u4e0e\u529f\u80fd\u964d\u4f4e\u3001\u541e\u54bd\u5480\u56bc\u969c\u788d\u3001\u8ba4\u77e5\u969c\u788d\u4ee5\u53ca\u4f4e\u6536\u5165\u4eba\u7fa4\uff0c\u80a5\u80d6\u7684\u76f8\u5173\u5f71\u54cd\u4e5f\u5728\u4e8e\u9aa8\u9abc\u808c\u542b\u91cf\u4e0e\u529f\u80fd\u964d\u4f4e\u3002<\/p>\n\n\n\n

\u80fd\u91cf\u9700\u8981\uff1a<\/strong>\u63a8\u8350\u4ee3\u8c22\u8f66\u6d4b\u5b9a\u80fd\u91cf\u6d88\u8017\uff0c\u524d\u63d0\u662f\u4fdd\u8bc1\u6d4b\u91cf\u8bbe\u5907\u7684\u6d88\u6bd2\u3002\u6216\u8005\u4f7f\u7528\u9884\u6d4b\u516c\u5f0f\uff0c\u5982\uff1a<\/p>\n\n\n\n

(1\uff09\u5e74\u9f84>65\u5c81\uff0c\u6709\u5408\u5e76\u75c7\u7684\u65b0\u51a0\u611f\u67d3\u60a3\u8005\uff0c\u603b\u80fd\u91cf\u6d88\u8017\u4e0e\u4f9b\u7ed9\u76ee\u6807\u63a8\u8350 27 kcal\/kg BW\/ day\u3002<\/p>\n\n\n\n

(2) \u4e25\u91cd\u4f4e\u4f53\u91cd\u5e76\u4f34\u6709\u5408\u5e76\u75c7\u7684\u65b0\u51a0\u611f\u67d3\u60a3\u8005\uff0c\u603b\u80fd\u91cf\u6d88\u8017\u4e0e\u4f9b\u7ed9\u76ee\u6807\u63a8\u835030 kcal\/kg BW\/ day\u3002<\/p>\n\n\n\n

(3) \u8001\u5e74\u60a3\u8005\u63a8\u8350\uff1a\u80fd\u91cf\u6d88\u8017\u4e3a 30 kcal\/kg BW\/ day; \u9700\u6839\u636e\u60a3\u8005\u7684\u8425\u517b\u72b6\u6001\u53ca\u4f53\u529b\u6d3b\u52a8\u5ea6\u3001\u75be\u75c5\u72b6\u6001\u548c\u8010\u53d7\u6027\u4e2a\u4f53\u5316\u8c03\u6574\u3002<\/p>\n\n\n\n

\u4e25\u91cd\u4f4e\u4f53\u91cd\u60a3\u8005\u5177\u6709\u518d\u5582\u517b\u7efc\u5408\u75c7\u53d1\u751f\u7684\u9ad8\u98ce\u9669\uff0c\u80fd\u91cf\u4f9b\u7ed9\u9700\u9010\u6e10\u589e\u52a0\u8fbe\u523030 kcal\/kg BW\/ day\u7684\u4f9b\u7ed9\u76ee\u6807\u3002<\/p>\n\n\n\n

\u86cb\u767d\u8d28\u9700\u8981<\/strong>\uff1a\u5e38\u6839\u636e\u516c\u5f0f\u8ba1\u7b97\uff0c\u5982\uff1a<\/p>\n\n\n\n

(1) \u8001\u9f84\u60a3\u80051 g \/kg BW\/ day; \u6839\u636e\u60a3\u8005\u8425\u517b\u72b6\u6001\u3001\u4f53\u529b\u6d3b\u52a8\u3001\u75be\u75c5\u72b6\u6001\u4e0e\u8010\u53d7\u6027\u8fdb\u884c\u4e2a\u4f53\u5316\u8c03\u6574\u3002<\/p>\n\n\n\n

(2) \u6709\u5408\u5e76\u75c7\u7684\u5185\u79d1\u4f4f\u9662\u60a3\u8005\u5efa\u8bae\u86cb\u767d\u8d28\u4f9b\u7ed9 >1 g \/kg BW\/ day\uff0c\u4ee5\u9632\u6b62\u4f53\u91cd\u4e22\u5931\u3001\u51cf\u5c11\u5e76\u53d1\u75c7\u53d1\u751f\u3001\u4e25\u91cd\u4f4e\u4f53\u91cd\u53ca\u518d\u5165\u9662\u98ce\u9669\uff0c\u4fc3\u8fdb\u529f\u80fd\u5eb7\u590d\u3002<\/p>\n\n\n\n

