结核病重症患者营养评估及营养支持治疗专家共识

doi:10.19982/j.issn.1000-6621.20220041

摘要/Abstract

摘要：

结核病与机体营养状态之间存在着双向的关系,相互影响,互为因果。结核病可以导致营养风险发生,易出现营养相关性疾病,如营养缺乏、免疫功能低下、电解质紊乱等;反之,营养状况差可导致机体淋巴细胞减少,细胞免疫功能低下,易患结核病和其他感染性疾病。营养不良状态是影响成人结核病重症患者预后及死亡的独立危险因素,但关于结核病重症患者的营养评估及营养支持治疗,我国尚缺乏相关指导性文件。因此,为使结核病重症患者得到规范的个体化营养评估及营养支持治疗,改善患者预后,降低病亡率,中国人民解放军总医院第八医学中心和《中国防痨杂志》编辑委员会联合组织专家,结合我国目前结核病营养支持治疗的经验和方法,以及美国和欧洲最新的肠内肠外营养指南,共同拟定《结核病重症患者营养评估及营养支持治疗专家共识》。本共识阐述了结核病重症患者进行营养评估及营养支持治疗的重要性,常用营养制剂种类,并针对结核病重症患者营养评估及营养支持治疗的原则和标准、营养要素种类和给予方式、不同结核病重症类型、合并症及特殊人群的营养支持治疗等给出了推荐意见。

关键词: 结核, 重症监护, 营养评价, 营养支持, 治疗应用, 总结性报告(主题)

Abstract:

There is a two-way relationship between tuberculosis and nutritional status, they are related to each other. Tuberculosis can lead to the occurrence of nutritional risk, and is easy to develop nutritional related diseases, such as lack of nutrition, low immune function, electrolyte imbalance and so on. And poor nutritional status can lead to lymphocytic reduction, low cellular immunity and susceptibility to tuberculosis and other infectious diseases. Malnutrition is an independent risk factor affecting the prognosis and mortality of adult patients with severe tuberculosis. However, the relevant guidance documents on nutritional assessment and nutritional support treatment for patients with severe tuberculosis is still lacking. Therefore, combined with the experience and methods of nutritional support therapy in China and the latest guidelines for enteral and parenteral nutrition in the United States and Europe, the Eighth Medical Center of Chinese PLA General Hospital and the Editorial Board of Chinese Journal of Antituberculosis jointly organized experts to draw up Expert consensus on nutrition assessment and nutritional support treatment for patients with severe tuberculosis, in order to get standardized individual nutritional assessment and nutritional support treatment for patients with severe tuberculosis, and improve the prognosis and reduce mortality. This consensus expounds the importance of nutritional assessment and nutritional support treatment for patients with severe tuberculosis, the types of commonly used nutritional agents, and gives recommendations on the principles and standards of nutritional assessment and nutritional support treatment, the types and ways of giving nutrition, the types of severe tuberculosis, the complications and the nutritional support for special populations.

Key words: Tuberculosis, Intensive care, Nutrition assessment, Nutritional support, Therapeutic uses, Consensus development conferences as topic

中图分类号:

R52
R151

陈志, 梁建琴. 结核病重症患者营养评估及营养支持治疗专家共识[J]. 中国防痨杂志, 2022, 44(5): 421-432. doi: 10.19982/j.issn.1000-6621.20220041

CHEN Zhi, LIANG Jian-qin. Expert consensus on nutritional assessment and nutritional support treatment for patients with severe tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(5): 421-432. doi: 10.19982/j.issn.1000-6621.20220041

图/表 1

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证据	具体描述	表示方法
质量等级
高	非常确信真实的效应值接近效应估计值	A
中	对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大不相同的可能性	B
低	对效应估计值的确信程度有限:真实值可能与估计值大不相同	C
极低	对效应估计值几乎没有信心:真实值很可能与估计值大不相同	D
推荐强度
强	支持使用某项干预措施的强推荐,干预措施明显利大于弊	1
弱	支持使用某项干预措施的弱推荐,干预措施可能利大于弊	2
弱	反对使用某项干预措施的弱推荐,干预措施可能弊大于利或利弊关系不明确	2
强	反对使用某项干预措施的强推荐,明确显示干预措施弊大于利	1