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1、第一页，共二十一页。第二页，共二十一页。第三页，共二十一页。RecommendationsAll patients who are not expected to be on a full oral diet within 3 daysApplicationThere are no data support using early EN can improve their Prognosis，but the committee still recommend the early（24h）appropriate amount of feeding,once the patienthave a h
2、aemo-dynamically stable and a functioninggastrointestinal tract.Exogenous energy supply:the acute and initial phase:25kcal/kg/d less favourableRecovery：25kcal/kg/d severe under-nutrition：the EN energy supply should up to 25kcal/kg/d，if not reached，please add PNIf the patient intolerance(such as high
3、 gastric residuals)to EN,metoclopramide（胃复安）or Erythromycin（红霉素）should be considered.Use EN in patients who can be fed via the enteral route.Via jejunal versus gastric feeding,there is no significant difference.If the patients tolerate EN and can reach the target energy value,PN should be avoid.第四页，
4、共二十一页。Via EN can not be fed sufficiently,PN Should supplementType of formulaWhole protein formulae are superior to the peptide-basedformulaeImmune-modulating formulae(formulae enrichedwith arginine(精氨酸),nucleotides（核苷酸）and w-3 fatty acids)are superior to standard enteral formulae:In elective upper G
5、I surgical patients;in patients with a mild sepsis(APACHE 15);in patients with severe sepsis,may be harmful and are not Recommended;in patients with trauma;in patients with ARDS(formulae containing o-3 fatty acids and antioxidants).Due to insufficient data,no recommendation support the Immune-modula
6、ting formulae apply to the burned patients,but the trace elements(Cu,Se and Zn)should besupplemented in a higher than standard dosethe severe illness ICU patients,should not receive an immune-modulating formula enriched with arginine,nucleotides and w-3 fatty acids if the EN700ml/d.Glutamine should
7、be added to standard enteralformula in burned patients and trauma patients第五页，共二十一页。第六页，共二十一页。1.2 EN-Is early EN superior to delayed EN?第七页，共二十一页。第八页，共二十一页。第九页，共二十一页。第十页，共二十一页。第十一页，共二十一页。第十二页，共二十一页。第十三页，共二十一页。第十四页，共二十一页。第十五页，共二十一页。第十六页，共二十一页。第十七页，共二十一页。第十八页，共二十一页。第十九页，共二十一页。第二十页，共二十一页。欧洲ESPEN关于危重症患者的肠内营养指南内容(nirng)总结ESPEN Guidelines on EnteralNutrition:Intensive care。Recovery,2530 kcal/kg/d.。Recovery：25kcal/kg/d。EN,metoclopramide（胃复安）or Erythromycin（红霉素）。THANK YOU第二十一页，共二十一页。
欧洲ESPEN危重症患者的肠内营养指南课件