\u8102\u80aa\u4e0e\u78b3\u6c34\u5316\u5408\u7269\u9700\u8981\uff1a<\/strong>\u65e0\u547c\u5438\u529f\u80fd\u4e0d\u5168\u7684\u60a3\u8005\u8425\u517b\u4f9b\u7ed9\u4e2d\u8102\u8d28\u4e0e\u78b3\u6c34\u5316\u5408\u7269\u6bd4\u4f8b\u4e3a30\uff1a70\uff1b\u673a\u68b0\u901a\u6c14\u6cbb\u7597\u7684\u60a3\u8005\u5efa\u8bae 50\uff1a50\u3002<\/p>\n\n\n\n

Statement 3<\/strong><\/p>\n\n\n\n

Subjects with malnutrition should ensure sufficient supplementation with vitamins and minerals.<\/strong><\/p>\n\n\n\n

\u8425\u517b\u4e0d\u826f\u60a3\u8005\u5b58\u5728\u7ef4\u751f\u7d20\u4e0e\u5fae\u91cf\u5143\u7d20\u7f3a\u4e4f\uff0c\u9700\u8981\u8865\u5145\u3002<\/strong><\/p>\n\n\n\n

Vit D \u7f3a\u4e4f\u4e0e\u4e00\u4e9b\u75c5\u6bd2\u611f\u67d3\u6027\u75be\u75c5\u76f8\u5173\uff0c\u5305\u62ec\u6d41\u611f\u3001HIIV\u3001\u4e59\u809d\u75c5\u6bd2\uff1b\u4e2d\u8001\u5e74\u662f\u8fd9\u6b21COVID-19\u7684\u6613\u611f\u4eba\u7fa4\uff0c\u672a\u6765\u9700\u8fdb\u4e00\u6b65\u786e\u5b9aVitD\u7684\u72b6\u6001\u3002\u53e6\u4e00\u4e2a\u662fVitA\uff0c\u88ab\u547d\u540d\u4e3a\u201c\u6297\u611f\u67d3\u201d\u7ef4\u751f\u7d20\u3002\u513f\u7ae5\u9ebb\u75b9\u53ef\u5bfc\u81f4\u4e25\u91cdVitA\u7f3a\u4e4f\uff1b VitA\u7684\u8865\u5145\u80fd\u591f\u964d\u4f4e\u9ebb\u75b9\u4e0e\u9ebb\u75b9\u80ba\u708e\u3001HIV\u4e0e\u759f\u75be\u60a3\u513f\u7684\u75c5\u6b7b\u7387\u3002\u7814\u7a76\u663e\u793a\uff0c\u7ef4\u751f\u7d20A\u3001E\u3001B6\u53caB12\u3001Zn\u548cSe\u7684\u7f3a\u4e4f\u4e0e\u75c5\u6bd2\u611f\u67d3\u7684\u4e0d\u826f\u9884\u540e\u76f8\u5173\u3002\u8fd1\u671f\u4e00\u9879\u6709\u5173COVID-19\u611f\u67d3\u60a3\u8005\u7684\u7efc\u8ff0\uff0c\u63d0\u51fa\u4e86\u8003\u8651\u7ef4\u751f\u7d20\u3001A\u3001D \u3001B\u3001C, omega-3 \u591a\u4e0d\u9971\u548c\u8102\u80aa\u9178\u4ee5\u53ca\u7852\u3001\u950c\u548c\u94c1\u7684\u8865\u5145\u7684\u5efa\u8bae\u3002ESPEN\u4e13\u5bb6\u5bf9\u6b64\u5efa\u8bae\uff1a\u5bf9\u4e8e\u8425\u517b\u4e0d\u826f\u98ce\u9669\u7684\u65b0\u51a0\u60a3\u8005\u6bcf\u65e5\u8865\u5145\u7ef4\u751f\u7d20\u4e0e\u5fae\u91cf\u5143\u7d20\uff0c\u53d1\u6325\u5176\u5728\u62b5\u6297\u611f\u67d3\u65b9\u9762\u7684\u4f5c\u7528\u3002<\/p>\n\n\n\n

Statement 4<\/strong><\/strong><\/p>\n\n\n\n

Patients in quarantine should continue regular physical activity while taking precautions. <\/strong><\/p>\n\n\n\n

\u9694\u79bb\u60a3\u8005\u91c7\u53d6\u9884\u9632\u6cbb\u7597\u7684\u540c\u65f6\uff0c\u7ee7\u7eed\u8fdb\u884c\u6709\u89c4\u5f8b\u7684\u4f53\u529b\u6d3b\u52a8\u3002<\/strong><\/p>\n\n\n\n

