新型冠状病毒感染住院患者肠外肠内营养支持治疗指南

标题: 新型冠状病毒感染住院患者肠外肠内营养支持治疗指南
title: Guidelines for parenteral and enteral nutrition support treatment for hospitalized patients with COVID-19
版本: 原创版
version: Original
分类: 快速建议指南
classification: Rapid advice guideline
领域: 诊疗
field: Diagnosis and Treatment
国家和地区: 中国
Country and region: China
指南使用者: 临床医生、营养师、护士和药师
Guide users: Clinicians, dietitians, nurses and pharmacists
证据分级方法: GRADE证据质量分级标准
Evidence grading method: GRADE guidelines
制定单位: 四川省急危重症临床医学研究中心、四川省人民医院
Formulating unit: Sichuan Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital
注册时间: 2023-01-04
Registration time:
注册编号: PREPARE-2023CN006
Registration number:
指南制订的目的: 新冠病毒严重威胁着人民群众的生命健康,且目前尚无针对新冠病毒的特效抗病毒药物,对症治疗仍为临床主要的治疗方法。新冠病毒对于各类人群普遍易感,感染者除出现咽部不适、咳嗽和发热等主要症状外,还可能伴有恶心、腹泻、胃纳减退等消化道症状,严重者快速进展为急性呼吸窘迫综合征、脓毒症休克和多器官功能衰竭。其中,老年感染者、合并慢性基础性疾病感染者和免疫力低下感染者更易进展为重症患者。部分患者会因上述消化道症状导致营养素吸收功能障碍,并可能因味觉和嗅觉功能的减退或丧失导致食物摄入不足而引发营养不良。对于重症患者而言,由于病毒的攻击和继发的感染,大量炎性因子的释放引发免疫-内分泌-代谢的瀑布级联反应,造成患者代谢功能的严重失调,促使营养不良的发生发展。营养不良导致免疫功能减弱,将进一步导致不良预后的发生发展。虽然,近三年以来国际和国内对新冠患者医学营养支持治疗的循证医学证据不断出现,然而循证、个案化的干预方法仍有待完善。为更好的治疗各种住院,尤其是重症感染患者,落实推进优化措施,改善治疗效果,规范新冠病毒感染者的营养治疗,特制定本指南。
Purpose of the guideline: COVID-19 is a serious threat to people's life and health, and there is no specific antiviral drug, symptomatic treatment is still the main clinical treatment method. COVID-19 is universally susceptible to all people, In addition to the main symptoms such as pharyngeal discomfort, cough and fever, the infected persons may also be accompanied by gastrointestinal symptoms such as nausea, diarrhea, hypotoleration, etc. In severe cases, the symptoms rapidly progress to acute respiratory distress syndrome, septic shock and multiple organ failure. Among them, the elderly infected patients, those with chronic underlying diseases and those with low immunity are more likely to progress to severe cases. Some patients will suffer from nutrient absorption dysfunction due to the above digestive tract symptoms, and may suffer from malnutrition due to the decrease or loss of taste and smell function leading to insufficient food intake. For severe patients, due to virus attack and secondary infection, the release of a large number of inflammatory factors triggers a cascade reaction of immune-endocrine-metabolism, resulting in serious metabolic dysfunction of patients and promoting the occurrence and development of malnutrition. Malnutrition leads to weakened immune function, which will further lead to the development of poor prognosis. Despite the continuous emergence of evidence-based medical evidence in the past three years, evidence-based and individualized intervention methods remain to be improved. This guideline has been formulated to better treat all kinds of hospitalized patients, especially those with severe infection, implement and promote optimization measures, improve treatment effects, and standardize nutritional treatment for those infected with COVID-19.