如何合理实施肠外营养支持吴国_豪 课件.ppt

* 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 dermatitis, poor wound healing, infection, growth retardation. Amount of EFA required stated as 100-200 g fat as lipid per week * Therefore a mixed fuel system is beneficial to patients who may experience respiratory distress e..g. those with cardiac failure, sepsis, and those who are being weaned off artificial ventilation and malnourished patients with a depleted lean body mass [from Kabiven binder Chapter 2 under To reduce Respiratory stress] * The effect of sepsis in modifying post-surgical fuel utilization in critically ill patients was determined from 374 observations (246 septic [S] and 128 nonseptic [N] in 12 intubated ICU patients studied serially. Patients received TPN (values/24 hrs: Septic, N2, 9.1 +/- 2.2 gm; glucose, 543 +/- 211 kcal/m2, Nonseptic, N2, 8.3 +/- 3.6 gm; glucose, 550 +/- 346 kcal/m2). In some periods, intravenous lipid (L) was given to raise total caloric intake to 826 +/- 223 kcal/ 24 hr/m2. The VO2, VCO2, respiratory rate, minute volume, and blood gas levels were measured, and respiratory quotient (RQ) and metabolic rate (MR) computed. Statistics were performed by 2-way ANOVA and analysis of covariance. Without lipid, mean VCO2 for S (126 ml/min/m2) and N (128 ml/min/m2) were not significantly different, but VO2 in S (146 ml/min/m2) and N (132 ml/min/m2), and the RQ values S (0.88) and N (0.97), were different (p less than 0.0001). In 360 studies RQ was shown to be increased by the total caloric intake, but red