营养支持治疗解析.pptVIP

确定蛋白质需要量 1g氮=6.25g 蛋白质 正常蛋白质需要量 ? 1.0-1.5 g/kg/d 有应激因素时，×系数 所需能量（kcal/150）=所需含氮量，或 6.25 ×（kcal/150)=所需蛋白质量 供给的能量中糖脂之比为1：1 糖的供给量：4 mg/Kg/min; 6 g/Kg/d 脂的供给量：1.0-1.5 g/Kg/d 确定糖和脂肪的需要量 供给的能量中糖脂之比为1：1 糖的供给量：4 mg/Kg/min; 6 g/Kg/d 脂的供给量：1.0-1.5 g/Kg/d 确定糖和脂肪的需要量 营养性高碳酸血症-肺部疾病营养支持时 最主要的代谢并发症1 高脂配方可降低机械通气病人 的呼吸商,避免高碳酸血症的发生 徐甲芬等.肺病专用低糖类营养配方对呼吸衰竭病人的影响肠外与肠内营养,2004;11:4:202-204 决定经肠道还是肠道外营养 尽可能经肠道内营养 即使经肠道营养不能满足能量所需，尽可能经肠道补充部分营养 经肠外补充不足量 Canadian Clinical Practice Guidelines for Nutrition Support in Mechanically Ventilated, Critically Ill Adult patients Journal of Parenteral and Enteral Nutrition 2003, 27: 355-373 Clinical trials were assigned “level 1” if randomization was concealed, outcome adjudication was blinded, and an intention-to-treat analysis was performed. Trials were assigned “level 2” if any 1 of the above characteristics was unfulfilled. For each intervention that had 2 similar studies to estimate the common risk ratios and associated 95% confidence intervals (CIs) for death and infectious complications. The common risk ratios and their CIs were estimated using the random effects model of DerSimonian and Laird as implemented in Revman 4.1. We considered p0.25 to be supportive of a trend and p0.05 to be statistically significant. Language of summary recommendations Conditions Language of recommendation If there were no reservations “Strongly recommended” about endorsing an intervention If evidence was supportive but “Recommended” there were minor uncertainties about the safety, feasibility, or costs of the intervention If the supportive evidence was “Should be considered” weak and/or there were major uncertainties about the safety, feasibility, or costs of the intervention If there was either inadequate or No recommendation ,ie, conflicting evidence