肠外营养概要介绍--执业医师Parenteral Nutrition – An Overview for the Practising Clinician【国外优秀研究报告】.ppt

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肠外营养概要介绍--执业医师Parenteral Nutrition – An Overview for the Practising Clinician【国外优秀研究报告】.ppt

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肠外营养概要介绍--执业医师Parenteral Nutrition – An Overview for the Practising Clinician【国外优秀研究报告】

Parenteral Nutrition – An Overview for the Practising Clinician David Armstrong, Division of GastroenterologyMcMaster University Hamilton Health SciencesHamilton, Ontario, Canada Parenteral Nutrition - Overview Indications, Contraindications and Routes of Administration Macronutrient and Micronutrient Use in TPN Importance of a Parenteral Nutrition Team “Death from starvation is as final as death from cardiac standstill!” Starvation Adult volunteers Fasted for 30-40 days: 25% weight loss More prolonged fasting: 50% weight loss Weakness Apathy Reduced work capacity; cardiorespiratory failure Total starvation is fatal in 8 to 12 weeks IRA Fast (5/91-8/91): death at 45 days (1/10 - with gunshot) and 57-73 days (9/10) What is Nutritional Support? “The provision of nutrients orally, enterally or parenterally with therapeutic intent. This includes, but is not limited to, provision of total enteral or parenteral nutrition support, and provision of therapeutic nutrients to maintain and /or restore optimal nutrition status and health.” ASPEN, 2002 Who Should Get Nutritional Support? Patients who: Cannot meet nutrient requirements Have documented inadequate oral intake Have unpredictable return of GI function Need a prolonged period of NPO/bowel rest Enteral (GI Tract) versus Parenteral (IV) Nutrition Not a flip of the coin decision “If the gut works, use it!” Parenteral Nutrition Common Indications for PN Inability to absorb adequate nutrients via the GI tract : Massive small-bowel resection / short bowel syndrome Severe, untreatable steatorrhea / diarrhoea / malabsorption Complete bowel obstruction, or intestinal pseudo-obstruction Prolonged acute abdomen or ileus Severe catabolism GI tract unusable within 5–7 days Enteral access not feasible, not adequate or not tolerated Pancreatitis with intolerance (eg pain) of jejunal nutrition High output EC fistula (500 mL) no distal enteral access Potential Indications for PN Enterocutaneous fistula IBD unresponsive to medi