成人脓毒症患者医学营养治疗指南(2025版)

背景2治疗流程：筛查、肠内、肠外目录CONTENT3治疗原则：能量、蛋白、途径、中医4特殊营养素的推荐背景：脓毒症在全球范围的发病率高MaleFemaleBoth sexesIncident cases(95%Ul)Age-standardisedIncident cases(95%Ul)Age-standardisedIncident cases(95%Ul)Age-standardisedincidence perincidence perincidence per100000 population100000 population100000 population(95%U川(95%U)(95%U)Infections159616324535(3235-641.6)171654604824(3441-6954)331271594668(3374-654-8)(1141667922490150)(1232475924539248)(24112267-45885664)Injuries1202056317(242-40-8)66332917-8(132-231)186535824-7(18-8-317)(916529-1548161)(494773-850850)(1421131-2392774)Non-communicable5567578157.6(126-8-203-8)83497302164(167.6-290-8)13917451186-0(150-0-237-0)diseases(4499826-7157847)(6520440-11096832)(11313974-17629415)All causes22731266642-8(507-7-834-8)26178518716-5(560-2-925-1)48909968677-5(5357-876-1)(18037098-29410723)(20630286-33702305)(38929606-62859320)Data are n(95%Ul),unless otherwise stated.Ul=uncertainty interval.Table 1:Incident cases of sepsis and age-standardised incidence of sepsis,for all ages,both sexes,and all locations,according to category of underlying cause,20172017年，全球估计脓毒症发病人数有接近5000万，死亡人数为1100万，接近20%；发病率和死亡率在各地区差异很大，撒哈拉非洲、大洋洲、南亚、东亚和东南亚的负担最重。Kristina E Rudd et al.Global,regional,and national sepsis incidence and mortality,1990-2017:analysis for the Global Burden of Disease Study.Lancet 2020:395:200-11背景：脓毒症营养风险发病率高及带来的风险TABLE 1:Baseline clinical characteristics of patientsTotal (n=194)Survivors (n=121)Nonsurvivors (n=73)P ValueCharacteristicsAge,years69(59-80)69(59-78)69(57-83)0.630Male sex,n (%143(73.7)87(71.9)56(76.7)0.463Septic shock,n(%)141(72.6)79(65.3)62(84.9)0.002Noradrenaline dose,ug/kg/min0.18(0.000.40)0.10(0.00-0.300.25(0.10-0.50)0.477Mechanical ventilation,n(%)162(83.5)91(75.2)71(95.9)0.001Length of ICU stay,days5(3-9)5(3-9)5(2-10)0.724ComorbiditiesHypertension,n (%78(40.2)47(38.8)31(42.7)0.620Diabetes mellitus,n (%49(25.3)24(19.8)25(34.2)0.025Stroke,n(%)28(14.4)18(14.8)10(13.7)0.822SurvivorsNon-SurvivorsCOPD,n(%)10(5.2)3(2.5)79.6)0.061FIGURE 1:mNUTRIC score in survivors and nonsurvivors groupsSource of infectionmNUTRIC score:median 4 vs 6,P<0.001Abdominal86(44.3)68(56.2)18(24.6)Respiratory82(42.3)42(34.7)40(54.8)Urinary tract10(5.26(4.9)4(5.5)mNUTRIC<5Skin11(5.71(0.8)10(13.7)Other5(2.6)4(34)1(14)Initial physiologic variables,0.6Heart rate,bpm107(90-120)100(90-120)110(100-120)0.008MAP,mmHg73.0(63.0-85.0)75.5(70.0-88.0)70.0(60.0-73.0)0.001"nNUTRIC≥5Severity of illnessSOFA score10(6-12)7(5-11)11(10-14)<0.001APACHE IⅡscore18(13-23)14(11-2023(19-27)<0.001SAPS 2 score44(34-56)39(39-47)53(42-61)<0.001mNUTRIC score6(5-7)<0.0010Log Rank 33.06,P<0.0015(4-6)4(3-5)mNUTRIC 25116(59.8)51(42.1)65(89.0】<0.00120Duration of follow-up(days)Data are introduced as median(interquartilerange)and number(n)of patients (%)as appropriate.COPD,chronic obstructive pulmonary disease;APACHEIl,acute physiology and chronic health evaluation;ICU,intensive care unit;MAP,meaarterial pressure;mNUTRIC,modified Nutrition Risk in CriticallyFiGv 3:Mortality of septic