\u5c45\u5bb6\u9694\u79bb\u662f\u964d\u4f4e\u611f\u67d3\u98ce\u9669\u6700\u6709\u6548\u7684\u529e\u6cd5\uff0c\u4f46\u51cf\u4e86\u5c11\u5e73\u65f6\u7684\u4f53\u529b\u6d3b\u52a8\u4e0e\u964d\u4f4e\u4e86\u80fd\u91cf\u6d88\u8017\uff0c\u7531\u6b64\u5f71\u54cd\u9aa8\u9abc\u808c\u529b\u91cf\u53ca\u514d\u75ab\u529f\u80fd\u3002\u589e\u52a0\u9002\u5b9c\u7684\u4f53\u529b\u8fd0\u52a8\uff080.5\u5c0f\u65f6\uff5e1\u5c0f\u65f6\uff09\uff0c\u53ca\u592a\u6781\u62f3\u3001\u745c\u4f3d\u3001\u6c14\u529f\u7b49\uff0c\u4ee5\u4fdd\u6301\u8eab\u5fc3\u5065\u5eb7\u4e0e\u808c\u8089\u542b\u91cf\u4e0e\u4eba\u4f53\u7ec4\u6210\u3002<\/p>\n\n\n\n

Statement 5<\/strong><\/p>\n\n\n\n

Oral nutritional supplements (ONS) should be used whenever possible to meet patient\u2019s intake and reach nutritional goals, ONS shall provide at least 400 kcal\/day including 30 g or more of protein\/day and shall be continued for at least one month. Efficacy and expected benefit of ONS shall be assessed once a month.<\/strong><\/p>\n\n\n\n

\u53e3\u670d\u8425\u517b\u8865\u5145\u5242\uff08ONS\uff09\u4ee5\u4fdd\u8bc1\u6444\u5165\u91cf\u4e8e\u8425\u517b\u8fbe\u6807\u3002\u53e3\u670d\u8425\u517b\u8865\u5145\u91cf400 kcal\/day\uff0c\u5305\u542b\u86cb\u767d\u8d28>30g\uff0fday\uff0c\u6301\u7eed1\u4e2a\u6708\u4ee5\u4e0a\uff0c\u6bcf\u6708\u8bc4\u4f30\u6548\u679c\u4e0e\u83b7\u76ca\u3002<\/strong><\/p>\n\n\n\n

    \u7ecf\u53e3\u8fdb\u98df\u603b\u662f\u4f18\u5148\u9009\u62e9\u7684\u8425\u517b\u6444\u5165\u9014\u5f84\uff0c\u5e76\u5e94\u5c3d\u65e9\u5f00\u59cb\uff0824\uff5e48hr\u5185\uff09\uff0c\u5c24\u5176\u662f\u8001\u9f84\u53ca\u6709\u5408\u5e76\u75c7\u7684\u65b0\u51a0\u611f\u67d3\u60a3\u8005\uff1b\u4f46\u4ecd\u9700\u6ce8\u610f\u8981\u9010\u6e10\u8fbe\u5230\u76ee\u6807\u3002\u53e3\u670d\u8425\u517b\u8865\u5145\u5242\uff08ONS\uff09\u53ef\u63d0\u4f9b\u6709\uff1a\u4e0d\u540c\u80fd\u91cf\u5bc6\u5ea6\u5236\u5242\u3001\u5e38\u89c4\u914d\u65b9\u5236\u5242\u4ee5\u53ca\u7279\u6b8a\u5f3a\u5316\u914d\u65b9\u5236\u5242\uff0c\u4ee5\u6ee1\u8db3\u86cb\u767d\u8d28\u3001\u5fae\u8425\u517b\u7d20\uff08\u7ef4\u751f\u7d20\u4e0e\u5fae\u91cf\u5143\u7d20\uff09\u7684\u9700\u8981\u3002<\/p>\n\n\n\n

S<\/strong>tatement 6<\/strong><\/p>\n\n\n\n

In polymorbid medical inpatients and in older persons with reasonable prognosis, whose nutritional requirements cannot be met orally, enteral nutrition (EN) should be administered. Parenteral nutrition (PN) should be considered when EN is not indicated or targets.<\/strong><\/p>\n\n\n\n

\u4f34\u6709\u5408\u5e76\u75c7\u4e0e\u8001\u5e74\u60a3\u8005\uff0c\u5982\u7ecf\u53e3\u6444\u98df\u4e0d\u80fd\u6ee1\u8db3\u9700\u8981\uff0c\u5e94\u7ed9\u4e88EN\u8865\u5145\uff0c\u5982\u4e0d\u80fd\u7ecf\u80c3\u80a0\u8425\u517b\u6216EN\u65e0\u6cd5\u8fbe\u6807\u65f6\u9009\u62e9\u80a0\u5916\u8425\u517b\uff08PN\uff09<\/strong><\/p>\n\n\n\n

