成人脓毒症患者医学营养治疗指南（2025版）

·510·中华医学杂志2025年2月18日第105卷第7期Natl Med J China.February18,2025.Val.105.No.7·标准与规范·成人脓毒症患者医学营养治疗指南(2025版)中华医学会肠外肠内营养学分会通信作者：陈尔真，上海交通大学医学院附属瑞金医院重症医学科上海市重症医学质控中心，上海200025，Email:rjchenerzhen(@163.com【摘要】医学营养治疗影响脓毒症患者的预后，但是临床实施过程存在争议。为进一步规范脓毒症患者医学营养治疗，中华医学会肠外肠内营养学分会(CSPN)组织国内50余位重症医学、临床营养学、循证医学和统计学专家，按照推荐意见分级评价、制定与评估(GRADE)系统的标准和流程，通过系统性检索与证据梳理，并结合临床专家的实践经验制订本指南。指南针对脓毒症患者医学营养治疗中的营养风险筛查、早期医学营养治疗（肠内营养、肠外营养、能量供给、最佳目标蛋白质供给)、肠内营养治疗的输注方式、中医与肠道功能、营养补充剂（维生素、谷氨酰胺、山-3脂肪酸、硒）、益生菌、质子泵抑制剂的使用等方面作出了相应的推荐意见，最终形成14个问题、14条推荐意见，以期完善脓毒症患者医学营养治疗流程。【关键词】脓毒症；重症医学；医学营养治疗；营养风险筛查；蛋白质供给；能量供给基金项目：国家自然科学基金(82272234、82270087、82372203)：上海申康医院发展中心临床科学技术创新计划(SHDC22021316.SHDC22023218)实践指南注册：国际指南协作网（网址：htps:∥guidelines.ebmportal.com/cspenzhongguochengrennongduzhenghuanzhey ingyangzhiliaozhinan)AGuidelines for medical nutritional therapy in adult sepsis patients(2025 edition)Chinese Society of Parenteral and Enteral NutritionCorresponding author:Chen Erzhen,Department of Emergency,Ruijin Hospital,Shanghai Jiao TongUniversity School of Medicine;Shanghai Critical Care Medicine Quality Control Center,Shanghai200025,China,Email:rjchenerzhen@163.comAbstract Although medical nutritional therapy affects the prognosis of sepsis patients,there is controversy over its clinical implementation process.To further standardize the medicalnutrition therapy of sepsis patients,the Chinese Society of Parenteral and Enteral Nutrition(CSPEN)organized more than 50 experts from critical care medicine,clinical nutrition,evidence basedmedicine and statistics to formulate the guidelines.The guideline was based on grading ofrecommendations,development and evaluations (GRADE)standards and procedures,throughsystematic retrieval and evidence sorting,and combined with the practical experience of clinicalexperts.The guidelines provide recommendations on nutritional risk screening in medical nutritiontherapy for sepsis patients,early medical nutrition therapy (enteral nutrition,parenteral nutrition,energy intake,optimal target for protein delivery),enteral nutrition infusion mode,traditionalChinese medicine and protecting intestinal function,nutritional supplements (vitamin,glutamine,omega-3 fatty acids,selenium),probiotics,and the use of proton pump inhibitors.Ultimately,14questions and 14 recommendations were formed in order to improve the medical nutrition therapyD0L:10.3760/cmaj.cm112137-20240813-01859收稿日期2024-08-13本文编辑朱冬冬引用本文：中华医学会肠外肠内营养学分会.成人脓毒症患者医学营养治疗指南(2025版)中华医学於志，2025.105(7：510-528.D0L:10.3760/cma.j.cn112137-20240813-01859.