ASPEN成年危重病患者营养支持治疗的实施与评估指南

1、 PAGE PAGE 7营养支持ASPEN 成年危重病患者营养支持治疗的实施与评估指南临床营养危重病患者营养支持治疗的实施与评估指南成年危重病患者营养支持治疗实施与评估指(1/6)翻译：清华大学长庚医院周华 许媛来源：中国病理生理学危重病医学专业委员会官网 营养评估Question: oes the use of a nutrition risk inicator ientify patients who willmost likely benefit from nutrition therapy?问题：营养风险筛查工具能否辨别哪些患者最可能从营养治疗中获益？A1. Base on exper

2、t consensus, we suggest a etermination of nutrition risk(forexample,nutritionalscoreNRS-2002,score)beonallpatientsamittetotheICUforwhomvolitionalintakeisanticipateto beinsufficient.Highnutritionientifiesthosepatientsmostlikelytobenefit from 根据专家共识，我们建议关于收入ICU且预计摄食不足的患者进行营养风险（如营养风险评分 评分。高营养风险患者的识别， 最

3、可能使其从早期肠内营养治疗中获益。A2. Base on consensus, suggest that nutritionalassessmentinclueanevaluationofcomorbiconitions,functionofthegastrointestinal(GI) anofaspiration.suggestnotusingtraitionalnutritioninicators or surrogate markers, as they are not valiate in critical care.根据专家共识，我们建议营养评估应当囊括关于于合并且症、胃肠道功能以

4、及误吸风险的评估。我们建议不要使用传统的营养指标或其替代指标，因为这些指标在ICU 的应用并且非得到验证。Question:isthebestmethoforneesintheill aultpatient?问题：确定成年危重病患者能量需求的最佳方法是什么？A3a. We suggest that inirect calorimetry (IC) be use to etermine energyavailableanintheabsenceofthataffectthe ofQuality of Evience: Very Low。如果有条件且不影响测量准确性的因素时，建议应用间接能量测热法

5、，calorimetry，IC) 确定能量需求。证据质量：非常低A3b. Base on expert consensus, in the absence of IC, we suggest that apublisheequationorasimplisticequationkcal/kg/ay)beuseto(seesectionQfor obesityrecommenations.)根据专家共识，当没有IC 时，我们建议使用已发表的预测公式或鉴于体重(2530 kcal/kg/ 确定能量需求（Q部分有关肥胖患者的推荐意见。）Question: Shoul protein provisio

6、n be monitore inepenently from energy provision in critically ill ault patients?问题：关于于成年危重病患者，除能量提供外，是否需要单独监测提供的蛋白质量？A4. Base on consensus, suggest an ongoingevaluation ofaequacy of protein provision be performe.根据专家共识，我们建议连续评估蛋白质供给的充分性。 开始肠内营养Question: What is the benefit of early EN in critically

7、ill ault patients compareto withholing or elaying this therapy?问题：关于于成年危重病患者而言，与不给予或延迟给N 相比，早期有何益处？B1. We recommen that nutrition support therapy in the form of early ENbeinitiatehoursintheillpatientisunableto maintain volitionalintake.Quality of Evience: Very Low关于于不能维持自主进食的危重病患者，我们推荐24 48 小时内经过早期E

8、N 开始营养支持治疗。证据质量：非常低Question:IsainoutcometheuseoforPNforault illpatients?问题：成年危重病患者使用或PN 关于预后的影响有何不同？B2. We suggest the use of EN over PN in critically ill patients who requirenutrition support therapy.Quality of Evience: Low to Very Low关于于需要营养支持治疗的危重病患者而非PN 的营养供给方式。证据质量：低至非常低Question:Istheclinicalev

9、ienceofcontractility(bowelsouns,flatus)priorto initiatinginillaultpatients?问题：在成年危重病患者开始EN 前是否需要有肠道蠕动的证据（肠鸣音，排气）？B3. Base on expert consensus, we suggest that, in the majority of MICUanSICUpatientpopulations,GIcontractilityfactorsshoulbeevaluate initiatingovertsignsofcontractilityshoulnotbepriorto i

10、nitiation of鉴于专家共识，我们建议，关于于多MICU 和SICU 患者，不管启用时需要关于胃肠道蠕动情况进行评估，但此前并且不需要有肠道蠕动的体征。Question:isthelevelofinfusionoftheGIfor ill patients? How oes the level of infusion of affect patient outcomes?问题：危重病患者胃肠道输注EN 的最佳速度是多少？EN 输注速度如何影响患者预后？B4a. We recommen that the level of infusion be iverte lower in the G

