临床营养基础剖析.pptVIP

2021/2/6 * SCFA的生理作用 SCFA促进小肠隐窝细胞更新和迁移,抑制过度增殖 促进水钠吸收,防止腹泻 扩张结肠血管,增加结肠血流可达24%,改善结肠和回肠末端的微循环 促进肠高糖素、酪酪肽（PYY）、胰高血糖素、胰岛素的分泌 刺激迷走神经、交感神经 2021/2/6 * SCFA 人体不能合成SCFA,只能由可溶性膳食纤维酵解产生 结肠上皮细胞70%的能量来源于SCFA,SCFA为机体提供总能量的3～9% 丁酸是结肠首选能源物质 D-葡萄糖和谷氨酰胺主要为近端结肠供能,丁酸主要为远端结肠供能 2021/2/6 * SCFA在消化外科的应用 口服增强肠吻合口的强度:增加血供,促进细胞更新、移行 灌肠缓解旷置性结肠炎:平衡菌群 逆转禁食所致的肠粘膜萎缩 口服治疗短肠综合征 灌肠可缓解溃疡性结肠炎 盲肠切除术后灌肠可缓解腹泻 2021/2/6 * 市售EN制剂配方比较膳食纤维 DF:膳食纤维 2021/2/6 * 肠内营养制剂与匀浆膳的比较 肠内营养制剂 匀浆膳 配方完全均衡,成份确切。 配方不完整,成分不确切。 不含乳糖。 不能去除乳糖,容易造成腹泻。 安全卫生。 制备过程容易发生微生物污染。 渗透压低。 渗透压高,容易造成高渗性腹泻。 质地均匀细腻,便于管饲。 溶解度差,易结块,管饲时易堵管。 保存期长,不易受污染。 不能保存,易受污染、变质。 操作方便。 操作麻烦,不安全。 * 过量喂养同样存在风险。脂肪过量的话可发生高甘油三酯血症，诱发胰腺炎。 如果葡萄糖过量，可能导致高血糖，如果经尿液排出，即为尿糖。另外，过多的葡萄糖将转化为脂肪，如果脂肪沉积在肝脏，将导致脂肪肝的发生，甚至影响肝功能。 容量负荷过多的话可导致充血性心衰，伴发二氧化碳产生增加，氧消耗增加，导致呼吸负担加重。 研究证明，过量喂养可增加并发症发生率和死亡率。 * 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 w