如何合理实施肠外营养支持-吴国豪 ppt课件推荐.ppt

感谢诸位关注！ * * * * * * * * * * Picture from Ute Brauer - modified * See also Nordenstrom (1994) Nutrition 10, 96-110 - statement that the use of indirect calorimetry have shown that few hospitalized patients have energy requirements 30 kcal/kg/day. See Hunter et al (1998) Br J Surg 75, 875-878 - Harris Benedict eqn vs measured resting energy expenditure in ventilated, surgical patients – rationale for choosing 30 kcal/kg/day for non-ventilated patients. May need lower calories in patients on ventilators who are difficult to wean. States that no multiplication factors are needed to relate the Harris-Benedict formula to measured resting energy expenditure in critically ill patients. States that weight is responsible for 80% of the variability in H-B eqn see Chan et al (2002), on prediction of EE in critically ill medical patients in ICU [JPEN 26, S15] - measured EE by indirect calorimetry was more closely predicted by simple estimate of 25 kcal/kg/day . * Taken from Sobotka Soeters (Basics in Clinical Nutrition, Ed for ESPEN course, 2nd edition) * 18/g/kg glucose = 12.5 mg/kg/min (from Collier et al., 1997, Chap 6 of Baker, Baker Davis 1st Ed). Collier et al also states that the greater energy cost of lipogenesis from glucose may cause lower fat deposition in infants. * A retrospective study from the Ohio State University Medical Centre, Ohio State University, in patients not normally predisposed to hyperglycaemia (n = 102). * * * * Note that Chapter 3.2 on Carbohydrate by Carpentier in Basics in Clinincal Nutrition 2nd ed of ESPEN course recommends a maximal infusion rate of 5 mg/kg/min. * Above values taken from our product labels. Check also Melnik et al in Torosian Monograph: Nutrition for the Hospitalized Patient, p 272. Values of osmolarity for dextrose monhydrate slightly different from above. * EFA deficiency impair synthesis of membrane phospholipids and eicosanoids. Defective membrane function and repair can lead to symptoms such as dermat