摘要
在临床营养理念不断更新的同时,危重症病人的营养支持治疗始终是大家关注的焦点。尤其是近30年来,人们对营养素在维持危重症病人内稳态的分子与生物学效应方面的认识取得了巨大进步。传统观点认为,营养支持对于危重症病人起辅助作用,通过提供外源性能量物质以维持自身的瘦体组织,帮助病人渡过整个应激反应期。而最近的观点更倾向于"营养治疗",通过早期肠内营养、恰当的宏量及微量营养素的供给、细致的血糖调控等手段达到减轻病人的应激代谢、防止细胞的氧化损伤、调节整体的免疫反应等目的。2016年2月,美国重症医学会(SCCM)和美国肠外肠内营养学会(ASPEN)联合发布了新的重症病人营养支持治疗实施与评价指南,将2009年版的12个章节增至18个章节,面向临床医生、护士、营养师和药师,针对18岁以上的重症病人,提供了最佳营养疗法的新建议,以期能够协助医疗团队进行个体化的营养治疗,减少并发症、缩短住院时间、降低疾病严重程度、改善病人结局。
With the continuous update of clinical nutrition concept, the nutrition support therapy in the adult critically ill patients has always been the hotspot. Over the past 30 years, exponential advances have been made in the understanding of the molecular and biological effects of nutrients in maintaining homeostasis in the critically ill population. Traditionally, nutrition support in the critically ill population was regarded as adjunctive care designed to provide exogenous fuels to preserve lean body mass and support the patient throughoutthe stress response. Recently, the strategy has evolved to represent nutrition therapy, in which the feeding is thought to help attenuate the metabolic response to stress, prevent oxidative cellular injury, and favorably modulate immune responses. Improvement in the clinical course of critical illness may be achieved by early EN, appropriate macro- and micronutrient delivery, and meticulous glycemic control. In February 2016, Society of Critical Care Medicine （SCCM） and American Society for Parenteral and Enteral Nutrition （ASPEN） jointly updated the guidelines for the provision and assessment of nutrition support therapy in the aduh critically ill patient. The particular report is an update and expansion of guideline published by ASPEN and SCCM in 2009. The intended use of the guideline is for all healthcare providers involved in nutrition therapy of the critically ill--primarily, physicians, nurses, dietitians, and pharmacists, with a view to provide guidance and advice for the medical team aiming to reduce disease severity, diminish complications, decrease length of stay in the ICU, and favorably impact patient outcomes.
出处
《中国实用外科杂志》
CSCD
北大核心
2018年第3期289-292,共4页
Chinese Journal of Practical Surgery
关键词
危重症
营养支持治疗
critically ill
nutrition support therapy
