肠内营养支持治疗目标.ppt.pptVIP

肠内营养支持治疗目标---足量or滋养;肠内营养发展现状;华瑞;营养支持模式及理念的变迁;Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. J Burn Care Res. 2011 Jan-Feb;32(1):104-9 Early hypocaloric enteral nutritional supplementation in acute organophosphate poisoning--a prospective randomized trial Clin Toxicol (Phila). 2009 May;47(5):419-24. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials Intensive Care Med. 2009 ;35(12):2018-27. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial JAMA. 2008 Dec 17;300(23):2731-41. The impact of delaying enteral feeding on gastric emptying, plasma cholecystokinin, and peptide YY concentrations in critically ill patients. Crit Care Med. 2008 May;36(5):1469-74. ;Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials Intensive Care Med. 2009 ;35(12):2018-27. ;2008版CSPEN指南;;标准剂量的早期肠内营养可能会造成更严重的临床结果。;;;;早期足量喂养有害;早期足量PN;早期足量EN;适度营养支持;机体能量和蛋白质的贮备机制;肥胖悖论;;机体储备;;;重症患者常合并营养不良;;当今营养支持的功能分为：;关注指标;肠内营养研究热点;2013年加拿大危重症营养实践指南新增10条推荐意见;滋养的概念;;滋养的概念;Rice TW,Wheeler AP,Thompson BT,et al.Initial trophic vs full enteral feeding in patients with acute lung injury:the EDEN randomized trial.JAMA,2012,307:795-803;低热量营养支持可能有益;滋养;;;;主张 If the gut works, use it.;;大样本、多中心、随机对照研究;研究概况;快速达标组的喂养方案;前6天两组所给的能量有显著差异;持续低量组和快速达标组的临床结局无显著差异;两组的存活率和住院时间无显著差异;快速达标组：第2、3天胃肠不耐受增加;持续低量有助于血糖控制;持续低量有利于控制液体量;研究结论;2013年加拿大营养指南;近期国内文献研究;;结果：;结 论：;;近期国外文献;;;早期添加PN;;;早期肠外???养也是安全的;小结1;小结2;感谢聆听;Thank You !;滋养内容;滋养内容;早期肠内营养从短肽开始为什么不是从氨基酸开始？