11、Iinthoseillpatientsathighforaspiration(seesection4)or those have shown intolerance to Quality of Evience: Moerate to High关于于具有误吸高危因素（4 部分）或不能耐受经胃喂养的重症患者，我们推荐减慢输注的速度。证据质量：中至高B4b. Base onconsensus suggest that, in most illpatients, it is acceptable to initiate EN in the stomach.鉴于专家的共识方式。Question: Is

12、EN safe uring perios of hemoynamic instability in ault critically ill patients?问题：关于于成年危重病患者，血流动力学不稳定是否安全？B5.Baseonconsensus,suggestthatinthesettingofhemoynamiccompromiseorinstability,shoulbeuntilthepatient isfullyan/orstable.Initiation/reinitiationofmaybeconsiere cautioninpatientsunergoingofvasopre

13、ssorsupport.根据专家共识，我们建议在血流动力学不稳定时，应当暂停EN 直至患者接受了充分的复苏治疗和（或）病情稳定。关于于正在撤除升压药物的患者，可以考虑谨慎开始或重新开始EN。OSINGOF的剂量Question: What population of patients in the ICU setting oes not requirenutrition support therapy over the first week of hospitalization?问题：哪些患者住ICU 的第一周内无需营养支持治疗？C1. Base on consensus, suggest t

14、hat patients at lownutritionnormalbaselinenutritionstatusanlowisease(for example,3orscore5)cannotmaintainvolitional intakeoNOTspecializenutritionovertheof hospitalization in theICU.根据专家共识，我们建议那些营养风险较低及基础营养状况正常、疾病较轻（例如NRS-2002 3 或 NUTRIC 评分 5）的患者，即使不能自主进食，住ICU 的第一周内不需要特别给予营养治疗。Question:Forpopulationo

15、fpatientsintheICUsettingisitto provietrophicovertheofhospitalization?问题：哪些ICU 患者在住院第一周内适合滋养型喂养(trophic EN)？C2.We recommen that either trophic or full nutrition by EN is appropriatefor patients acute synrome (ARS)/acute lung (ALI)anthoseexpectetohaveaurationofmechanicalventilation72hours, astheseoffe

16、einghavesimilarpatientoutcomesovertheweek of hospitalization. Quality of Evience: High关于于急性呼吸窘迫综合(ARS)/急性肺损伤患者以及预期机械通气时间72 小时的患者，我们推荐给予滋养型或充分的肠内营养，这两种营养补充策略关于患者住院第一周预后的影响并且无差异。证据质量：高Question:populationofpatientsintheICUfull(ascloseas possibletonutritiongoals)beginningintheofhospitalization? Howsoons

17、houlnutritiongoalsbeinthesepatients?U 患者住院第一周需要足量（尽可能接近目标喂养量？这些患者应多长时间达到目标量？C3. Base on expert consensus, we suggest that patients who are at highnutrition (for example, 5 or score 5, without or malnourishe shoul be avance goal as quicklyastolerateoverhoursmonitoringforsynrome. toprovie80%ofestimate

18、orcalculategoalanprotein 4872hoursshoulbemaeinorertoachievetheclinicalbenefitofover the ofhospitalization.根据专家共识，我们建议具有高营养风险患者（25或不考虑IL-6情况下评分或严重营养不良患者，应在 2448小时达到并且耐受目标喂养量；监测再喂养综合征。争取4872 小时提供预计蛋白质与能量供给目标，从入院第一周中获益。Question:oestheamountofproteinproviemakeainclinical outcomes of ault illpatients?问题：

19、蛋白质供给量关于成年危重病患者临床结局有何不同影响？C4. We suggest that sufficient (high-ose) protein shoul be provie.Proteinexpectetobeintheofactualboy peray,anmaylikelybeevenhigherinormulti-patients (see sections M anP).Quality of Evience: Very Low我们建议充分的（大剂量的）蛋白质供给。蛋白质需求预计.2 2.0 g/kg（实际体重天，烧伤或多发伤患者关于蛋白质的需求量可能更高P 部分）。证据质量：

20、非常低临床营养危重病患者营养支持治疗的实施与评估指南成年危重病患者营养支持治疗实施与评估指(2/6)翻译：清华大学长庚医院周华 许媛来源：中国病理生理学危重病医学专业委员会官网ANOF耐受性与充分性的监测Question: How shoul tolerance of EN be monitore in the ault critically illpopulation?问题：如何监测成年危重病患者EN 耐受性？1. Base on expert consensus, we suggest that patients shoul bemonitoreailyfortoleranceofsugg

