如何合理实施肠外营养支持-吴国豪幻灯片.ppt

如何合理实施临床营养支持How to Implement Rational Clinical Nutrition Therapy  吴国豪 复旦大学附属中山医院普外科 复旦大学普通外科研究所 Prevalence of malnutritionThe German hospital malnutrition study 癌性恶病质的发生率 Malnutrition is common in cancer patients Malnutrition occurs in 30-87% of cancer patients Shills ME;et al: Cancer Res 1977; 37: 2366 Nixon DW et al: Am J Med1980; 68: 683 Tchekmedyian NS et al: Oncology 1995; 9: 79 Andreyev et al:Eur J Cancer 1998;34:503 Monitto CL et al: Am J Physiol 2001; 281: E289 Stephens NA et al: Medicine 2007;36:(2):78-81 Cumulative Mortality: Protein-Energy Malnutrition Malnutrition Is Associated with Increased Complications Numerous studies have demonstrated complications of malnourished patients to be 2-20 times greater than those of well nourished patients. Malnutrition Is Associated with Increased Complications 42% of patients with severe malnutrition experience major complications 9% of patients with moderate malnutrition experience major complications Severely malnourished patients are four times as likely to have post-operative complications as well-nourished patients Clinical Outcomes of malnutrition Clinical Outcomes of malnutrition Clinical Outcomes of malnutrition Clinical Outcomes of malnutrition Clinical Outcomes of malnutrition 营养支持对营养状态的影响 Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes Nutritional Therapy Affects Outcomes 问题二:那些病人需要营养支持? Which patients should we feed? which patients can safely be left to resume feeding themselves? 14 days’ starvation - dangerous depletion of lean body mass mortality rises in ICU patients with a second week of severe under-feeding 5 days without feed increases infections but not mortality one view is therefore that 5-7 days is the limit Which patients should we feed? all malnourished patients all