湘雅儿科精品课件-PROTEIN-ENERGYMALNUTRITION.pptVIP

PROTEIN-ENERGYMALNUTRITION(PEM)  DepartmentOfPediatrics  LiqunLiu  章节（1）   To master the clinical manifestation of PEM. To master the ways of prevention and treatment of PEM. To master the complications of PEM . To be familiar with the etiology and pathophysiology of PEM. 能量和/或蛋白质缺乏(energy and protein deficiency)所致的一种营养缺乏症。多见于3岁以下的婴幼儿,体重减轻(loss of body weight),皮下脂肪减少(decrease of subcutaneous fat),水肿(edema),器官功能紊乱(disturbance of the function of visceral organs and tissues) 。 Definition 长期摄入不足 (insufficient intake of protein and energy in long periods) 消化吸收障碍 (the disturbance of digestion and absorption) 需要量增多 (requirements increasing) 消耗量过大 (consumption enlarging) Etiology Reasonable feeding, to advocate breast feeding Reasonable regime Prevent and treat diseases, correct deformity Monitor the growth and development prevention 新陈代谢异常 蛋白质：低蛋白血症 水肿（edema) 脂肪：消瘦(emaciation)，肝脏脂肪浸润及变性(fatty infiltration and degeneration) 碳水化合物：糖原不足 低血糖（hypoglycemia) 水、盐代谢：脱水、低血钾、低血钙等 体温调节 病理生理 各系统功能低下 消化系统 食欲不振(Anorexia), 腹泻(diarrhea) 循环系统 血压下降、脉搏细弱、肢凉 泌尿系统 多尿、低比重尿 神经系统 表情淡漠、智力低下、学习困难 免疫功能 易感染 病理生理 Marasmus: total calorie deficiency Edema: protein deficiency Marasmus － edema clinical types marasmus edema 体重不增为最早症状 体重减轻 (Initiated with failure to gain weight, followed by loss of weight) 皮下脂肪减少、消失顺序： abdomen truck buttock limbs face 器官功能紊乱(disorders of multiple organs and tissues) 临床分度(消瘦型） 3岁以下儿童营养不良特点 Ⅰ Ⅱ Ⅲ 体重低于正常 15-25% 25-40% 40% 腹壁皮褶厚度 0.8-0.4cm 0.4cm 消失 身长 正常 稍低 明显低 消瘦 不明显 明显 皮包骨样 皮肤 正常 苍白松弛 苍白无弹性 精神