摘要目的:脓毒症是一种由感染引起的危及生命的器官功能障碍，通常伴随高代谢状态。营养支持，特别是肠内营养（enteral nutrition，EN），在维持胃肠功能、调节免疫反应以及改善重症患者的预后方面起着至关重要的作用。脓毒症患者EN的最佳启动时机尚缺乏统一、明确的临床指导。方法:本研究为单中心、前瞻性、随机对照试验，连续纳入入住重症监护室（intensive care unit，ICU）的脓毒症患者。研究比较ICU入室后48 h内启动早期肠内营养（early enteral nutrition，EEN）与48 h后启动延迟肠内营养（delayed enteral nutrition，DEN）对患者临床结局的影响。主要结局指标为30 d病死率，次要结局指标包括ICU病死率、ICU住院天数、总住院天数、抗生素使用天数、机械通气时间、升压药使用时间、连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）时间及胃肠道耐受性。结果:共纳入68例患者，其中EEN组34例，DEN组34例。两组在30 d病死率方面差异无统计学意义（15% vs. 18%， P = 0.742）。然而，EEN组的总住院天数显著短于DEN组（16.00 d vs. 19.00 d， P= 0.024）。次要结局指标分析显示，两组在CRRT时间（ P= 0.790）、机械通气时间（ P = 0.669）、ICU病死率（ P= 0.283）、ICU住院天数（ P= 0.056）、抗生素使用天数（ P= 0.698）及升压药使用时间（ P= 0.093）方面差异均无统计学意义。EEN组腹胀发生率显著高于DEN组（26.5% vs. 5.8%， P= 0.045），但在其他胃肠道不良反应方面，包括腹泻、呕吐、胃残留量>250 mL及胃肠道出血，两组差异均无统计学意义（ P> 0.05）。此外，两组在能量及蛋白质摄入量、肌肉质量（以股四头肌厚度和膈肌厚度评估）以及炎症指标（IL-6水平）方面差异均无统计学意义（ P> 0.05）。 结论:与DEN相比，EEN未显著降低脓毒症患者30 d病死率，但可缩短住院时间。两组在能量和蛋白质摄入、胃肠道耐受性、肌肉质量及炎症反应等方面的临床结局相似。

abstractsObjective:Sepsis is a life-threatening organ dysfunction triggered by infection, frequently accompanied by a hypermetabolic state. Nutritional support, particularly enteral nutrition (EN), plays a crucial role in maintaining gastrointestinal function, modulating immune response, and improving prognosis in critically ill patients. However, clear clinical guidelines on the optimal timing of EN initiation in sepsis patients are currently lacking.Methods:This single-center, prospective, randomized controlled trial consecutively enrolled sepsis patients admitted to the Intensive Care Unit (ICU). Patients were randomized to receive early enteral nutrition (EEN), initiated within 48 hours of ICU admission, or delayed enteral nutrition (DEN), initiated after 48 hours. The primary outcome was 30-day mortality. Secondary outcomes included ICU mortality, ICU and total hospital length of stay, duration of antibiotic use, mechanical ventilation, vasopressor support, continuous renal replacement therapy (CRRT), and gastrointestinal tolerance.Results:A total of 68 patients were enrolled, with 34 in each group. No significant difference was observed in 30-day mortality between the EEN and DEN groups (15% vs. 18%, P= 0.742). However, the total hospital length of stay was significantly shorter in the EEN group than in the DEN group (16.00 days vs. 19.00 days, P= 0.024). Secondary outcomes, including duration of CRRT ( P= 0.790), mechanical ventilation ( P = 0.669), ICU mortality ( P = 0.283), ICU length of stay ( P = 0.056), days of antibiotic use ( P = 0.698), and duration of vasopressor use ( P = 0.093), showed no significant differences between the two groups. Abdominal distension was significantly more frequent in the EEN group (26.5% vs. 5.8%, P = 0.045), whereas no significant differences were found in other gastrointestinal adverse events, such as diarrhea, vomiting, gastric residual volume >250 mL, or gastrointestinal bleeding (all P > 0.05). Additionally, no significant differences were observed between the groups in terms of energy and protein intake, muscle mass (assessed by quadriceps femoris and diaphragm thickness), or inflammatory markers (IL-6 levels) (all P > 0.05). Conclusions:Compared with DEN, EEN did not significantly reduce 30-day mortality in sepsis patients but was associated with a shorter total hospital length of stay. The two groups demonstrated similar outcomes in energy and protein intake, gastrointestinal tolerance, muscle mass preservation, and inflammatory response.