外科营养6.pptVIP

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2017-09-06 发布于广东
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外科营养6.ppt

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* Recently, the use of peripherally-inserted central catheters has increased. These catheters are inserted in the cephalic or basilic vein and threaded into the superior vena cava. The catheter can be used alone (as shown in the slide) or with an implanted infusion port. Garanowski L. J Intraven Nurs 1993;16:167-194 * Parenteral nutrition complications are classified as catheter-related, metabolic, or gastrointestinal. Clinicians responsible for parenteral nutrition should be aware of these complications and know how to prevent and treat them. Ryan JA. Complications of total parenteral nutrition. In: Fischer JE, ed. Total Parenteral Nutrition. Little, Brown and Company; 1976;55-100. * Mechanical complications include poor catheter placement, phlebitis, thrombosis, catheter occlusion, rupture, or embolus. Ryan JA. Complications of total parenteral nutrition. In: Fischer JE, ed. Total Parenteral Nutrition. Little, Brown and Company; 1976; 55-100. ASPEN Board of Directors. JPEN 2002;26 Suppl 1:37SA. * * * Infectious complications include problems at the catheter insertion site, in the tunnel or subcutaneous reservoir, and bacterial colonization of the catheter. For a complete review of this subject, see Chapter 19 of the Program Manual. Kemp L, et al. JPEN 1994;18(1):71-74Reed CR. Intensive Care Med 1995;21:177-183 * * 多项2级临床研究表明：与延迟肠内营养比较，早期肠内营养能明显降低死亡率和感染率。 * * * * * * 这是一个只使用葡萄糖和氨基酸作为营养支持的病人，其皮肤大面积脱落。之后，给其肠外营养中增加了脂肪乳 * Parenteral nutrition solutions containing lipids are associated with less hyperglycemia, lower serum insulin concentrations, and less risk of liver injury. High doses can interfere with immune functions and high infusion rates can affect respiratory functions. Lipid emulsions should be used according to appropriate guidelines and should be carefully monitored in patients with hyperlipidemia, symptomatic atherosclerosis, or acute pancreatitis with hypertriglyceridemia. * ω-3脂肪酸与ω-6脂肪酸有不同来源及功能： ω-6脂肪酸不仅为机体提供能量供应而且ω-6脂肪酸与ω-3脂肪酸的代谢产物在机体炎症反应中起到重