静脉营养的临床应用教学稿件.pptVIP

靜脈營養的臨床應用 Parenteral Nutrition;Clinical Decision Algorithm?;Fat Requirements; Electrolytes Requirements for Adult Patients ;Vitamins;Essential Trace ElementsAMA/NAG Suggested Daily IV Intake;Metabolic Complications of PN;Metabolic Complications of PN Steatosis;Metabolic Complications of PNCholestasis, Gallbladder Stasis, and Cholelithiasis;Systemic Inflammatory Response Syndrome (SIRS);胰島素於玻璃瓶PVC及靜脈管的吸附作用; Hyperglycemia a. Hyperosmolar state b. Osmotic diuresis c. Dehydration d. Immunosuppression Hepatic steatosis Ventilatory alterations Increased resting energy expenditure;The Potential Hazards of OverfeedingLipid;The Potential Hazards of OverfeedingAmino Acid;Metabolic Complications and TreatmentHyperglycemia;Refeeding Syndrome;TPN or PPN ?;全靜脈營養的適應症Total Parenteral Nutrition; ; ;Guidelines for Nutritional Therapy in Liver Disease;Recommended macronutrient intake for patients with ARF＆CRF requiring N S; 病人預期NPO 5-7天 不適當的胃腸功能維持在5-7天 轉移至口服管灌期 中央靜脈輸入是禁忌時 營養不良病患 預期須給予數日的NPO 高新陳代謝性病患 使用PPN即可符合病患熱量及蛋白質的須求時;全靜脈營養與周邊靜脈營養; 無法或不必要用下腔頸靜脈插管 提供高滲透壓溶液時 因菌血症而須將中心靜脈插管拆除 下腔靜脈先前的插管引起靜脈炎 無專業人員;Protein Sparing Effect;The Importance: hypocaloric PPN Support Sufficient Protein in Postoperative;Glycal-Amin (3% Amino Acid and 3% Glycerin injection with Electrolytes) ;;3;;碳水化合物的代謝障礙;癌症惡體質的糖類代謝;葡萄糖利用性不良;宿主 Cytokine Production; Premixed, ready-to use, peripheral IV nutrition support 使用甘油而非葡萄糖為熱量來源 提供氨基酸、碳水化合物及電解質 (包括鈉、鉀、鎂、鈣、鏻等) 735 mOsm/L;2L+500mL;;Glycal-Amin? 3% Amino Acid and 3% Glycerin Injection With Electrolytes ; 糖尿病與癌症病患 維持與穩定血糖 COPD病患 避免Pulmonary stress 避免因SIRS引起的高血糖症 避免TPN結束時的低血糖症;藥師 龐振宜;永遠是要考慮到必須給予病患 足夠的營養以維持其生命