儿科体外膜肺氧合患儿营养支持的最佳证据总结

Best evidence summary on nutritional support in pediatric patients with extracorporeal membrane oxygenation

目的系统检索并总结儿科行体外膜肺氧合患儿营养支持的最佳证据。方法检索国内外各循证指南网站、急危重症协会、营养协会网站和数据库发布的关于儿科体外膜肺氧合治疗营养支持的文献,检索时限为建库至2022年12月31日。对纳入文献进行质量评价和证据等级评定后,对证据进行归纳和总结。结果共纳入10篇文献,其中指南3篇,系统评价1篇,专家共识4篇,队列研究2篇,总结出包含营养团队的构建、营养筛查和评估、营养需求量的计算、营养支持途径的选择、开始营养支持的时机、喂养不耐受的监测与管理6个主题,共24条最佳证据。结论临床医护人员应成立专门营养团队,为体外膜肺氧合患儿及时进行营养筛查,准确计算营养需求量,选择最佳营养支持途径和时机,密切监测喂养不耐受情况,提高患儿救治成功率。

Objective To systematically search for and summarize the best evidence on nutritional support in pediatric extracorporeal membrane oxygenation(ECMO)patients.Methods Literature on nutritional support for pediatric ECMO published by various evidence-based guideline websites,critical care associations,nutrition associations websites and databases both domestically and internationally.The search period was from the establishment of the database to December 31,2022.After quality evaluation and evidence level assessment of the included literature,the evidence was concluded and summarized.Results A total of 10 articles were included,including 3 guidelines,1 systematic review,4 expert consensus,and 2 cohort studies.There were 6 topics,including construction of nutrition team,nutrition screening and assessment,calculation of nutrition requirement,selection of nutrition support pathway,timing of starting nutrition support,and monitoring and management of feeding intolerance,with a total of 24 best evidences.Conclusion Clinical medical staff should establish a special nutrition team for pediatric ECMO patients to carry out nutrition screening in time,accurately calculate nutrition requirements,select the best path and timing of nutrition support,and closely monitor feeding intolerance,so as to improve the success rate of treatment of children.