CRRT时如何实施营养支持治疗？技术总结.ppt

配方 CRRT时维生素的流失 水溶性维生素可经CRRT清除，目前还不知道丢失的程度和确切的需要量 水溶性维生素如：vit C, vit B1在CRRT治疗中被部分清除；脂溶性维生素与转运蛋白或血浆脂蛋白结合而不被清除 Vit C丢失:100mg/d 　 叶酸丢失:265 mg/d 　 微量元素（trace elements） 微量元素是必需营养物质，具有调控、免疫和抗氧化的作用； 代谢后是各种酶的重要组成部分和调控因子(谷胱甘肽过氧化物酶 and超氧化物歧化酶) 锌，铜，铬，特别是硒均可经CRRT清除 内容 CRRT时营养策略 时机：基础病情+自身状态：循环？应激？　 途径：肠内，肠外，并取 营养素：个体化 This study found that a metabolic cart can improve the accuracy of energy provision and that a protein intake of 2.5 g · kg?1 · d?1 in these patients increases the likelihood of achieving a positive nitrogen balance and improving survival. Enteral feeding is preferable, but if this is not possible or does not achieve the target, then it should be supplemented by parenteral feeding. Conclusions Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend patients receive standard enteral formulations with standard ICU recommendations for energy and protein and to use specialty renal formulas in those patients demonstrating significant electrolyte abnormalities. recommend that patients undergoing renal replacement therapy should receive increased protein intake and avoid protein restriction as a means to delay initiation of dialysis. As with all critically ill patients, enteral nutrition (EN) is preferred over parenteral nutrition (PN) for the patient with AKI without contraindications to EN. 危重病人能量补充原则 合理的热量：有效营养支持的保障 能量需求：注意不同疾病状态、时期以及不同个体　 营养供给时应考虑到机体的器官功能、代谢状态及其对补充营养底物的代谢、利用能力 应激早期，能量供给：20~25kcal/kg/day，即所谓“允许性”低热卡 病情稳定后能量补充需要适当增加 CRRT病人能量的补充 长时间CRRT体外循环可导致热量丢失 体温下降可以减少高热导致的能量消耗、稳定循环、减少蛋白质分解 目前很多超滤机可以按要求加热 专家建议CRRT时能量供给 25~30kcal/kg/day Maursetter L, Kight CE, Mennig J, Hofmann RM. Nutr Clin Pract. 2011 Aug;26(4):382-90. Wooley JA,etall.Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy. Nutr Clin Prac