    \u53e3\u670d\u996e\u98df\u5e38\u4e0d\u80fd\u6ee1\u8db3\u60a3\u8005\u9700\u8981\uff0c\u5982\u679c\u4e0d\u80fd\u7ecf\u53e3\u6444\u98df\u8d85\u8fc73\u5929\uff0c\u6216\u80fd\u91cf\u6444\u5165\u8fbe\u4e0d\u5230\u76ee\u6807\u91cf\u7684\u4e00\u534a\u5927\u4e8e1\u5468\u8005\uff0c\u5e94\u7ed9\u4e88\u7ba1\u9972EN\u8865\u5145\uff0c\u5e76\u76d1\u6d4bEN\u76f8\u5173\u5e76\u53d1\u75c7\u3002\u4e0d\u8bba\u662f\u5e74\u9f84\u6216\u662f\u75be\u75c5\uff0c<\/p>\n\n\n\n

\u786e\u5b9a\u8425\u517b\u6cbb\u7597\u7b56\u7565\u4e5f\u9700\u8981\u8003\u8651\u547c\u5438\u652f\u6301\u7684\u7279\u70b9\u3002\u89c1\u88682. <\/p>\n\n\n\n

Table 2. Nutritional support depending on the respiratory support allocated to the ICU patient<\/p>\n\n\n\n

Setting<\/td>Ward<\/td>ICU Day 1\uff5e2 <\/td>ICU Day 2<\/td>Ward rehabilitation<\/td><\/tr>
Oxygen Therapy and mechanicalventilation<\/td>No or consider O2 support  (High) Flow Nasal Cannula<\/td>FNC followed by mechanical ventilation<\/td>Mechanical ventilation<\/td>Possible extubation and transfer to ward<\/td><\/tr>
Organ Failure<\/td>Bilateral pneumonia, thrombopenia<\/td>Deterioration of respiratory status; ARDS; possible shock<\/td>MOF possible<\/td>Progressive recovery after extubation<\/td><\/tr>
Nutritional support<\/td>Screening for malnutrition;  oral feeding\/ONS,  EN or PN if needed<\/td>Define energy and protein target In case of FNC or NIV, administer energy\/proteinorally or enterally and if not possible<\/td>Prefer early enteral feeding Protein and mobilization<\/td>Assess dysphagia and use oral nutrition if possible; if not: EN or PN Increase protein intake and add<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Pre intubation period<\/strong>\uff08\u6c14\u7ba1\u63d2\u7ba1\u524d\uff09<\/strong><\/p>\n\n\n\n

Statement 7<\/strong><\/p>\n\n\n\n

In COVID-19 non-intubated ICU patients not reaching the energy target with an oral diet, oral nutritional supplements (ONS) should be considered first and then enteral nutrition treatment. If there are limitations for the enteral route it could be advised to prescribe peripheral parenteral nutrition in the population not reaching energy-protein target by oral or enteral nutrition.<\/strong><\/p>\n\n\n\n

\u53e3\u670d\u996e\u98df\u672a\u8fbe\u5230\u4f9b\u7ed9\u76ee\u6807\u4e14\u672a\u4e88\u6c14\u7ba1\u63d2\u7ba1\u7684\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u60a3\u8005\uff0c\u9996\u5148\u8003\u8651\u9009\u62e9\u53e3\u670d\u6dfb\u52a0\u8425\u517b\u5236\u5242\uff0c\u5176\u6b21\u662f\u80a0\u5185\u8425\u517b\u3002\u7ecf\u53e3\u4e0e\u7ba1\u9972EN\u4e0d\u80fd\u6ee1\u8db3\u86cb\u767d\u8d28\u80fd\u91cf\u9700\u8981\u7684\u60a3\u8005\uff0c\u63a8\u8350\u7ecf\u5916\u5468\u9759\u8109\u80a0\u5916\u8425\u517b\u8865\u5145\u3002<\/strong><\/p>\n\n\n\n

