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2. . . . . : . . : Clinical Nutrition, 2009; 28:359-479 3. ! (ESPEN) 2009 . , . , , . , , . , , , . , 2009 . , . , , , , , , , , , . . . 4. 4Clinical Nutrition 28 (2009) 359-364 : . a, , b, d , , , b , , Windeyer, .: +39 02 26410267, 329 7655385d.: +44 8451 555 0009011 ( ESPEN) () , . , . ESPEN . . , . (SIGN) . , - ( Ia) , , ( Ib) . II, IIb III : , , ; , - ; , , , , , . . / ( IV). 11 . 87 16 . . , , , ( ESPEN, , , ESPEN). - ESPEN , . , Clinical Nutrition. . , . 300 , . , 50%, , . . 2009 . . : dottfb@tin.it (. ), a.forbes@ucLac.uk, espenjournals@espen.org (. ), 5. Clinical Nutrition 28 (2009) 359-3641. . (). (, ) .1 . . , , .2 ( ESPEN), , , (), () , . , , .3 , ESPEN, , , , . , , , , . , . . , , (, , ) .5 , . , . , , , , . ESPEN ,4 , , .5 : ? ? ? ? ? - ? . , , , . , , . 7% 30%, , . , ESPEN 4 , , , . , , , , . , , . , , , 6. 6Clinical Nutrition 28 (2009) 359-364 - . , , , , . .6-8 , .2. 2005 . ESPEN . ESPEN. , parenteral (//), TPN (), nutritional support ( ), intravenous (//), HPN () , , , , . (Scopus, PubMed, Cochrane Library, Medline, EMBASE). ESPEN , : ,9,10 ,11,12 ,13,14 ,15 ,17-21 ,17-21 - 22, .23 , , , . , .24-26 27 .28 ( 1). () , , . - , ; , .29 , .30 . ( Ib) - ( Ia), . II, IIb III : , , 1 Ia- Ib , IIa , , IIb , - III , , , , , IV / BC 7. Clinical Nutrition 28 (2009) 359-3647 2 ESPEN /. . , . , . , . , . , . , . , . , . , . , . , ; , - ; , , , , , . . / ( IV). , . , . , , , , , . , , , , . , , , , . 11 , ( 2). 87 16 . , , . , , . , , , . - ESPEN , , , ESPEN ( ). - ESPEN , . , , , , . , Clinical Nutrition . , , . , , 300 , , 11 ( 2).3. , . , ESPEN. (ASPEN) ,17-21 , ,31-38 (, , ) . ESPEN ASPEN, 8. 8Clinical Nutrition 28 (2009) 359-364 2002 .21 , , . , .39 -, , .3.1. . ? , . , - 1980- ,40 , .41 20 , . ASPEN 1993 ., 16% (- , ), 29% ( II III), 55% .19 , ( , 15,8%; , 28,2%; , 56,0%). , . , , . - , . . ASPEN21 : , - , , , . , , . (, ) , , , .42 , ( ) . , : , (, ; , ); (, , n-3 . .); (, , . .) (, . .) (, , . .). , . 44,45 , , , , , . , , . , , , , (). , , , , - 9. Clinical Nutrition 28 (2009) 359-3649 3 , , , 46 ( ) , , , , , , . , . , , . 3 . , , ( ), . , , : ; ; / . , , . , , , , , , , , , . , , , . , 26 (~1000 ), , .47 , .48 , , ( ). . , , - Veteran Affairs,49 : 459 , , 97 (17%) , , , , . , . , 50 , , , 8 , , (43% 5% ). , .50 , , , , . , , - . , , , , . , .51 - , , , , . , , , !52 , - 10. 10Clinical Nutrition 28 (2009) 359-364 , . . , , , , , , .53 , / , , , , . , : , , , , ; , , , . , I. , , . , , . , . , . , , , , , . Van Way54 , , , . , , , ( 4).55 , 1983 .56 . , , , .413.2. , , 4 , , 55 : , . . : , , , , , . . : , , , , , , , . , - . D: , , , , , , , . , . : , . , . 11. Clinical Nutrition 28 (2009) 359-364 . , , , .2 , , , , , .57 , , , , , , . ,58 , , . , , , . , , , , , . 59 60 , , . . ESPEN . , , . , . , . , . , 11 , . , . Clinical Nutrition . , . 