临床营养支持存在的一些问题与争议

The present situation and controversial issues of nutrition support in clinic

科学、合理的营养支持对改善患者的临床结局具有重要意义。本文结合国内营养风险与营养不良的调研结果、临床营养药物的发展与使用现状等,论述营养药物在临床实践中存在应用不足与过度滥用并存、肠外肠内药品应用比例亟待改进等问题。同时提出四个在营养支持研究中颇具争议的问题并深入探讨,包括谷氨酰胺和ω-3脂肪酸在危重患者中的应用,危重患者肠外营养干预时机的选择,以及产品化与个体化肠外营养混合液的比较。旨在引起临床相关人员对营养药物合理、规范应用的重视,继续探索我国营养支持的循证医学证据。

Patients will beneift from scientiifc and reasonable nutrition support in clinical practices. This article focus on the problems in nutrition practices by reviewing the research results of nutritional risk and malnutrition, the development and present application of nutrition drugs and so on. Meanwhile, advance of the study on four controversial issues of nutrition support was also introduced, including the application of glutamine and omega-3 polyunsaturated fatty acids supplement in critically ill patients, timing of parenteral nutrition in critically ill patients, and comparison of standardized versus custom parenteral nutrition. Clinicians should devote more attention to rational and standard administration of nutrition drugs, as well as provide more evidences in nutrition support.