NIV<\/strong>\uff1a\u8425\u517b\u8c03\u67e5\u7814\u7a76\u663e\u793a\uff0c\u63a5\u53d7\u65e0\u521b\u901a\u6c14\u6cbb\u7597\uff08NIV\uff09\u53ca\u62d4\u9664\u6c14\u7ba1\u63d2\u7ba1\u540e\u7684\u60a3\u8005\uff0c\u901a\u5e38\u9009\u62e9\u7ecf\u53e3\u6444\u98df\u3002\u4f46NIV\u6cbb\u7597\u7684ARDS\u60a3\u8005\u663e\u793a\u51fa\u80fd\u91cf-\u86cb\u767d\u8d28\u6444\u5165\u4e0d\u8db3\u3002\u80a0\u5185\u6cbb\u7597\u53ef\u80fd\u56e0\u9f3b\u80c3\u7ba1\u53d7\u5230\u5f71\u54cd\uff1a1\uff09\u6f0f\u6c14\u53ef\u80fd\u5f71\u54cdNIV\u7684\u6548\u679c\uff1b2\uff09\u80c3\u6269\u5f20\u53ef\u80fd\u5f71\u54cd\u8188\u808c\u529f\u80fd\u4e0eNIV\u7684\u6548\u679c\uff1b3\uff09\u4e0a\u8ff0\u7ed3\u679c\u53ef\u5bfc\u81f4EN\u4f7f\u7528\u4e0d\u5145\u5206\uff0c\u7279\u522b\u662f\u65e9\u671f\uff0848hr\uff09\u9636\u6bb5\uff0c\u5bfc\u81f4\u9965\u997f\u4e0e\u8425\u517b\u4e0d\u826f\u98ce\u9669\u589e\u52a0\u3002<\/p>\n\n\n\n

FNC and HFNC<\/strong>\uff1a\u6709\u7814\u7a76\u663e\u793a\u63a5\u53d7HFNC\u6cbb\u7597\u7684\u60a3\u8005\u4ea6\u5b58\u5728\u6709\u6444\u5165\u4e0d\u8db3\u7684\u60c5\u51b5\uff0c\u5e76\u7531\u6b64\u5bf9\u8425\u517b\u72b6\u6001\u4ea7\u751f\u4e0d\u826f\u5f71\u54cd\u3002\u5efa\u8bae\u5bf9\u7ecf\u53e3\u8425\u517b\u8865\u5145\u7684\u60a3\u8005\u4e5f\u8981\u5145\u5206\u8bc4\u4f30\u5176\u8425\u517b\u6444\u5165\u91cf\uff0c\u9700\u8981\u8005\u7ed9\u4e88EN\u8865\u5145\u3002<\/p>\n\n\n\n

Ventilated period<\/strong><\/p>\n\n\n\n

\u5982\u679cHFNC or NIV\u6cbb\u75972\u5c0f\u65f6\u4ecd\u672a\u83b7\u5f97\u6539\u5584\u6c27\u5408\u6548\u679c\uff0c\u5e94\u4e88\u6c14\u7ba1\u63d2\u7ba1\u3002\u53ef\u501f\u9274ESPEN-ICU\u8425\u517b\u6cbb\u7597\u6307\u5357\uff0c\u5bf9\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684COVID-19 \u60a3\u8005\u91c7\u53d6\u5982\u4e0b\u8425\u517b\u6cbb\u7597\u7b56\u7565\uff1a<\/p>\n\n\n\n

Statement 8<\/strong><\/p>\n\n\n\n

In COVID-19 intubated and ventilated ICU patients enteral nutrition (EN) should be started through a nasogastric tube; post-pyloric feeding should be performed in patients with gastric intolerance after prokinetic treatment or in patients at high-risk for aspiration; the prone position per se does not represent a limitation or contraindication for EN.<\/strong><\/p>\n\n\n\n

\u6c14\u7ba1\u63d2\u7ba1\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u6cbb\u7597\u7684\u65b0\u51a0\u80ba\u708e\u60a3\u8005\uff0c\u9996\u9009\u9f3b\u80c3\u7ba1\u9014\u5f84\u7684\u80a0\u5185\u8425\u517b\uff08EN\uff09\u65b9\u5f0f\uff0c\u7532\u6c27\u6c2f\u666e\u80fa\u6cbb\u7597\u540e\u4ecd\u4e0d\u80fd\u8010\u53d7\u7ecf\u80c3\u5582\u517b\u7684\u60a3\u8005\u6216\u5b58\u5728\u8bef\u5438\u9ad8\u98ce\u9669\u7684\u60a3\u8005\uff0c\u5c1d\u8bd5\u7a7a\u80a0\u5582\u517bEN\uff1b\u539f\u5219\u4e0a\u4fef\u5367\u4f4d\u4e0d\u662fEN\u7684\u7981\u5fcc\u75c7\u3002<\/strong><\/p>\n\n\n\n

\u80fd\u91cf\u9700\u8981<\/strong>\uff1a\u5982\u80fd\u6d4b\u91cf\u5b9e\u9645\u80fd\u91cf\u6d88\u8017\u5219\u636e\u6b64\u6307\u5bfc\u80fd\u91cf\u4f9b\u7ed9\u75c5\u9010\u6e10\u8fbe\u5230\u76ee\u6807\uff0c\u6216\u901a\u8fc7PAC\u6d4b\u5f97\u6c27\u8017\u91cf\uff08VO2\uff09\u6216\u901a\u8fc7\u547c\u5438\u673a\u6d4b\u5f97\u4e8c\u6c27\u5316\u78b3\u4ea7\u751f\u91cf\uff08VCO2\uff09\uff0c\u7531\u6b64\u8ba1\u7b97\u80fd\u91cf\u6d88\u8017\u8f83\u4e3a\u51c6\u786e\u3002<\/p>\n\n\n\n