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( , ), , , , ( ), , . , , . . , , , . . - , . , . , , , , , , , , . . , , , ( ), , . 2009 . . 14. 14Clinical Nutrition 28 (2009) 359-364 : , (), ( , , ). , , , , ( ). ( ) , 850 /. , . .C1 : (), , (-), . : , , , . , , . (>3 ) , . . (), .B2 , , , . , , . ( -- ), - .C3 , ( ) , . . - . -, v. basilica v. brachialis .A4B4 , , . ( ). , , . / , , .C, B5 15. 15Clinical Nutrition 28 (2009) 359-364 : , - , . , , . , , ( ), ( ); - . B 6 , - : ( ) , ( ) , , , 2% , , , . : B6 () ( ) (b) , , ( , ).A7 ( ) , , () , (b) , () , , (d) ( ). .B8 ( ), , () - , (b) , () / (d) (, , ). , .B9 , . , ( ) , , 8 .C10 , .C11 , , , . : , - .B12 16. 16Clinical Nutrition 28 (2009) 359-364 , , .1. ? , (), ( , , ). , , , ( ). ( ) () , 850 /. , (). (). : , , . , , .1 : , 5 9; , 600 / (INS 2006) 500 /; , 10% 5%; , ; ; / ; ; >3 . ( ), , 800900 /, . , 30 .2 , , , 1100 / 10 .3 .4 -, , , 5, . , -, : , , , (r=0,95).6 , , . , ( ). 2025 3 5 Fr. (1) , , (2) . , , 6 ( ). , . , , , , . , , , , () 17. Clinical Nutrition 28 (2009) 359-364(b) .7 , (v. basilica v. brachialis) , . : ; ( , ); , ; ; ( ); , 5 9; ( / ).2. , ? : (), , (-). : , , , . , , , ( ). (>3 ) , . . , (), ( ). : , (. ., , ) , .17 , , () 2030 , ( , , , ). , 8 ( ). , : , , ( ). - , (v. basilica, v. brachialis, v. cephalica). 5060 . , , 20 .9 - ( 3 ) , , .8 - (), , , . , -, , . , - , , .9,10 ,11 , , , , ( ). (>3 ) () , ( , , , , , Lifecath, RedoTPN . .) 18. 18Clinical Nutrition 28 (2009) 359-364. , , , , , , . , . , , ( ). , , . - . b) 3. ? , , , ( ). , , ( ). ( - ), , , ( ). : , ( ) . ( ), ( ; ; - ; . .) . , .12 , ( ) , -, .13 , , / , . , , , , . , ( , . .). , (, ). , ( ). , , .14 , , ( ) , ( ; ).4. ? , , ( ) , . - 19. Clinical Nutrition 28 (2009) 359-364 ( ). - ( ). : -, . - , 1996 ., , , .15 2001 . , , - : , , .16 2002 . : , ; ( 1). -18 , , , .17 -, 2003 .,18 , , . , , , , , 2000 (~2200) 1000 .19 - , -19 , .20 , , , , - .21 ( ). , , , , , , . .22 -, v. basilica v. brachialis ( ). : - v. cephalica v. basilica v. basilica, v. brachialis v. cephalica . . , , ( ), 23-25: - . , ( ), . , ( ). , , , . , , , -, , . 20. 20Clinical Nutrition 28 (2009) 359-364 - , , . ( ) v. cephalica - . .26 (, ) . , .5. , , ? . ( ). , , ( ). / , , ( ). : (, , ). . , , , , - . , . ,27 , .28,29 , . , , , , , (, . .). ( 1 ) , 1224 . ) - 6. , , ? , - , . , , . , , ( ), ( ); - . , - : ( ) , ( ) , , , 21. Clinical Nutrition 28 (2009) 359-364 2% , , , . : : , . , . , , : . , . , , . . , ( ). Maki ., , / /, 21- .30 , ( ), , - , /, , / ( , , ). , , , - , , . , ( ). , , ( ). , , . . - . 32 , . 33 , (530 5 ), , 20 - , . , , , , 22. 