靜脈營養(yǎng)的臨床應(yīng)用-全文預(yù)覽
【正文】 ? 血糖的穩(wěn)定 ? 電解質(zhì)的平衡 ? 鉀 、鎂、磷 的監(jiān)測 ? 酸鹼平衡 ?Nutrition Support Overfeeding ? Respiratory Acidosis ?Parenteral Nutrition Acidosis ? Metabolic Acidosis ? 避免靜脈營養(yǎng)停止時的低血糖癥 J. Nutrition 1999: 129. 290S294S Systemic Inflammatory Response Syndrome (SIRS) Current Opinion in Clinical Nutrition and Metabolic Care 1999, 2:6978 ? 抑制 central Insulin action ? Increase gluconeogenesis ? Peripheral insulin resistance ? Reduce uptake of glucose ? Significant hyperglycemia OP 2 4 6 8 10 12 14 16 18 20 Postoperative Day Relative insulin sensitivity (%) 100 80 60 40 20 胰島素於玻璃瓶 PVC及靜脈管的吸附作用 Anesthesiology 40: 4, 400404, 1974 RL GLASS RL PVC D5RL GLASS D5RL PVC 0 5 10 15 20 MINUTES 20 30 40 50 60 ? Hyperglycemia a. Hyperosmolar state b. Osmotic diuresis c. Dehydration d. Immunosuppression ? Hepatic steatosis ? Ventilatory alterations ? Increased resting energy expenditure Ref： 1. Nutrition Support Theory and Therapeutics 1st Ed , P471； 1997 2. The Metabolic Hazards of Overfeeding Critically Ill Patients, ASPEN, 1997. The Potential Hazards of Overfeeding Glucose The Potential Hazards of Overfeeding Lipid ? TG 250mg/dl 4 hrs after lipid infusion for piggybacked lipids and 400mg/dl for continuous lipid infusion ? Immunosuppression （ RES Blockade） ? Increased prostaglandin production ? Hypercholesterolemia ? Hyperlipidemia ? Impaired liver function ? Ventilatory alterations ? Reducing the dose and/or lengthening the infusion time Ref： 1. The Metabolic Hazards of Overfeeding Critically Ill Patients, ASPEN, 1997. The Potential Hazards of Overfeeding Amino Acid ? Ureagenesis ? Hyperchloremic acidosis ? Ventilatory alterations ? Increased resting energy expenditure 1. Nutrition Support Theory and Therapeutics 1st Ed , P471； 1997 2. The Metabolic Hazards of Overfeeding Critically Ill Patients, ASPEN, 1997. Metabolic Complications and Treatment Hyperglycemia ? 1. Slow infusion rate ? 2. Give insulin U of insulin /g of dextrose/liter ? 3. Increase fat emulsion therapy Refeeding Syndrome ? Cardiac insuficiency peripheral edema hyertension ? Excess glucose ? Hyperglycemia ? Hypokalemia ? Hypophosphatemia ? hypomagnesemia Ref： Nutrition in Critical Care. 1994 TPN or PPN ? 全靜脈營養(yǎng) 的適應(yīng)癥 Total Parenteral Nutrition ?營養(yǎng)有危機的人 ?體重過輕的病人 ?短時間內(nèi)體重下降超過 10% ?有 10天以上無法經(jīng)口進食 ?胃腸道消化吸收有困難 ?嚴重外傷、燒傷 ?嚴重敗血癥 Hicaliq I TeruAmino 12X Hicaliq II TeruAmino 12X StressII 一天 總 液 量 ml 1200 1200 1800 總 熱 量 Kcal 807 1027 1541 Glucose gm 140 206 309 Xylitol gm 25 25 Amino Acid gm Na mEq 75 75 K mEq 30 30 45 Ca mEq Mg mEq 10 10 15 Cl mEq 75 75 Acetate mEq 25 25
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