Icu危重患者经肠外营养治疗及肠内营养支持对肝功功能及微量元素变化.docVIP

Icu危重患者经肠外营养治疗及肠内营养支持对肝功功能及微量元素变化【摘要】：目的营养支持对危重患者提高免疫功能和高分解、高代谢、微量元素相对缺乏的患者是十分重要的。早期给予全肠外营养（TPN）和肠外营养（PN）与肠内营养（EN）对ICU危重患中降低应激状态下机体的分解代谢反应，改善机体重要脏器及白蛋白水平和免疫功能，降低并发症发生。方法：对我院2009年12月-2010年12月ICU36例危重患者（GCS评分≥3）在入院48小时后，所有患者经锁骨下途径留置中心静脉导管，并进行X线检查确定导管位置，给予全肠外营养支持治疗5-10天为一疗程，经治疗后患者病情稳定，消化道情况基本稳定或无异常，可逐渐度过到肠外营养（PN）+肠内营养（EN）。肠内营养途径均为鼻胃管或鼻空肠等。TPN平均氮的摄入量为0.15-0.2g.kg-1d-1，非蛋白热量83.6-104.6 kg-1d-1，其中葡萄糖供能65%-70%，脂肪供能占25%-30%，加入适量的微量元素及维生素和离子，对于血糖高的患者给予胰岛素16-36单位不等。结果：给予ICU危重患者早期TPN+PN+EN营养支持可提高其患者的抗病能力，患者明显精神好转病情稳定，对肝功功能恢复及免疫功能提高十分重要。患者的IgA、IgG、IgM水平及血清白蛋白水平（P＜0.01），保持在正常水平及各种营养指标无显著的差异。 【关键词】危重患者;肠外营养;肠内营养;肝功能;微量元素 Parenteral nutrition in critically ill patients after treatment with enteral nutritionOn changes in liver function and trace elements WangFengying Yin Hiumei Dong Ping 【Abstract】Objective：It’s very important that Nutritional supporting improve immune function and high decomposition, high metabolic, trace elements for critically ill patients. Early gives full parenteral nutrition (TPN)、 parenteral nutrition (PN) and enteral nutrition (EN) in the ICU critical in dicates reduce stress state of the body, improve the body of catabolic reactions vital organs and albumin levels and immune function, reducing complications.Methods: In our December 2009-2010 in December ICU36 cases in critical patients (GCS score p 3) in hospital after 48 hours, All of the patients the subclavian way lien central venous catheter and X-ray examination to determine the position, Give full parenteral nutrition support treatment 5-10 days for one period of treatment, After treatment in patients with stable condition, digestive conditions basically stable or no abnormalities, But gradually spent to parenteral nutrition (PN) + enteral nutrition (EN).Enteral nutrition approaches are nasal gastric tube or nasal jejunum, etc. TPN average nitrogen intake.15-0.2 g.k g-1d-1, nonprote in 104.6 kg - heat suitable -1d -1, including glucose powering 65 percent to 70 percent, adipose offer can 2