急诊危重症监护__培训课件.pptVIP

高分解代谢 蛋白合成减少 分解增加 显著负氮平衡 急性体重丢失 营养不良 免疫应答下降 组织愈合减慢 呼吸肌肉萎缩 细胞代谢障碍 MODS 病情迁延 ICU内滞留 危重病人的高分解反应 对危重症实施营养支持必要性 危重症患者存在营养代谢改变 这些改变导致不良转归 对危重症患者进行恰当的营养支持改善转归 作用与目标： 改善病人的营养状态 维持细胞的代谢和组织器官的结构与功能 调节重症病人的代谢与免疫状态 调控神经内分泌等功能 降低 医院获得性感染，降低病死率 缩短住ICU时间 中国PCI指南2012版推荐 更多摄入含有不饱和脂肪酸的食物，如w-3脂肪酸 不饱和脂肪酸： 使胆固醇酯化，降低血中胆固醇和甘油三酯 降低血液粘稠度，改善血液微循环。 抑制血小板聚集 营养支持时机选择 危重病患者，营养支持只有在生命体征稳定（血流动力学、呼吸功能稳定包括药物、呼吸机等治疗措施控制下）的情况下才能进行。 早期营养支持有助于改善危重病患者的结局。在生命体征稳定的前提下，危重病患者应在入ICU后24-72小时开始营养支持。 预计3天不能恢复正常口服饮食的病人都要接受肠内营养支持 快速床旁生化检测POCT 迅速评估电解质紊乱 快速监测血糖 酸碱平衡状况 辅助重症病人“滴定式”精确治疗 PiCCO technology is a complete haemodynamic monitoring system based on the transpulmonary thermodilution technique. An indicator (cold) is injected into the circulation and the course of its concentration downstream is recorded. In the case of PiCCO technology, this means central venous injection of a cold bolus and detection of the temperature course in a peripheral large artery (femoral, axillary, brachial) through a special thermodilution catheter. The second component of PiCCO technology is pulse contour analysis, which is calibrated from the results of the thermodilution measurement and delivers continuous haemodynamic parameters in contrast to intermittent thermodilution. This is a diagram of the pathway followed by the indicator following injection: following central venous injection, first through the right heart (atrium and ventricle), then through the lung, then through the left heart (atrium and ventricle) and the aorta as far as the detection site (location of the thermodilution catheter). The individual cardiac chambers and the lung with the extravascular lung water are thus mixing chambers in which the cold bolus is distributed. Important conclusions about the level of the CO can be drawn from the shape of the thermodilution curve. The area under the thermodilution curve is inversely proportional to the CO, i.e. when the CO is high, the area is small and vice versa. When the CO is high, the co