\u80fd\u91cf\u4f9b\u7ed9<\/strong>\uff1a\u6025\u6027\u75be\u75c5\u65e9\u671f\uff08\u7b2c\u4e00\u5468\uff09\u964d\u70ed\u5361\u8425\u517b\uff08<70 %\u9884\u6d4b\u91cf\uff09\u4f18\u4e8e\u7b49\u70ed\u5361\u4f9b\u7ed9\u3002<\/p>\n\n\n\n

\u86cb\u767d\u8d28\u9700\u8981<\/strong>\uff1a1.3 g\/kg\uff0fday\uff0c\u9010\u6e10\u8fbe\u5230\u76ee\u6807\u91cf\u3002\u80a5\u80d6\u60a3\u8005\u5e94\u6309\u77eb\u6b63\u4f53\u91cd\u8ba1\u7b97\uff0c\u5373\uff1a\u7406\u60f3\u4f53\u91cd\uff08IBW\uff09+ (\u5b9e\u9645\u4f53\u91cd-\u7406\u60f3\u4f53\u91cd) x 0.33\u3002\u6b64\u5916\uff0c\u6ce8\u610f\u589e\u52a0\u4f53\u529b\u6d3b\u52a8\u4ee5\u4fc3\u8fdb\u86cb\u767d\u5408\u6210\uff0c\u63d0\u9ad8\u8425\u517b\u6cbb\u7597\u6548\u679c\u3002<\/p>\n\n\n\n

Statement 9<\/strong><\/p>\n\n\n\n

In ICU patients who do not tolerate full dose enteral nutrition (EN) during the first week in the ICU, initiating parenteral nutrition (PN) should be weighed on a case-by-case basis. PN should not be started until all strategies to maximize EN tolerance have been attempted.<\/strong><\/p>\n\n\n\n

\u7b2c\u4e00\u5468\u4e0d\u80fd\u8010\u53d7\u8db3\u91cf\u80c3\u80a0\u9053\u5582\u517b\uff08EN\uff09\u7684ICU\u60a3\u8005\uff0c\u5e94\u6839\u636e\u75c5\u4eba\u5177\u4f53\u75c5\u60c5\u5177\u4f53\u8bc4\u4f30\u786e\u5b9a\u662f\u5426\u542f\u52a8\u80a0\u5916\u8425\u517b\uff08PN\uff09\uff0c\u5e76\u5e94\u8be5\u5728\u5c1d\u8bd5\u5404\u79cd\u5582\u517b\u7b56\u7565\u4e0e\u6700\u5927\u7a0b\u5ea6\u8010\u53d7\u7684EN\u5582\u517b\u91cf\u540e\uff0c\u518d\u51b3\u5b9a\u542f\u52a8PN\u3002<\/strong><\/p>\n\n\n\n

\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u8425\u517b\u4f9b\u7ed9\u5e94\u6ce8\u610f\u9010\u6e10\u589e\u52a0\uff0c\u8c28\u614e\u8fbe\u5230\u5168\u91cf\u3002<\/p>\n\n\n\n

EN\u7981\u5fcc\u75c7: \u5ef6\u8fdf\u5f00\u59cbEN\u7684\u60c5\u51b5:<\/p>\n\n\n\n

- \u4f11\u514b\u5c1a\u672a\u63a7\u5236\uff0c\u8840\u6d41\u52a8\u529b\u5b66\u4e0e\u7ec4\u7ec7\u704c\u6ce8\u5c1a\u672a\u8fbe\u6807\uff1b<\/p>\n\n\n\n

- \u5a01\u80c1\u751f\u547d\u7684\u4f4e\u6c27\u8840\u75c7\u3001\u9ad8\u78b3\u9178\u8840\u75c7\u4e0e\u9178\u4e2d\u6bd2\u5c1a\u672a\u7ea0\u6b63\uff1b<\/p>\n\n\n\n

\u9884\u9632\uff1a\u75c5\u60c5\u7a33\u5b9a\u65e9\u671f\u4ee5\u4f4e\u5242\u91cfEN\u5f00\u59cb<\/p>\n\n\n\n

