危重病患者的临床营养支持ppt课件.pptVIP

Infection Mortality CONCLUSION: The use of EN as opposed to PN results in an important decrease in the incidence of infectious complications in the critically ill and may be less costly. EN should be the first choice for nutritional support in the critically ill. Data Sources.—Computerized search of published research on MEDLINE from 1980 to 1998, personal files, and review of relevant reference lists. Study Selection.—We reviewed 210 titles, abstracts, and papers. Primarystudies were included if they were randomized clinical trials of critically ill or surgical patients that evaluated the effect of TPN (compared with standard care) on complication and mortality rates. We excluded studies comparing TPN with enteral nutrition Data Synthesis.—There were 26 randomized trials of 2211 patients comparing the use of TPN with standard care (usual oral diet plus intravenous dextrose) in surgical and critically ill patients. Conclusions: Total parenteral nutrition does not influence the overall mortality rate of surgical or critically ill patients. It may reduce the complication rate, especially in malnourished patients, but study results are influenced by patient population, use of lipids, methodological quality, and year of publication. Mortality and infection Conclusions: In critically ill patients who have an intact gastrointestinal tract, starting PN at the same time as EN provides no benefit in clinical outcomes over EN alone. More research is needed to determine the effects of combination EN + PN on clinical outcomes in critically ill patients who are poorly intolerant to EN. 急性胰腺炎的营养支持治疗 1974年Feller等提出胰腺“休息”理论,即在急性胰腺炎中,先行静脉内高营养,然后才过渡到肠内营养支持的观点 口服和经鼻管饲喂养,可以刺激胰腺头相和胃相分泌,增加胰液分泌。提示早期经口摄食可导致症状复发和延迟并发症的恢复 营养支持治疗在重症胰腺炎的效果已基本得到肯定 急性胰腺炎的营养支持治疗 近年来, 其不良反应得到了更多的关注，并发现PN对胰腺炎自然病程并无影响,总体病死率仍在20% Guillon等提出急性胰腺炎患者接受PN治疗,增加了感染性并发症的发生。其原因为肠道屏障功能的削弱,补体系统功能下降及脂质对免疫系统的抑制作用等 实验表明,食物分解的产物距幽门愈远,刺激胰泌素分泌作用愈小，距幽门90cm以上,几乎不会对胰腺分泌构成影响，因而,早期对重症胰腺炎进行肠内营养不会加重病情 中华消化杂志2005年8月 目的 为明确全胃肠外营养(