22Clinical Nutrition 28 (2009) 359-364( ). , , . , , . , , - - , . - , () , (b) , , , () (). - , .10 , 2101 , , , - , .34 , . -, Turcotte .35, 48 , 1979 2004 ., , , . -, . , , , - , -.24 , - () , (b) , , () ( 9000) (d) , ( ).10 - , - , . - , , , , -, , - .11 , , , (, , , , ), (, , , ), ( ). , , , ( ). - ( ), - , ( ). - , . , , . , , ; ( ) 23. Clinical Nutrition 28 (2009) 359-364 ( ).13 , , , - , .36 , 988 , , - .37 .38 - , , , () , . - ,39 2000 ., , , . , - . , , , . , - .40 , , , , ( ). -, ( , ), , , 23 ( ).14 , . ( ), ( ) , , , ( , ), ( ) ( - ). , ( ). - - , . . .21 , , v. basislica . , .24,25 , ( ). , - , , ( ). . - , , . 24. 24Clinical Nutrition 28 (2009) 359-364 , - , ( ). , . , , , . , , , , - .41,42 , 108 , Pronovost .43 , ( ; ; ; ; , ) ( 66%) - . , , , , - , ( ). - .8,44 : . , , , 15 , . . , , .8 , , . . , ( , , ) : (1) + ; (2) + ( ). - 2% 70% . ( ). , , ( ).45 , , (, , ) . , - ( ). ; , , ( ). , , . , 7 ( ). , ( ). ( ). , , . , . , , 25. Clinical Nutrition 28 (2009) 359-364 , 7 , ( ). , , , , ( ). , , - . , (Biopatch) ( ).46-48 , , , ( ). . , , . , , , , . , , ( ). ( ). ( ), Statlock Biopatch . 1 . - , . . 2% 70% ( ). / . . 25 . , .49 , , , . , ( ). 70% 2%, ( ). 24 , , 72 , ( ). - , ( ). , , . , , . ( ); ( ). - . - , . ( ). , - . - , , , 26. 26Clinical Nutrition 28 (2009) 359-364 . - , , , . , , . ( ). , ( ).50-52 , . , , - , ( ). , , . ( ). , , . / , / - (, , , . .) , , - . ) - .7. ? () ( ) (b) , , ( , ) ( ). : - , , 2001 . ( 1). 53, - ( ); ( ). , - , : , . - ( ).54, 558. ? , , () , (b) , () , , (d) ( ) ( ). . : , , , ( ). , ( ). , , , ( ). 27. Clinical Nutrition 28 (2009) 359-36427 1 , . , . , , . , , . ACS 2008 . . 2008. http://www.facs.org/fellows_info/statements/st-60.html AVA 2008 . . 2008. www.avainfo.org ASPEN 2002 : . JPEN 2002, 26 (n 1, ): 36SA37SA ASPEN 2004 : . JPEN 2004, 8, n 6: S40-S70 AUSPEN 2008 Gillanders L., Angstmann K, Ball P .: . Nutrition 2008, 24: 998-1012. BCSH 2006 : . 2006 ., , 100 , . www.evanetwork.info CDC 2002 : - . MMWR 2002; 51 (No. RR-10): 1-32. www.evanetwork.info EPIC 2007 Pratt RJ, Pellowe CM, Wilson JA .: EPIC2: , , . Journal of Hospital Infection (2007) 65S, S1-S64. www.evanetwork.info GAVeCeLT 2007 Campisi C, Biffi Rm Pittiruti M GAVeCeLT: , . . JAVA 2007, 12 (No 1): 38-46. www.evanetwork.info IDSA 2001 Mermel LA, Farr BM, Sheretz RJ . - . Clinical Infectious Diseases 2001; 32:1249-72. www.evanetwork.info INS 2006 : . Journal of Infusion Nursing, vol. 29 ( 1): S1-S92. NICE 2002 : . 2002. , 11 , . www.nice.org.uk www.evanetwork.info RCN 2005 : . 2005. , 20 , . www.rcn.org.uk www.evanetwork.info RNAO : : . 2004. . 111 , 1100, , (). www.rnao.org/bestpractices www.evanetwork.info SINPE 2002 SINPE . RINPE 2002, 20 (suppl. 5): S21-S22, S29-S33 SHEA/IDSA 2008 SHEA/IDSA: , , . Infect Control Hosp Epidemiol 2008; 29: S22-S30. , - , Staphylococcus aureus, (), ( ), .56 , , . , - - , , , , , ( ). - (), ( ). 28. 28Clinical Nutrition 28 (2009) 359-3649. - ?10. , , ? , , () , (b) , () , / (d) (, , ). , ( ). , , ( ). ( ) , , 8 , ( ).: ( ) , , ( ).57 ( ). , , - , S. aueus, - , 58 ( ). - 710 ( ). , , , , ( ). , , , 510 ( ). ) , : - , , , , .59-61 , , . , , , . , , . , , , , . , ( 50% )35< 60 353040, , < 60 30 , //. , //. ESPEN: . NKF: . EBPG-ERA: . : . : . () . NKF, ESPEN EDTA 5 ( ). 