- \u4f11\u514b\u5728\u6db2\u4f53\u3001\u8840\u7ba1\u6d3b\u6027\u836f\u6216\u6b63\u6027\u808c\u529b\u836f\u6cbb\u7597\u4e0b\u5f97\u5230\u63a7\u5236\uff0c\u4f46\u4ecd\u9700\u8b66\u60d5\u80a0\u9053\u7f3a\u8840\u7684\u8868\u73b0<\/p>\n\n\n\n

- \u7a33\u5b9a\u7684\u4f4e\u6c27\u72b6\u6001\uff0c\u5408\u5e76\u4ee3\u507f\u6216\u5141\u8bb8\u6027\u9ad8\u78b3\u9178\u8840\u75c7\u4e0e\u9178\u4e2d\u6bd2\u60a3\u8005<\/p>\n\n\n\n

\u5f53\u75c5\u60c5\u7a33\u5b9a\uff0c\u5305\u62ec\u7ee7\u7eed\u4fef\u5367\u4f4d\u6cbb\u7597\u65f6\uff0c\u53ef\u5c1d\u8bd5\u80a0\u5185\u8425\u517b\u3002\u4ece\u6d4b\u5b9a\u7684\u80fd\u91cf\u6d88\u8017\u91cf\u768430%\u5f00\u59cb\uff0c\u9010\u6e10\u589e\u52a0\u3002\u4f7f\u7528\u4f30\u6d4b\u516c\u5f0f\u65f6\u63a8\u8350\uff1a20 kcal\/kg\/day\uff0c\u7b2c2\u5929\u8fbe\u5230\u9884\u8ba1\u768450-70%\u7528\u91cf\u3001\u7b2c4\u5929\u8fbe\u523080~100%\u9884\u6d4b\u91cf\u3002\u86cb\u767d\u8d28\u4f9b\u7ed9\u57283~5\u5929\u8fbe\u52301.3g\/kg\/day\uff0c\u80c3\u6b8b\u4f59\u91cf\u9ad8\uff08>500 mL\uff09\u7684\u60a3\u8005\u5c3d\u65e9\u653e\u7f6e\u5341\u4e8c\u6307\u80a0\u7ba1\u3002\u4f7f\u7528\u542b\u03a9-3\u8102\u80aa\u9178\u80a0\u5185\u8425\u517b\u5236\u5242\u53ef\u80fd\u6709\u52a9\u4e8e\u4fc3\u8fdb\u6c27\u5408\u3002\u5e94\u7ef4\u6301\u8840\u7cd6\u57286-8 mmol\/l\u6c34\u5e73\uff0c\u76d1\u6d4b\u7518\u6cb9\u4e09\u916f\u548c\u7535\u89e3\u8d28\uff08\u5305\u62ec\u78f7\u548c\u9541\uff09<\/p>\n\n\n\n

\u673a\u68b0\u901a\u6c14\u540e\u4e0e\u541e\u54bd\u56f0\u96be\uff1a<\/strong><\/p>\n\n\n\n

\u75c5\u4eba\u4e0d\u518d\u9700\u8981\u673a\u68b0\u901a\u6c14\u65f6\uff0c\u4ecd\u5e38\u5408\u5e76\u6709\u541e\u54bd\u95ee\u9898\u548c\u7ee7\u53d1\u6027\u541e\u54bd\u56f0\u96be\uff0c\u7531\u6b64\u5e94\u9650\u5236\u7ecf\u53e3\u8fdb\u98df\u3002<\/p>\n\n\n\n

Statement 10<\/strong><\/p>\n\n\n\n

In ICU patients with dysphagia, texture-adapted food can be considered after extubation. If swallowing is proven unsafe, EN should be administered. In cases with a very high aspiration risk, postpyloric EN or, if not possible, temporary PN during swallowing nasoenteral tube can be performed.<\/strong><\/p>\n\n\n\n

\u5408\u5e76\u541e\u54bd\u969c\u788d\u7684ICU\u60a3\u8005\uff0c\u62d4\u9664\u6c14\u7ba1\u63d2\u7ba1\u540e\u5148\u8003\u8651\u8d28\u5730\u9002\u5408\u7684\u98df\u7269\uff1b\u5982\u679c\u541e\u54bd\u4e0d\u5b89\u5168\uff0c\u5e94\u7ed9\u4e88\u7ba1\u9972EN\u3002\u8f83\u9ad8\u8bef\u5438\u98ce\u9669\u60a3\u8005\u9009\u62e9\u5e7d\u95e8\u540e\u5c0f\u80a0\u5582\u517b\uff0c\u5728\u653e\u7f6e\u9f3b\u80a0\u7ba1\u5230\u8fbe\u5582\u517b\u90e8\u4f4d\u671f\u95f4\u53ef\u7ed9\u4e88\u6682\u65f6\u6027PN\u3002<\/strong><\/p>\n\n\n\n

