如何合理实施肠外营养支持吴国豪课件_1.ppt

如何合理实施临床营养支持How to Implement Rational Clinical Nutrition Therapy ;;Prevalence of malnutritionThe German hospital malnutrition study ;;癌性恶病质的发生率;Malnutrition is common in cancer patients;营养不良的危害 ;Cumulative Mortality: Protein-Energy Malnutrition ;Malnutrition Is Associated with Increased Complications;Malnutrition Is Associated with Increased Complications;Clinical Outcomes of malnutrition;Clinical Outcomes of malnutrition;Clinical Outcomes of malnutrition;Clinical Outcomes of malnutrition;;Clinical Outcomes of malnutrition;作用与目标:调整病人的代谢改变及内 稳态失衡, 改善营养状态与免疫机能 降低医院获得性感染发生率 缩短住ICU时间 最终改善病死率 ;营养支持对营养状态的影响;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;Nutritional Therapy Affects Outcomes;问题二:那些病人需要营养支持?;Which patients should we feed?;Which patients should we feed?;外科病人的营养支持;围手术期营养支持指征;;;Parenteral nutrition;Who Needs Parenteral Nutrition?;;改善肠道功能,完整性 防止饥饿或创伤所致的肠道结构异常 增加内脏血流 刺激肠道免疫功能,维护机体防御水平 ;危重病人胃肠功能的损害 ;EN vs PN in critically ill patients meta-analysis(13RCT —Infectious complications);EN vs PN in critically ill patients meta-analysis(13RCT —Mortality);;;;能量代谢;能量代谢与能量需求;能量代谢与能量需求;Energy Balance;机体能量代谢组成;创伤时代谢改变;Stress on energy expenditure and protein losses;能量消耗及需求;能 量 需 求;能量供给;能量消耗的估算方法;Energy guidelines for nutrition support; 肠外营养液的基本成分;Role of carbohydrates;glucose requirement;Glucose metabolism during starvation and critical illness ;Resting energy expenditure (REE) at different glucose intakes in infants;Disadvantages of sole glucose system;Influence of infusion rate on incidence of hyperglycaemia;应激性高血糖与营养支持中的血糖控制 ; ;Intensive insulin therapy in the critically ill patients;应激性高血糖与营养支持中的血糖控制;应激性高血糖与营养支持中的血糖控制;标准：80~110mg/dL（Van den berghe） 140mg/dL 措施：补充外源性胰岛素，减少葡萄糖及非蛋白质热卡的补充量，避免过度喂养（+