21、estthatcessationof shoulbeavoie.suggestthatafeeingstatusofnilperos (NPO) for the patient the time of iagnostic tests or shoul be minimize to limit propagation of ileus an to inaequate 根据专家共识耐受性。我们建议应当避免不恰当的中止。我们建议，患者在接受诊断性检查或操作期间，应当尽可能缩短禁食的医嘱，以免肠梗阻加重，并且防止营养供给不足Question:ShoulGRVsbeuseasaforaspiration

22、tomonitorICU patients on问题：GRV 是否应当作为接受EN 的 ICU 患者监测误吸的指标？2a. We suggest that GRVs not be use as part of routine care to monitorICU patients on EN.我们建议不应当把GRV 作为接受的ICU 患者常规监测的指标。2b.suggestthat,forthoseICUsGRVsstillutilize,holing forGRVs500mlintheabsenceofothersignsofintolerance(seesection1) shoul be

23、avoie.Quality of Evience: Low我们建议，关于于仍然监测GRV 的 ICU，应当避免在GRV 60%of an protein by the route alone. Initiating supplementalPNpriortothisperioinillpatientsonsome en oes not improve outcomes an may be to the patient. Quality of Moerate无论低或高营养风险患者，接受肠内营7-10天，如果经摄入能量与蛋白质量仍不足目标的60%，我们推荐应考虑给予补充型。在开始 天内给予补充型，

24、不仅不能改善预后，甚至可能有害。证据质量：中HOF PN 肠外营养支持最大获益的适应症Question: PN is neee in the ault ill patient, can be aopte to improve efficacy?问题：成年危重病患者何时需要PN 支持？提高有效性的策略是什么？H1. Base on expert consensus, we suggest the use of protocols an nutritionsupportteamstohelpincorporatetomaximizeefficacyanassociate ofPN.根据专家共识，我

25、们建议使用营养支持实施方案与营养支持小组，以促进营养支持策略的最大化获益并且降低PN 相关风险。Question: In the caniate for PN (high or malnourishe),shoultheosebeajusteovertheofhospitalization in theICU?问题：关于于具有PN 适应症的患者（ICU 第一周应如何调整营养供给量？H2. We suggest that hypocaloricPN osing ( 20 kcal/kg/ay or 80% ofestimatenees)aequateprotein(1.2gprotein/kg/

26、ay)be consiereinpatients(highormalnourishe) PN,initiallyovertheofhospitalizationintheICU. Quality of Low关于于高营养风险或严重营养不良、需PN支持的患者，我们建议住ICU第一周内给予低热卡PN（20 kcal/kg/ay 或能量需要目标的80%），以及充分的蛋白质补充1.2g/kg/ay）。证据质量：低Question:Shoulsoy-baseIVfatemulsionsbeprovieintheof ICU stay? Is an avantage to using (i.e., mei

27、um-chainoliveoilOO,ofoils)over traitionalsoybeanoil(SO)-baselipiemulsionsinillaultpatients?问题：成年危重症患者在收住ICU 第一周内是否给予大豆油基础的静脉脂肪乳剂(IVFE)？给予新一代的静脉脂肪乳剂（/长链甘油三酯MCT，橄榄油，鱼油，混合油类，是否比传统大豆油基础的脂肪乳剂更有优势？H3a. We suggest withholing or limiting SO-base IVFE uring the first weekfollowinginitiationofPNintheillpatien

28、ttoamaximumof100(oftenivieinto2oses/week)ifisconcernforessentialfattyaci eficiency.Quality of Evience: Very Low危重病患者开始PN 输注，如果考虑必需脂肪酸缺乏，其最大补充剂量100g每周（常分2 次补充）。证据质量：非常低H3b. Alternative IVFE may provie outcome benefit over soy-base IVFE;cannot make a recommenation at this time ue to lack of availabili

29、tyoftheseprouctsintheU.S.theseOOanbecomeavailableintheUniteStates,baseonopinion,suggestthattheirusebeconsiereintheillpatientis an caniate forPN.新一代的比大豆油基础的关于预后具有更好影响类产品的缺乏，故尚不能做出任何推荐意见。根据专家意见，一旦这类脂肪乳OO在美国上市PN 适应症的重症患者使用。Question: Is an avantage to using commercially available PN PN) compoune PN 预混合的

