Expert consensus on enteral nutrition treatment for burned children (2025 edition)
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摘要: 烧伤会显著增加机体能量消耗,及时有效的营养支持对于烧伤治疗至关重要。儿童烧伤后的代谢反应与成人存在较大差异,在营养支持治疗方面也存在不同。中华医学会烧伤外科学分会小儿烧伤学组、中国女医师协会烧创伤专业委员会、北京人体损伤修复研究会儿童烧伤整形专业委员会组织专家通过文献查阅、问卷调查、证据筛选等环节,深入讨论后,在营养筛查、能量测算、营养时机和营养方式等方面达成了关于烧伤儿童肠内营养治疗的共识,以期为临床实践提供参考标准。Abstract: Burns lead to a substantial increase in energy expenditure of body, making timely and effective nutritional support essential for burn management. The metabolic responses to burns in children are significantly different from those in adults, necessitating distinct approaches for nutritional support and treatment. Through processes including literature review, questionnaire survey, and evidence screening, the experts from Pediatric Burn Study Group of Chinese Burn Association, Burn Trauma Professional Committee of Chinese Medical Women's Association, and Pediatric Burn and Plastic Surgery Professional Committee of Beijing Research Society for Human Body Injury Repair conducted in-depth discussions and reached a consensus on enteral nutrition treatment for burned children in terms of nutritional screening, energy calculation, nutritional timing, and nutritional modalities, hoping to provide reference standards for clinical practice.
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Key words:
- Burns /
- Child /
- Nutritional treatment /
- Enteral nutrition /
- Expert consensus
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参考文献
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图 1 烧伤儿童肠内营养流程图
注：营养风险筛查采用营养状态和生长发育风险筛查工具；能量消耗测算采用Curreri公式（儿童版）；<1岁患儿存在母乳禁忌证或母乳不足时,可选用强化铁配方奶；对口饲肠内营养进行能量摄入测算时,母乳能量密度按照每100毫升供能约300 kJ计算,配方奶及多聚膳食能量根据具体配方而定
Table 1. 2001版牛津大学循证医学中心证据等级标准
证据等级 具体描述 1a 同质RCT系统评价 1b 单个RCT（窄可信区间） 1c 全或无的病例报告,如传统治疗全部无效,系列病例报告全部死亡或存活 2a 同质队列研究的系统评价 2b 单个队列研究（包括低质量RCT,如随访率<80%的RCT） 2c 结果研究、生态学研究 3a 同质病例对照研究的系统评价 3b 单个病例对照研究 4 病例系列研究（包括低质量队列研究和病例对照研究） 5 基于经验,未经严格论证的专家意见 注：RCT为随机对照试验 
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Table 2. 营养状态和生长发育风险筛查工具的具体内容
评估项目 评估内容 分值（分） 无 有 主观临床评估 患儿是否营养不佳,包括肌肉和/或皮下脂肪减少和/或脸型消瘦 0 1 高营养风险疾病 患儿是否存在潜在的能引起营养不良的疾病,或者需要进行大手术。如,患儿存在神经性厌食、烧伤、支气管肺炎致呼吸困难、乳糜泻、囊性纤维化、早产或成熟障碍、慢性心脏病、传染病、炎症性肠病、癌症、慢性肝病、慢性肾病、胰腺炎、短肠综合征、肌肉疾病、代谢性疾病、创伤、精神障碍/发育迟缓等 0 2 营养摄入与丢失情况 是否存在以下情况中的1种：（1）最近几天,大便次数≥5次/d或呕吐次数≥3次/d；（2）入院前摄入减少；（3）入院前已进行营养干预；（4）因为疼痛缺乏足够的摄入 0 1 体重减轻或增加困难 在近几周/月内体重下降或1岁以下儿童体重增加缓慢 0 1 注：该表译自参考文献[19]；总分为0表示营养不良低风险,1~3分表示营养不良中等风险,4~5分表示营养不良高风险
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Table 3. Curreri公式（儿童版）
年龄（岁） 计算方法 <1 基础能量+15×烧伤总面积 1~3 基础能量+25×烧伤总面积 4~15 基础能量+40×烧伤总面积 注：该表译自参考文献[24]；能量单位为kcal,1 kcal=4 184 J；基础能量估算如下,患儿年龄≤6个月为110~120 kcal·kg-1·d-1,7~12个月为95~100 kcal·kg-1·d-1,>1岁且≤3岁为90~100 kcal·kg-1·d-1,4~6岁为80~90 kcal·kg-1·d-1,7~12岁为70~85 kcal·kg-1·d-1,13~14岁为44~55 kcal·kg-1·d-1,15岁（接近成人）为50~60 kcal·kg-1·d-1
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