临床药物手册( 英文原版)16.pdf

Nutrition Support 6 Fred Shatsky Nutrition status is a major determinant of patients’ morbidity and mortality. Mor- bidity increases with malnutrition, as manifested by depressed immunocompe- tence and impaired wound healing.1 Conditions that indicate a possible need for nutrition support are inadequate oral nutrition for longer than 7 days, recent body weight loss 10%, an illness lasting longer than 3 weeks, recent major surgery, a 3 lymphocyte count 1.2 × 10 / L, serum albumin 3 g/dL, serum transferrin 150 mg/dL, and serum prealbumin 15 mg/dL. Sepsis, trauma, and other factors that induce hypermetabolism might intensify the need. The term “nutrition support” can be applied to any nutrition regimen that is provided for conditions that preclude the use of regular foods. There are two broad categories of nutrition support, enteral and parenteral, determined by their route of administration. Enteral nutrition applies to regimens provided via any portion of the GI tract. Parenteral nutrition (PN), although implying all routes other than the GI tract, refers primarily to regimens that are provided directly by the intravenous route of administration. Less frequently used modes of PN such as intradialytic parenteral nutrition and intraperitoneal nutrition are not discussed in this chapter. Whenever possible, maintenance rather than repletion should be the primary objective of nutrition support. Early provision of nutrition requirements without exceeding energy balance promotes the synthesis of lean body mass rather than adipose tissue.2 NUTRITION ASSESSMENT Nutrition assessment of the patient can aid in diagnosing malnutrition and deter- mining its degree of severity, so that a proper nutrition support regimen can be formulated.