2019冠状病毒病(COVID-19)危重型患者的营养支持治疗

营养支持治疗是2019冠状病毒病（COVID-19）危重型患者治疗过程中不可缺少的一部分。COVID-19危重型患者常处于高炎症、高应激、高分解代谢状态，机体能量消耗显著增加。所有COVID-19危重型患者需早期采用NRS-2002或Nutric评分工具进行营养风险筛查；若存在营养不良的风险，则进一步采用主观整体评估（SGA）或全球领导人营养不良倡议（GLIM）等工具进行营养不良的评估。评估完成之后，结合病情，首先确定患者每日所需的能量、蛋白质、电解质及液体量等，然后再根据患者胃肠道功能受损的程度，选择口服营养补充、肠内营养、肠外营养或两者联合的方式进行营养支持；对于胃肠道功能正常需俯卧位通气或接受体外膜肺氧合治疗的患者，建议首选肠内营养。此外，在患者营养实施过程中需密切监测腹胀、腹泻、反流、静脉炎及肝功能损害等不良反应，及时调整营养方案，保障营养支持的顺利实施。基于COVID-19危重型患者的代谢特点，本文从营养风险筛查和评估、营养治疗目标量、营养干预和治疗、特殊人群的营养支持、营养支持治疗常见的不良反应等方面进行总结和建议，以期充分发挥营养支持治疗的临床作用，为COVID-19危重型患者的个体化营养支持治疗提供参考。

Nutritional support for critically ill patients with COVID-19

Nutritional support is an indispensable part in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19). Critically ill COVID-19 patients are often in a state of high inflammation, high stress, high catabolism, and their energy consumption increases significantly. All critically ill patients with COVID-19 should be screened for nutritional risk with NRS-2002 or Nutric tool in the early stage. If there is a risk of malnutrition, subjective global assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) are further used for malnutrition assessment. After assessment, the daily energy, protein, electrolyte and liquid quantity needed by the patients should be determined according to the actual condition. Then, according to the degree of gastrointestinal function impairment in patients, the oral nutrition supplement, enteral nutrition, parenteral nutrition or their combination are selected for nutritional support. For patients with normal gastrointestinal function who require prone position ventilation or receive extracorporeal membrane oxygenation (ECMO) treatment, enteral nutrition is recommended as the first choice. In addition, in the process of nutrition implementation, it is necessary to closely monitor the adverse reactions such as abdominal distention, diarrhea, regurgitation, phlebitis and liver function damage, timely adjust the nutrition program to ensure the smooth implementation of nutritional support. Based on the metabolic characteristics of critically ill patients with COVID-19, this paper makes a summary and suggestion on the following perspectives such as nutritional risk screening and assessment, target amount of nutritional treatment, nutritional intervention and treatment, nutritional support of special populations, and common adverse reactions in nutritional support treatment, so as to provide reference for individualized nutritional support therapy of critically ill patients with COVID-19.