重症患者营养支持与护理2课件.pptVIP

危重患者营养支持;;;临床营养支持的发展;临床营养支持的必要性;二十世纪医学的重要成就;危重病人营养支持目的 ;胃的消化与吸收;小肠内的消化吸收;胃肠道是人体最大的免疫器官;胃肠道的屏障 ;肠功能障碍对机体的影响;危重病时肠粘膜屏障的保护;危重疾病状态下营养与代谢改变 ;;;;;小结;营养不良的评估方法 ;营养不良类型及诊断;;三大热量基本来源;;;能量代谢与能量需要;能量需要量的确定;;;;;危重症患者能量供给认识;来自循证医学的建议;营养支持与代谢药物的管理;营养支持途径与选择原则 ;静脉营养的发展;;;;肠外营养液的成分;碳水化合物;脂肪乳剂;新型脂肪乳制剂;氨基酸;微营养素 ;特殊营养物质;来自循证医学的建议; 肠外营养支持途径和选择原则 ;全肠外营养并发症;Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. Most effects result from a sudden shift from fat to carbohydrate metabolism and a sudden increase in insulin levels after refeeding which leads to increased cellular uptake of phosphate. Formation of phosphorylated carbohydrate compounds in the liver and skeletal muscle depletes intracellular ATP and 2,3-diphosphoglycerate in red blood cells, leading to cellular dysfunction and inadequate oxygen delivery to the bodys organs. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes including phosphate, potassium, magnesium, glucose, and thiamine. Significant risks arising from refeeding syndrome include confusion, coma, convulsions, and death. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure. Oxygen consumption is also increased which strains the respiratory system and can make weaning from ventilation more difficult;与置管有关的并发症;感染并发症;代谢并发症;脏器并发症; 肠内营养支持（EN） ;肠内营养的优点;来自循证医学的建议;肠内营养应用指征 ;肠内营养的禁忌症 ;肠内营养种类;;肠内营养途径选择与营养管放置 ;肠内营养投给方法;肠内营养的并发症;肠内营养不耐受;;影响肠内营养耐受性的因素;应用目标指导下的EN方案;肠内营养的管理与肠道喂养安全性评估 ;;营养支持的管理;小结;小结;Thanks