\u62d4\u7ba1\u540e\u541e\u54bd\u56f0\u96be\u53ef\u6301\u7eed\u523021\u5929\u4e4b\u4e45\uff0c\u591a\u53d1\u751f\u5728\u8001\u5e74\u4e0e\u957f\u65f6\u95f4\u7559\u7f6e\u63d2\u7ba1\u7684\u60a3\u8005\uff0c\u8bc4\u4f30\u541e\u54bd\u529f\u80fd\u4ee5\u9632\u6b62\u76f8\u5173\u5e76\u53d1\u75c7\uff0c\u5fc5\u8981\u65f6\u6dfb\u52a0\u8865\u5145\u6027\u80a0\u5916\u8425\u517b\u4ee5\u8fbe\u5230\u8425\u517b\u76ee\u6807\u3002<\/p>\n\n\n\n

ICU-acquired weakness (ICUAW)<\/strong><\/p>\n\n\n\n

\u9aa8\u9abc\u808c\u4f53\u79ef\u4e0e\u529f\u80fd\u4e27\u5931\u662f\u5f71\u54cdICU\u751f\u5b58\u7684\u4e00\u4e2a\u91cd\u8981\u56e0\u7d20\uff0c\u5c24\u5176\u5728\u8001\u9f84\u53ca\u6709\u5408\u5e76\u75c7\u7684\u60a3\u8005\uff0c\u4ed6\u4eec\u60a3\u75c5\u524d\u591a\u5b58\u5728\u5206\u89e3\u4ee3\u8c22\uff0c\u52a0\u4e4b\u4fef\u5367\u4f4d\u4f1a\u5f71\u54cd\u808c\u8089\u4f53\u79ef\u4e0e\u529f\u80fd\u3002\u6536\u4f4f\u4e0eICU\u4e24\u5468\u4ee5\u4e0a\u7684COVID-19\u611f\u67d3\u60a3\u8005\uff0c\u66f4\u5bb9\u6613\u52a0\u91cd\u808c\u8089\u5206\u89e3\u4ee3\u8c22\u3002\u5145\u5206\u7684\u86cb\u767d\u8d28\u4f9b\u7ed9\u80fd\u591f\u9632\u6b62\u4e25\u91cd\u7684\u808c\u8089\u542b\u91cf\u4e0e\u529f\u80fd\u4e27\u5931\u3002<\/p>\n\n\n\n

Final considerations<\/strong><\/p>\n\n\n\n

\u8425\u517b\u5e72\u9884\u662fSARS-CoV-2\u611f\u67d3\u60a3\u8005\u6cbb\u7597\u7684\u4e00\u90e8\u5206\uff0c\u5341\u9879ESPEN\u4e13\u5bb6\u5efa\u8bae\u65e8\u5728\u7ba1\u7406\u5404\u9636\u6bb5\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u60a3\u8005\u7684\u8425\u517b\u6cbb\u7597\uff0c\u4ee5\u4fc3\u8fdb\u75c5\u7a0b\u7f29\u77ed\u548c\u751f\u5b58\u7387\u63d0\u9ad8\uff0c\u4f7f\u60a3\u8005\u7684\u8425\u517b\u4f9b\u7ed9\u4e0e\u751f\u547d\u652f\u6301\u6cbb\u7597\u6210\u4e3a\u76f8\u4e92\u7ed3\u5408\u7684\u7efc\u5408\u63aa\u65bd\u3002\u4e13\u5bb6\u63d0\u5021\uff0c\u5efa\u7acb\u4e00\u79cd\u673a\u5236\uff0c\u4f7f\u6709\u5173\u75be\u75c5\u6551\u6cbb\u7684\u4eba\u5458\uff0c\u5305\u62ecWHO\u3001\u56fd\u5bb6\u536b\u751f\u7ba1\u7406\u90e8\u95e8\u3001\u8425\u517b\u5e08\u3001\u516c\u536b\u4e13\u5bb6\u4eec\uff0c\u80fd\u591f\u5206\u4eab\u533b\u52a1\u4eba\u5458\u7684\u4e13\u4e1a\u77e5\u8bc6\uff0c\u5728\u533b\u7597\u8d44\u6e90\u5206\u914d\u65b9\u9762\u8ba4\u8bc6\u5230\u8425\u517b\u4f9b\u7ed9\u4e5f\u662f\u75be\u75c5\u6cbb\u7597\u7684\u4e00\u9879\u57fa\u672c\u9700\u6c42\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

ESPEN expert statements and practical guidance for nutr […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18869"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18869"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18869\/revisions"}],"predecessor-version":[{"id":18872,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18869\/revisions\/18872"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18869"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18869"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18869"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}