美国胃肠病学院临床指南：成人住院患者营养疗法

　　2016年3月8日，自然（Nature）出版集团旗下《美国胃肠病学杂志》（AJG）正式发表了《美国胃肠病学院临床指南：成人住院患者营养疗法》（ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient），通讯作者为美国肠外肠内营养学会（ASPEN）前任主席、路易斯维尔大学医学院医学系胃肠病学、肝病学和营养学教授：斯蒂芬·麦克拉夫（Stephen A. McClave）。其他作者包括重症医学会（SCCM）前任主席、俄勒冈健康科学大学外科学教授：罗伯特·马丁代尔（Robert G. Martindale），还有两位作者来自梅奥医院内科、约翰·霍普金斯大学内科。

　　该指南旨在为成人住院患者提供最佳营养疗法方案，指南涉及的临床问题有：营养疗法的适应症、营养评定、肠内营养、肠外营养、临终营养疗法。针对这些临床问题，指南共提出38条推荐意见。

Am J Gastroenterol. 2016 Mar;111(3):315-34.

ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient.

McClave SA, DiBaise JK, Mullin GE, Martindale RG.

University of Louisville School of Medicine, Louisville, Kentucky, USA; Mayo Clinic, Scottsdale, Arizona, USA; Johns Hopkins University, Baltimore, Maryland, USA; Oregon Health Sciences University, Portland, Oregon, USA.

The value of nutrition therapy for the adult hospitalized patient is derived from the outcome benefits achieved by the delivery of early enteral feeding. Nutritional assessment should identify those patients at high nutritional risk, determined by both disease severity and nutritional status. For such patients if they are unable to maintain volitional intake, enteral access should be attained and enteral nutrition (EN) initiated within 24-48 h of admission. Orogastric or nasogastric feeding is most appropriate when starting EN, switching to post-pyloric or deep jejunal feeding only in those patients who are intolerant of gastric feeds or at high risk for aspiration. Percutaneous access should be used for those patients anticipated to require EN for >4 weeks. Patients receiving EN should be monitored for risk of aspiration, tolerance, and adequacy of feeding (determined by percent of goal calories and protein delivered). Intentional permissive underfeeding (and even trophic feeding) is appropriate temporarily for certain subsets of hospitalized patients. Although a standard polymeric formula should be used routinely in most patients, an immune-modulating formula (with arginine and fish oil) should be reserved for patients who have had major surgery in a surgical ICU setting. Adequacy of nutrition therapy is enhanced by establishing nurse-driven enteral feeding protocols, increasing delivery by volume-based or top-down feeding strategies, minimizing interruptions, and eliminating the practice of gastric residual volumes. Parenteral nutrition should be used in patients at high nutritional risk when EN is not feasible or after the first week of hospitalization if EN is not sufficient. Because of their knowledge base and skill set, the gastroenterologist endoscopist is an asset to the Nutrition Support Team and should participate in providing optimal nutrition therapy to the hospitalized adult patient.

PMID: 26952578

DOI: 10.1038/ajg.2016.28