胰腺炎营养治疗国际共识指南-guo-2012.6.docx

International Consensus Guidelines for Nutrition Therapy in Pancreatitis胰腺炎营养治疗国际共识指南Apr 24, 2012 Version of RecordMar 28, 2012 Online First Version of Record Platinum (A): guideline statement meeting the criteria for high grade of evidence with uniform consensus across multiple societal reports白金（A）：指南建议符合如下标准，具有高水平证据支持并且多个协会指南意见相一致 Gold (B): guideline statement that meets criteria for low/intermediate grade of evidence or where there is lack of consensus across societal reports (at least 1 societal report is in disagreement)黄金（B）：指南建议符合如下标准，中低水平证据支持，或者协会指南之间缺乏共识（至少一个协会指南建议不一致） Silver (C): guideline statement meeting the criteria for high grade of evidence, published only in a single societal report (consensus not applicable in this case)白银（C）：指南建议符合如下标准，仅有一个协会发布的具有高水平证据支持的建议（共识不适用于此等情况）Table 4. Final Grade of Recommendation for International Consensus GuidelinesInternational Guidelines RecommendationsGrade CategorizationGrade of RecommendationNumber of SocietiesStrength of EvidenceConsensus AgreementA (platinum)Multiple societiesHigh level of evidenceConsensusB (gold)Multiple societiesIntermediate to low level of evidenceLack of consensusC (silver)Single societyHigh level of evidenceNA（not applicable）Indication for Nutrition Therapy营养治疗指征1. Pancreatitis patients are at nutrition risk and should be screened. (Grade B: Gold)1. 胰腺炎患者存在营养风险，应当进行营养筛查。(Grade B: Gold)2. For mild to moderate disease, analgesics, intravenous (IV) fluids, and nil per os (NPO) with a gradual advancement to diet (usually within 34 days) are recommended. (Grade C: Silver)2. 对于轻中度患者，推荐镇痛剂、静脉补液、从开始禁食（NPO）逐渐过渡到日常饮食（一般3-4天）。(Grade C: Silver)The need for nutrition therapy (NT) by the enteral or parenteral route should be based on the extent of disease and nutrition status of the patient.根据疾病严重程度和患者营养状态判断是否需要肠内或肠外营养治疗（NT）。3. NT is not generally needed for mild to moderate disease unless complications ensue. (Grade A: Platinum)3. 轻中度胰腺炎一般无需NT，除非并发症出现。(Grade A: Platinum)4. NT should be considered in any patient regardless of disease severity if the anticipated duration of being NPO is 57 days. (Grade B: Gold)4. 预期禁食时间超过5-7天应当考虑NT，无需考虑疾病严重程度。(Grade A: Platinum)5. NT is needed in mild to moderate disease when the patient has been NPO for 57 days. (Grade B: Gold)5. 已经禁食5-7天的轻中度胰腺炎患者应当开始NT。(Grade B: Gold)6. Early NT is indicated for severe pancreatitis. (Grade A: Platinum)6. 重症胰腺炎是早期NT的指征。(Grade A: Platinum)7. NT is useful in the management of patients who develop complications of surgery. (Grade B: Gold)7. NT有益于出现外科并发症的胰腺炎患者的治疗。(Grade B: Gold)Use of Enteral Nutrition适用于肠内营养8. Enteral nutrition (EN) is generally preferred over parenteral nutrition (PN), or at least EN should, if feasible, be initiated first. (Grade A: Platinum)8. EN通常优于PN，或者说，只要可能就要先从EN开始。(Grade A: Platinum)9. EN may be used in the presence of pancreatic complications such as fistulas, ascites, and pseudocysts. (Grade C: Silver)9. 当出现诸如肠瘘、腹水、假性囊肿等胰腺并发症应当开始EN。(Grade C: Silver)10. Continuous EN infusion is preferred over cyclic or bolus administration. (Grade B: Gold)10. EN持续输注优于间断输注或推注。(Grade B: Gold)11. Nasogastric tubes may be used for administration of EN. Postpyloric placement is not necessarily required. (Grade B: Gold)11. 实施EN可以使用鼻胃管。并非必须幽门下置管。(Grade B: Gold)12. For EN, consider a small peptide-based medium-chain triglyceride (MCT) oil formula to improve tolerance. (Grade B: Gold)12. 对于EN，考虑中长链脂肪乳的短肽制剂改善EN耐受性。(Grade B: Gold)Use of Parenteral Nutrition适用于肠外营养13. Use PN if NT is indicated, when EN is contraindicated or not well tolerated. (Grade A: Platinum)13. 具有NT指征当EN禁忌或不能耐受时使用PN。(Grade A: Platinum)14. IV fat emulsions are generally safe and well tolerated as long as baseline triglycerides are below 400 mg/dL (4.4 mmol/L) and there is no previous history of hyperlipidemia. (Grade B: Gold)14. 只要基础甘油三酯低于400 mg/dL (4.4 mmol/L)并且之前没有高脂血症病史，通常静注脂肪乳是安全的并且能够耐受。(Grade B: Gold)15. Glucose is the preferred carbohydrate source with metabolic control of glucose as close to normal as possible. (Grade C: Silver)15. 葡萄糖是最主要的碳水化合物来源，血糖控制尽可能接近正常。(Grade C: Silver)16. Consider use of glutamine (0.30 g/kg Ala-Gln dipeptide). (Grade C: Silver)16. 考虑应用谷氨酰胺（0.30 g/kg丙氨酰-谷氨酰胺二肽）(Grade C: Silver)17. No specific complications of PN are unique to patients with pancreatitis. In general, avoid over-feeding. (Grade C: Silver)17. 没有胰腺炎患者特定的PN并发症。通常应当避免过度喂养。(Grade C: Silver)Both Enteral and Parenteral Nutrition肠内肠外营养都适用18. Meet macronutrient requirements with NT. (Grade B: Gold)a. Calories: 2535 kcal/kg/db. Protein: 1.21.5 g/kg/d18. 达到NT最大需要量(Grade B: Gold)a. 热卡: 2535 kcal/kg/db. 蛋白: 1.21.5 g/kg/dA.S.P.E.N./JPEN J Parenter Enteral Nutr. 2002;26(1):Suppl (Jan-Feb)ESPEN/Clin Nutr. 2002;21(2):173-183 British Society of Gastroenterology/Gut.2005;54(suppl 3):iii1-iii9American College of Gastroenterology/Am J Gastroenterol.2006;101:2379-2400Japan (JSEAM)/Hepatobiliary Pancreat Surg. 2006;13:42-47ESPENenteral nutrition:pancreas/Clin Nutr. 2006;25:275-284AGA/Gastroenterology. 2007;132:2022-2044A.S.P.E.N. and SCCM/JPEN J Parenter Enteral Nutr. 2009;33(3):277-316Chinese Societies/Chin J Dig Dis.2005;6(1):47-51Bangkok World Congress of Gastroenterology 2002/J Gastroenterol Hepatol.2002;17(suppl):S15-S39AGA, American Gastroenterological Association; A.S.P.E.N., American Society for Parenteral and Enteral Nutrition; Chinese Societies, Chinese Society of Gastroenterology, Chinese Medical AssociationPancreatitis Disease Group; ESPEN, European Society for Clinical Nutrition and Metabolism; JS