30、PN 制剂比配置的PN 混合液更有优势吗？H4. Base on expert consensus, use of stanarize commercially available PNcompounePNintheICUpatienthasnoavantageinof clinicaloutcomes.根据专家共识，标准商品化的PN 制剂（多腔袋）PN 液相比，未见任何影响ICU 患者临床结局的优势。Question: What is the esire target bloo glucose range in ault ICU patients?问题：成年ICU 患者预期的血糖控制目标是多

31、少？H5. We recommen a target bloo glucose range of 140or 150 180 mg/l forthe general ICU population; ranges for specific patient populations(post-cariovascularheamayifferanbeyonthescope of thisguieline.Quality of Evience: Moerate我们推荐综合ICU我们推荐综合ICU 患者的血糖控制目标在：140180 或 150180 mg/l；特殊患者（心血管术后，颅脑损伤）可能有超出指

32、南的不同推荐。证据质量：中Question: Shoul parenteral glutamine be use in the ault ICU patient?问题：成年ICU 患者肠外支持是否应补充谷氨酰胺？H6.recommenthatglutaminesupplementationNOTbeuseroutinelyinthesetting. QualityofMoerate我们推荐危重病患者肠外营养期间无需常规补充谷氨酰胺。证据质量：中Question:Intransitionfeeing,asanvolumeofistoleratebyapatient alreay receivin

33、g PN, at what point shoul the PN be terminate?PN支持的患者向过渡期间量逐渐增加H7BaseonconsensussuggestthatastolerancetoimprovestheamountofPNshoulbeanfinallyiscontinuethe patientis60%offrom根据专家共识，当EN 耐受性提高，达到目标能量60%以上时，我们建议经PN途径供给的能量可逐渐减量至终止。成年危重病患者营养支持治疗实施与评估指(4/6)翻译：清华大学长庚医院周华 许媛来源：中国病理生理学危重病医学专业委员会官网I. PULMONARY

34、 FAILURE 呼吸衰竭Question: What is the optimal carbohyrate-to-fat ratio for the ault ICUpatient with pulmonary failure?问题：成人ICU 呼吸衰竭患者碳水化合物与脂肪的最佳比例是多少？I1. We suggest that specialty high-fat/low-carbohyrate formulations esigne tothequotientanCO2prouctionNOTbeusemanipulatein ICU patients acute (not to be

35、confuse recommenationQuality of Evience: Very Low某些高脂低碳水化合物特殊配方系根据呼吸熵与减CO2产生而设计，我们不建议将这种配方用于合并且急性呼吸衰竭ICU（不要与推荐意见混淆）【证据质量：非常低】Question:oesuseofformulastofluiaministration benefittheaultICUpatientacute配方制剂限制液体摄入量的ICU 患者获益？I2. Base on expert consensus, we suggest that flui-restricte energy-ense ENformu

36、lations be consiere for patients with acute respiratory failure (especially if in a state of volume overloa).鉴于专家共识，我们建议急性呼吸衰竭患者考虑使用限制液体入量的高能量密度肠内营养配方（尤其在液体负荷过多时）。Question:ShoulphosphateconcentrationsbemonitoreorPN isinitiateintheICUpatient问题：关于于合并且呼吸衰竭的ICU 患者，开始EN 或 PN 时是否需要监测血磷浓度？I3. Base on exper

37、t consensus, we suggest that serum phosphate concentrationsshoulbemonitoreclosely,anphosphateneee.鉴于专家共识，我们建议密切监测血磷浓度，必要时应适当给予补充。肾 衰Question: In ault critically ill patients with acute kiney injury (AKI), what aretheinicationsforuseofspecialtyformulations?anproteinrecommenationstomorbiityinAKI?问题：关于

38、于合并且急性肾损的成年危重症患者，应用特殊肠内营养制剂的 指征是什么？为降低AKI患病率，适宜的能量与蛋白质补充为多少？J1. Base on expert consensus, we suggest that ICU patients with acute renalorAKIbeplaceonaformulation,anICU recommenations for protein actual boy per ay) an (2530kcal/kg/ay)provisionshoulbefollowe.Ifsignificantelectrolyte abnormalities evel

39、op, a specialty formulation esigne for electrolyteprofile)maybeconsiere.鉴于专家共识，我们建议患急性肾ICU患者使用标准肠内营养配方，并且摄入U推荐的标准剂量蛋白质.g实际体重/ 天）与能量天）。如果发生电解质鲜明异常，应考虑应用肾衰的 特殊配方制剂（恰当的电解质和蛋白比例）。Question:InaultillpatientsAKIhemoialysisor forproteinintaketosupportnitrogenlosses?问题：关于于接受血液透析或CRRT治疗的成年AKI 重症患者，为补充氮丢失， 合理补

