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鼻饲器材的改进 二、恒温营养泵的应用 滴注时用恒温营养泵持续喂养,根据患者适应性调节输入速度,控制营养液温度37~40℃ 预防性护理程序在实施肠内营养支持中的应用研究 程序共分12个步骤,依次为:医嘱管饲→营养小组会评估→选择营养配方→选择置管途径及装置→选择输注方式→制订操作流程及处理预案→按医嘱输注营养液→床边监护、交接班→病人及家属宣教→营养指标监测及评估→营养支持进展问题,医师、护士、营养师后勤反馈,达到循环管理。 早期肠内营养(EEN) 是指术后24H内即给病人实施肠内营养,以期改善病人的营养状况,提高病人的免疫功能,减少术后并发症的发生,同时还有助于促进胃肠功能回复,减少肠内细菌和内毒素移位,防治SIRS和MODS。 理论基础:研究发现上消化道切除后的病人刚手术结束时小肠绝对静止,3.8H后出现不规则运动,16.4H后出现典型的胃肠运动复合波,43H后肠鸣音恢复。 早期肠内营养(EEN) 一项Meta分析纳入了6个RCT,研究24h内给予患者早期肠内营养(EEN)相对于24h后开始EN,对患者临床结局的影响 EEN可显著降低外科患者的死亡率 EN联用PN 相比于单一的PN或EN,两者的吸收方式不同,机体可通过多种方式摄取营养,尽早摆脱营养不良的状态。 一般应用于危重症患者,在危重症患者方面更能体现其优越性。 目前两者联用在外科临床中的价值还未得到完全的体现,还有待进一步研究。 肠内营养,护理是关键 EN不同于PN,PN的患者没有选择权,医生医嘱多少量,患者接受多少;而肠内营养患者有选择权,当不能耐受时可以拒绝,而为了提高患者的耐受力,增加用量,应推广现代,规范,正确的管饲技术和日常护理 Page 3 – Complications After survival the most relevant question is how many complications occur and how can they be reduced. Enteral nutrition was shown to be significantly better than parenteral nutrition in this important outcome parameter. When looking specifically at hyperglycaemia, the study by Koretz showed that this metabolic complication was significantly reduced by 30% in critically ill patients - an impressive number. The meta-analysis by Peter encompassed 24 studies. These studies reported numbers of patient experiencing infective complications (not further specified). As you can see from the forest plot, most of the blue dots are on the right side, meaning the result favours enteral nutrition. And this is also statistically shown in the overall result where the diamond is clearly on the right side; it is not touching the neutrality line and therefore represents a significant result. The extent of this risk reduction can also be seen in the forest plot: 8% less complications were developed in this group when compared with the parenteral group. In the analysis by Koretz where only critically ill patients were included the reduction of infective complications was 9% when enteral nutrition was used. In addition to the infective complications reported
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