危重病患者的临床营养支持.ppt

肠外营养配方 小 结 使用NRS2002(ESPEN明确推荐)作为筛查是否存在营养风险的工具(A级) 有营养风险的住院患者才有临床营养(PN或EN)支持的适应证;住院患者按照NRS2002(ESPEN)评分≥3者即有营养风险,需要进行营养支持 连续5～10d无法从经口摄食达到营养需要量的重症患者,应当给予营养支持(A级) 有营养风险的有部分肠功能的腹部创伤/手术患者考虑首选EN支持(A级) 小 结 营养支持绝非急诊处理措施,应该在患者生命体征稳定后才进行 * * 1.中链脂肪酸是肝脏优秀的能量底物，能够快速进入肝细胞线粒体形成酮体。酮体可以很容易地被身体大部分组织，包括肠粘膜，所氧化，酮体是许多组织有效的能源。对于乳粒颗粒和内源脂蛋白之间相互作用的体外和体内研究表明，中/长链甘油三脂对低密度（LDL）和高密度脂蛋白（HDL）的组成改变的影响较小，这对长期胃肠外营养的患者是一大优点。 Mortality CONCLUSION: The use of EN as opposed to PN results in an important decrease in the incidence of infectious complications in the critically ill and may be less costly. EN should be the first choice for nutritional support in the critically ill. Data Sources.—Computerized search of published research on MEDLINE from 1980 to 1998, personal files, and review of relevant reference lists. Study Selection.—We reviewed 210 titles, abstracts, and papers. Primarystudies were included if they were randomized clinical trials of critically ill or surgical patients that evaluated the effect of TPN (compared with standard care) on complication and mortality rates. We excluded studies comparing TPN with enteral nutrition Data Synthesis.—There were 26 randomized trials of 2211 patients comparing the use of TPN with standard care (usual oral diet plus intravenous dextrose) in surgical and critically ill patients. Conclusions: Total parenteral nutrition does not influence the overall mortality rate of surgical or critically ill patients. It may reduce the complication rate, especially in malnourished patients, but study results are influenced by patient population, use of lipids, methodological quality, and year of publication. Mortality and infection Conclusions: In critically ill patients who have an intact gastrointestinal tract, starting PN at the same time as EN provides no benefit in clinical outcomes over EN alone. More research is needed to determine the effects of combination EN + PN on clinical outcomes in critically ill patients who are poorly intolerant to E