程乐梅--重病患儿营养支持治疗与监护 ppt课件.pptVIP

* * * * 定义： 糖异生：体内从非糖类物质如氨基酸、丙酮酸、甘油等合成葡萄糖的代谢，是维持血糖水平的重要过程。 若PH下降0．1则胰岛素敏感度下降30%，患者糖利用降低、呈高血糖。 FFA 游离脂肪酸 TG 甘油三酯 * 膳食营养素参考摄入量（DRIs） RDAs (推荐的日摄食量) * Lipids - Lipids may be safely used on a daily basis in most patients. Begin lipids at 1.0 gm/kg and advance by 1.0 gm/kg per day depending on a childs age and lipid clearance to the appropriate endpoint goal of 3 gm/kg in infants and 1 - 2.0 gm/kg in older children and adolescents, depending on clinical status. Essential Fatty Acid (EFA) Requirements - 20% Intralipid (2 kcal/cc) should be provided at a minimum dose of 0.5 - 1.0 gm/kg per day for provision of essential fatty acid (EFA) requirements. Signs of EFA deficiency include: reduced growth rate, impaired wound healing, increased susceptibility to infections, thromobocytopenia, and flaky dry skin . * * Protein - Infants under 2 years of age should be started on a pediatric parenteral amino acid solution such as TrophAmine (B. Braun, Irvine, CA). This amino acid formulation for pediatric patients provides numerous advantages including: provides essential amino acids for infants, promotes plasma amino acid profiles within normal neonatal target range, decreases the tendency for development of cholestasis, and decreases the pH of the solution thus improving calcium and phosphorus solubility (7.2 mEq of Ca + Phos per 100 ml of PN solution). Protein Advancement in Infants and Children - Begin at 1.5 - 2 gm/kg per day and advance to endpoint goal by Day 2. In infants with renal insufficiency or failure may need to limit protein to 1.0 gm/kg/day on first day of PN.严重感染：早期蛋白丢失2/3主来自于骨骼肌，以后多的来自于内脏蛋白 AA： 合成蛋白质； 合成嘌呤、嘧啶、儿茶酚胺、肌酐及EAA合成底物（40％） 小儿肠外氨基酸的解决方案如 TrophAmine 加利福尼亚州欧文市 B.布劳恩） 应开始蛋白-2 岁以下的婴儿。儿科病人的这种氨基酸构思提供了很多的优点，包括： 为婴儿提供人体必需的氨基酸、 促进血浆氨基酸正常新生儿目标范围内的配置文件、 减少的胆汁淤积、 发展趋势和降低 ph 值的解决方案，从而提高钙、 磷的溶解度 （7.2 mEq Ca + Pho 每 100 毫升的 PN 解决方案）。 婴儿和儿童的蛋白质进展开始每一天和第二天的终结点目标的进展的 1.5-2 克/千克。婴幼儿与肾功能不全或失败可能需要限制蛋白 1.0 gm/kg/天的 PN.严重感染：早期蛋白丢失2/3主来自于骨骼肌，以后多的来自于内脏蛋白的第一天 AA： 合成蛋白质； 合成嘌呤、