6 ( ). , , : (1 /.), (1020 /.) (3060 /.) ( , 13, 66). D , . . (15 /.) (5070 /.) . : - , / .64 0,65 //. , 0,83 //. (97,5 ).64 , , 0,91,0 //.65,66 6. , , /.8001000, /.20002500, /.1,82,5, 1000 + NKF,45 ESPEN21 EDTA67 , 1,11,4 //. 1015 //. 1013 1 , , , . , , .63 , , , , 3040 //., 2224 //., , . , , . , , . , ( 0,51,5 /.), 15 .63 - 800 .68 (22) , , ? , , . 88. 88Clinical Nutrition 28 (2009) 359-364: , , 30%.69,70 , , . .71-74 , . , , .75,76 . , - , , .77,78 , , , , .79,80 (23) , ? , , ( ). , , , : 20 /2, 10% 6 , 35 / 300 / ( ). , , ( ). , ( ). : 8001200 , 3060 .81 .82,83 ( ) , .84-87 , 182 , , , .88 , , . 78 //. 0,30,4 //. . . 1, , 0,8 //. 20 //., , .81 .1 , , , , , - . , . (24) , ? , , , . , , , , , . (25) , ? , , . , ( ) ( ). . : , 89. 89Clinical Nutrition 28 (2009) 359-364 10% 6 . 12 /).C , , . , , .C1,7 , , . 37 , ( ), , , 57 . . . , , . , () , , . , , (, , , ).A1,8 . , , . ( 24-48 ).B B1,9 1,10 , , . . 25 //., 30 //. 1520 //. , .B1,12B1,12 , , , . . , , .C2,11,6CAB 123. Clinical Nutrition 28 (2009) 359-364: , , , , .14 ,15 , .16 , , , .16 , , 0,20,24 //. ( , 1,21,5 //.). 0,140,2 , . . , , .17,18 1.3. ? , ( Ala-Gln >0,30 /) ( ). : , . (, ; ; - ).19 , Ala-Gln, (), .20,21 , 82 , , , (N=40), , (N=42).22-24 , 4,8%. , -. .25 , , 123( =0,68; 95% 0,451,09; =0,11) , . , , , . , Xian-Li .,26 3 (25,3, 28,6 .), , , Ockenga .,22 4 . , Sahin .27, , , , 0,3 /, (10%, 40% ). , , , Fuertes-Orozno .28 Xue .29. . -, , , , , 0,20 //. L- (> 0,30 //. Ala-Gln).20 (, , , ). 1.4. ? . : , . , , ( ). , , ( ). ( ). : , , , , , 124. 124Clinical Nutrition 28 (2009) 359-364 . , , , , 47 // (56 //.). , , , , , . , . , , 30 ( ), , . 50% 70% ( ). ( ).31,32 1.5. - ? . : ( ) . Martinez .33 , . , . , - . 1.6. ? . , - (). , 12 /, , (). , ( 0,8 1,5 //.), , (>72 ) (>12 /) ().: , , . , .34 , . , , , , . : 1238% , , () .35 ,36-38 / .39,40 12 /) (). 1.11. ? . : , . , . , . . . , (), . , .72 . 1.12. ? , , . (). 129. Clinical Nutrition 28 (2009) 359-36425 //., 30 //. 15-20 //. , (). : , , , , . , , , , .97 , , , . , - .98 , . , . . . . -.89 , , , .99,100 , , , , . , . , . , , . : , , . , ( 4,4 6,1 /) , , 129 ( ), .101,102 .103,104 , .105 , , . , , , . , , , . , , .792. () 2.1. ? , , , . . , , (). : 80% , , (). 1015% . 5% (). , . , , , . , (). , - , . , - 130. 130Clinical Nutrition 28 (2009) 359-364 , .1 2.2. ? - . - , 1% ().1 , , . ESPEN (espenjournals@espen.org). 1. eier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, M MacFie J. ESPEN guidelines on enteral nutrition. Clin Nutr 2006;25(2):27584. 2. insler MC, Hall C, London NJM, Neoptolemus JP. W Relationship of diagnostic serum amylase to aetiology and prognosis in acute pancreatitis. Gut 1992;33:9826. 3. radley EL. Indication for surgery in necrotizing pancreatitis: B a millennium review. J Pancrea