重症病人胃肠功能障碍肠内营养专家共识2021版

中华消化外科杂志2021年11月第20卷第11期Chin J Dig Surg,November2021.Vl.20.No.11·1123·指南与共识重症病人胃肠功能障碍肠内营养专家共识(2021版)亚洲急危重症协会中国腹腔重症协作组通信作者：蒋正英，重庆大学附属肿瘤医院重症医学科，重庆400030，Email:zhengyingjiange@cqu.edu.cn;常志刚，北京医院外科重症医学科，北京100730，Email:zhigangchang@126.com:李维勤，中国人民解放军东部战区总医院重症医学科，南京210002，Email:liweiqindr@vip.163.com【摘要】重症病人早期肠内营养至关重要，然而其临床实践仍充满挑战。中国腹腔重症协作组9家医院25位专家，针对重症病人胃肠功能障碍的病因及评估，早期肠内营养实施策略，以及各种临床实践中的具体方案进行讨论，并提出18项临床最为关注的问题，综合循证医学证据及临床经验，最终制订该共识，旨在为临床医师提供参考及指导，以期改善病人预后。【关键词】胃肠疾病：胃肠功能障碍：重症疾病：肠内营养；专家共识Expert consensus on enteral nutrition for gastrointestinal dysfunction in critically ill patients(2021 edition)Chinese Abdominal Intensive Care Association,Asia Society for Emergency and Critical Care MedicineCorresponding authors:Jiang Zhengying,Intensive Care Unit,Chongqing University Cancer Hospital,Chongqing 400030,China,Email:zhengyingjiang @cqu.edu.cn;Chang Zhigang,Department of SurgicalIntensive Care Unit,Beijing Hospital,Beijing 100730,China,Email:zhigangchang@126.com;Li Weiqin,Intensive Care Unit,General Hospital of Eastern Theater Command,Nanjing 210002,China,Email:liweiqindr@vip.163.comAbstract Early enteral nutrition plays an important role in the management of criticallyill patients,while there is still full of challenges in clinical practice.Twenty-five experts from9 hospitals of the Chinese Abdominal Intensive Care Association discussed and proposed 18 criticalissues of concern by clinicians,including causes,definitions,and evaluation of gastrointestinaldysfunction in critically ill patients,as well as principles and strategies on how to implement enteralnutrition in various clinical scenarios.Based on medical evidences as well as experts'clinical experi-ences,this expert consensus was finally developed,hoping to provide guidance for clinical practiceand improve outcome of patients.Key words Gastrointestinal diseases;Gastrointestinal dysfunction;Critical illness;Enteral nutrition;Expert consensus目前重症病人营养支持治疗相关指南及共识合，缩短机械通气时间、ICU住院时间和总体住院推荐危重症病人入住1CU24~48h内尽早启动肠内时间，以及降低病死率有关4。然而在临床实践营养2。肠内营养有助于营养胃肠黏膜，增强神中，由于ICU病人的个体差异性较大，不同病种或经内分泌功能，有益于保留肠道黏膜屏障功能和免病程病人胃肠功能受损程度不同、对肠内营养的耐疫功能。早期肠内营养与降低感染率，加速伤口愈受性差异很大，胃肠功能障碍重症病人开展肠内营D0I:10.3760/emaj.cm115610-20211012-00497收稿日期2021-10-12引用本文：亚洲急危重症协会中国腹腔重症协作组，重症病人胃肠功能障碍肠内营养专家共识(2021版)▣.中华消化外科杂志，2021,20111123-1136.D0:10.3760/cmaj.cnl115610-20211012-00497.