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d危重患者 肠内营养EEN_0721.ppt 57页

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吸入性肺炎 对策: 鼻饲前应吸尽呼吸道内分泌物; 鼻饲时病人取坐位或将床头抬高30。~45。,管饲后30 min~60 min再放下床头.以防食物反流; 每隔4 h观察鼻饲管位置1次,并做好记录。 监测胃内容物残余量,应保证残余量<200 mL,否则应暂停管饲,同时监听肠鸣音,判断胃肠蠕动情况; 出现反流时,应尽快吸尽气管及口鼻腔内反流物。 应用外径较细的鼻-空肠管 提高肠内营养耐受我们能做什么? 优化输注技术 幽门后喂养(小肠喂养) 病因处理 监测 适当的制剂和消化液/酶补充 逐渐加大浓度 控制速度 消化液回输、添加消化酶 保证无菌、不变质 小 结 ICU危重患者多伴有不同程度肠道功能障碍 早期肠内营养有利于危重患者的预后 实施EN时通路和肠内营养制剂的选择十分重要 早期肠内营养可以从短肽(百普力)开始 吸收快 肠屏障保护作用 防止病原微生物移位 防止应急性肠道损伤 谢谢 ! * * * Page 3 – Complications After survival the most relevant question is how many complications occur and how can they be reduced. Enteral nutrition was shown to be significantly better than parenteral nutrition in this important outcome parameter. When looking specifically at hyperglycaemia, the study by Koretz showed that this metabolic complication was significantly reduced by 30% in critically ill patients - an impressive number. The meta-analysis by Peter encompassed 24 studies. These studies reported numbers of patient experiencing infective complications (not further specified). As you can see from the forest plot, most of the blue dots are on the right side, meaning the result favours enteral nutrition. And this is also statistically shown in the overall result where the diamond is clearly on the right side; it is not touching the neutrality line and therefore represents a significant result. The extent of this risk reduction can also be seen in the forest plot: 8% less complications were developed in this group when compared with the parenteral group. In the analysis by Koretz where only critically ill patients were included the reduction of infective complications was 9% when enteral nutrition was used. In addition to the infective complications reported above, Peter also analyzed the non-infective complications. The result was that enteral nutrition again significantly reduced these complications by 5% (most pronounced in the medical group). It might be obvious – but still worthwhile to mention – that parenteral nutrition can pose a risk due to the

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