40、充氮的目标量是多少？J2. We recommen that patients receiving hemoialysis or CRRT receiveincrease protein, up to a maximum of 2.5g/kg/ay. Protein shoul NOT beinpatientsinsufficiencyasameanstoavoiorelay initiating ialysisQuality of Evience: Very Low我们推荐接受血液透析或CRRT 的患者增加蛋白质补充最大剂量可达2.5 g/kg/天。肾功能不全的患者不应为避免或延迟透析治疗而

41、限制蛋白质摄入量。证据质量：非常低肝 衰Question: Shoul energy an protein requirements be etermine similarly incritically ill patients with hepatic failure as in those without hepatic failure?问题：合并且肝衰与无肝衰的重症患者，是否供给同等量的能量与蛋白质？ K1Baseonconsensussuggestaorusualbeuse insteaofactualinequationstoanproteininpatientsanhepaticu

42、etocomplicationsofascites, volume epletion, eema, portal hypertension, an hypoalbuminemia. suggest nutrition avoi protein in patientsliverusingthesamerecommenationsasforother ill patients (see sectionC4).鉴于专家共识，由于肝硬化及肝衰患者腹水、血管内容量不足、水肿、门静脉高压及低蛋白血症等并且发症，我们建议使用能量及蛋白需要量的预测公式时， 应采用干重或平时体重而非实际体重。与其他危重病患者相

43、同，我们建议肝衰患者不应限制蛋白质摄入（C4 部分）。Question: What is the appropriate route of nutrition elivery in patients with hepatic failure?问题：肝衰患者恰当的营养供给途径是什么？K2. Base on expert consensus, we suggest that EN be use preferentially whenproviingnutritioninICUpatientsacutean/orchronicliver isease.鉴于专家共识，我们建议罹患急性和（或）慢性肝病I

44、CU 患者优先选择肠内营养治疗方式。Question: Is a isease-specific enteral formulation neee for critically ill patients with liver isease?问题：合并且肝病的危重病患者是否需要特殊疾病肠内营养配方？K3. Base on expert consensus, we suggest that stanar enteral formulations beuseinICUpatientsacuteanchronicliverisease.isnoevienceof benefit of amino ac

45、i formulations (BCAA) on coma intheICUpatientencephalopathyisluminal-actingantibioticsanlactulose.鉴于专家共识，我们建议罹患急性和慢性肝病ICU 患者选用标准配方肠内营养制剂。关于于已经接受肠腔内作用抗生素及乳果糖一线治疗的肝性脑病患者， 没有证据表明支链氨基酸）型肠内营养配方能够改善昏迷的严重程度。 急性胰腺炎Question: oes isease severity in acute pancreatitis influence ecisions toprovie specialize nut

46、rition therapy?问题：急性胰腺炎的疾病严重程度是否影响特殊配方营养治疗的选择？ L1aBaseonconsensussuggestthattheinitialnutritionassessment inacuteevaluateiseasetonutritionSinceiseasemaychangequickly,suggestoffeeing toleranceanneeforspecializenutrition鉴于专家共识，我们建议关于于急性胰腺炎患者的初始营养评估应考虑疾病的严重程度，以指导营养治疗策略。由于病情严重程度可能迅速改变，我们建议关于于喂养耐受性以及是否需要

47、特殊营养治疗进行反复评估。Question: o patients with mil acute pancreatitis nee specialize nutrition therapy?问题：轻症急性胰腺炎患者是否需要特殊营养治疗？L1b. We suggest NOT proviing specialize nutrition therapy to patients withmilacuteinsteaavancingtoanoralietastolerate.Ifan unexpectecomplicationevelopsoristoavancetooraliet 7ays,then

48、specializenutritionshoulbeconsiere. Quality of Low我们建议轻症急性胰腺炎患者不使用特殊营养治疗，如果能够耐受，应过渡到经口进食。如果发生意外并且发症或7 天内不能过渡到经口进食，则考虑进行特殊营养治疗。【证据质量：非常低】Question: patients specialize nutrition after amission for acute 问题：哪类急性胰腺炎患者在入院后早起需要特殊营养治疗？L1c. We suggest that patients with moerate to severe acute pancreatitis

49、shoulhave a naso-/oroenteric tube place an at a trophic an o ol s oe on s o n 8 os of amission).Quality of Evience: Very Low我们建议中度至重度急性胰腺炎患者留置经鼻或经口肠内营养管，一旦液体复苏完成后（入ICU 24-48小时内）即开始滋养型喂养，并且逐步过度到目标营养。【证据质量：非常低】Question:isthemostformulatouseinitiatinginthepatientmoeratetoacute问题：中重度急性胰腺炎患者开始早时，选择哪种配方最适

50、宜？L2. We suggest using a stanar polymeric formula to initiate EN in the patientacuteAlthoughpromising,theatainsufficienttorecommenplacingapatientacuteonan immune-enhancing formulation at thistime.Quality of Evience: Very Low我们建议重症急性胰腺炎患者开始时选择标准聚合物配方制剂然令人鼓舞，但尚不足以推荐重症急性胰腺炎患者应用免疫增强配N。【证据质量：非常低】Question

51、: Shoul patients with severe acute pancreatitis receive EN or PN?问题：重症急性胰腺炎患者应当接还是L3a. We suggest the use of EN over PN in patients with severe acute pancreatitiswho require nutrition therapy. Quality of Evience: Low我们建议需要营养治疗的重症急性胰腺炎患者优先选而非。【证据质量：低】Question:Shoulpatientsacutebefeintothestomach or s

52、mallbowel?问题：重症急性胰腺炎患者应给予经胃喂养还是经小肠喂养？L3b. We suggest that EN be provie to the patient with severe acutebyeithertheorjejunalroute,asisnoin toleranceorclinicaloutcomestheselevelsofinfusion.Quality of Evience: Low我们建议重症急性胰腺炎患者可经胃或经空肠接，因为两种途径在耐受性与临床预后方面并且无差异。【证据质量：低】Question:Intheofintolerance,canbeuset

53、oenhance tolerancetoinpatientsacute问题：关于于 EN 不耐受的重症急性胰腺炎患者，有哪些措施可以提高EN 的耐受性？L4. Base on expert consensus, we suggest that, in patients with moerate toacutehaveintolerancetoshoulbetaken to improve tolerance.鉴于专家共识，我们建议关于于不能耐受EN 的中重度急性胰腺炎患者，应采取相应措施改善耐受性。Question: Shoul patients with severe acute pancr

54、eatitis receive probiotics?问题：重症急性胰腺炎患者是否应给予益生菌治疗？L5. We suggest that the use of probiotics be consiere in patients with severeacuteQuality of Low我们建议接受早期EN 的重症急性胰腺炎患者可考虑使用益生菌。【证据质量：低】Question: When is it appropriate to use PN in patients with severe acutepancreatitis?问题：重症急性胰腺炎患者何时选Question: When i

55、s it appropriate to use PN in patients with severe acutepancreatitis?问题：重症急性胰腺炎患者何时选PN 为宜？L6.Baseonconsensus,suggestthat,forthepatientacuteisnotfeasible,useofPMshoulbeconsiereafterone fromtheonsetoftheepisoe.根据专家共识一周后应考虑使用。成年危重病患者营养支持治疗实施与评估指(5/6)翻译：清华大学长庚医院周华 许媛来源：中国病理生理学危重病医学专业委员会官网SURGICAL外科部分创伤Q

56、uestion: oes the nutrition therapy approach for the trauma patient ifferfrom that for otherill 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 feeingahighproteinpolymericietbeinitiateintheimmeiatepost-trauma perio24to48hoursofoncethep

57、atientishemoynamically stable.Quality of Evience: 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:Shoulimmune-moulationformulasbeuseroutinelyto improve outcomes in a patient 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-moulating formulations containing

58、 arginine anbeconsiereinpatientsQualityofLow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: oes the approach for nutrition for the patient ifferfrom that of other critically ill patients or trauma patients without hea 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？M2

59、a. We recommen that, similar to other critically ill patients, early enteralfeeingbeinitiateintheimmeiatepost-traumaperio24to48hours ofoncethepatientishemoynamicallystable.18 PAGE PAGE 26Quality of Evience: 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: Shoul immu

60、ne-moulating formulas be use in a patient with TBI?问题：TBI 患者是否应当使用免疫调节配方吗？M2b: Base on expert consensus, we suggest the use of eitherarginine-containing immune-moulating formulations or EPA/HA supplement with stanar enteral formula in patients with TBI.鉴于专家共识，我们建议患者使用含有精氨酸的免疫调节配方，或使用添加的标准配方。 开放腹腔Que