【正文】 ，共一百零四頁。ng) (Lipid) 維生素 (Vitamines) 電解質 (Electrolytes) 微量元素 (Trace elements),七大(qī d224。)2 給什么？,第十七頁，共一百零四頁。,2006/09/09,17,問題(w232。,2006/09/09,15,NRS 2002,Head injury, bone marrow transplantation, Intensive care patients (APACHE10).,Score 3,Severe,Major abdominal surgery, stroke. Severe pneumonia, hematologic malignancy,Score 2,Moderate,Hip fracture, chronic patients, in particular with acute complications: cirrhosis, COPD, chronic hemodialysis, diabetes, oncology,Score 1,Mild,Normal nutritional requirements,Score 0,Absent,Final screening (Severity of disease),第十五頁，共一百零四頁。,2006/09/09,13,NRS 2002,Is BMI 20.5? Yes No Has the patient lost weight within the last 3 months? Yes No Has the patient had a reduced dietary intake in the last week? Yes No 4. Is the patient severely ill?(e.g.ICU) Yes No → If“No“to all questions, rescreened at weekly intervals. → If“Yes“to any question, the final screening is performed.,Answer,Initial screening,第十三頁，共一百零四頁。ngyǎng)篩查,第十一頁，共一百零四頁。ngyǎng)篩查,第十頁，共一百零四頁。,2006/09/09,10,等級 理想體重的％ 正常值 90 輕度(qīnɡ d249。10%,營養(yǎng)(y237。 理想體重計算公式： 男：（身高cm80）0.7177。ngdī)或增加均可視為營養(yǎng)不良，其評判標準為在6個 月內因非主觀原因比平時體重降低或增加10%左右，或比過去 1個月的體重降低或增加5%，或體重為理想體重的177。 significant mortality,第八頁，共一百零四頁。,2006/09/09,8,營養(yǎng)(y237。,2006/09/09,7,體質指數(shù)(BODY MASS INDEX,BMI)= 體重(kg)/身高(shēn ɡāo)2(m2) 等級 BMI指數(shù) 正常值 18.5=BMI23.5 蛋白質: 熱量營養(yǎng)不良I級 17.018.4 蛋白質: 熱量營養(yǎng)不良II級 16.016.9 蛋白質: 熱量營養(yǎng)不良III級 16,營養(yǎng)(y237。,2006/09/09,6,營養(yǎng)(y237。h233。 流動門診患者 115% 門診留觀患者 2560% 住院患者 3565%,營養(yǎng)不良,第四頁，共一百零四頁。zo)營養(yǎng)支持？,第三頁，共一百零四頁。)報告,When?,第二頁，共一百零四頁。 如何進行營養(yǎng)支持？,病例(b236。,2006/09/09,2,患者Z，男，42歲，體重70 kg，急性重癥胰腺炎第3天。2006/09/09,1,腸外營養(yǎng)(y237。ngyǎng)支持,第一頁，共一百零四頁。昨天體溫39 oC，胃液500 ml，尿1500 ml，血尿淀粉酶升高(shēnɡ ɡāo)，血常規(guī)示W(wǎng)BC總數(shù)及中性WBC升高。ngl236。,2006/09/09,3,問題1 誰需要(xūy224。,2006/09/09,4,營養(yǎng)不良包括營養(yǎng)素攝入不足(b249。)、營養(yǎng)素代謝障礙造成的如何營養(yǎng)狀態(tài)紊亂，包括營養(yǎng)過度。,2006/09/09,5,增加發(fā)病率與死亡率 延緩傷口愈合(y249。) 增加并發(fā)癥 延長住院時間 增加醫(yī)療費用 增加再次住院率,營養(yǎng)不良,第五頁，共一百零四頁。ngyǎng)篩查,病史 首測參數(shù) 體重下降 體重 食欲、惡心(ě xīn) 身高 攝食量 BMI,第六頁，共一百零四頁。ngyǎng)篩查,第七頁，共一百零四頁。ngyǎng)篩查,BMI與死亡率 25 kg/m2 overweight 30 kg/m2 Obese。,2006/09/09,9,體重過度降低(ji224。20%。10% 女：（身高cm70）0.6177。ngyǎng)篩查,第九頁，共一百零四頁。)營養(yǎng)不良 8090 中度營養(yǎng)不良 6079 重度營養(yǎng)不良 60,營養(yǎng)(y237。,2006/09/09,11,Nutritional Riks Index Subjective global assessment Malnutrition Universal Screening Tool (MUST) Nutritional Risk Screening (NRS 2002) MNA (elderly),營養(yǎng)(y237。,2006/09/09,12,MUST,0 (LOW) 1 (MEDIUM) 2 or more (HIGH) ROUTINE CLINICAL CARE OBSERVE TREAT,Acute disease effect Add a score of 2 if there has been or is likely to be no or nutritional intake for 5 days,Hospital refer to dietitian or implement local policies. Generally food first followed by food fortification and supplements Care Homes (as for hospital) Community (as for hospital),BMI (kg/m2) 0 : 20.0 1 : = 18.520.0 2 18.5,Weight loss in 36 months 0 : 10 %,Hospital document dietary and fluid intake for 3 days Care Homes (as for hospital) Community Repeat screening, e.g. from 6 mo (with dietary advice if necessary),Repeat screening Hospital every week Care Homes every month Community every year for special groups, e.g. those 75 y,第十二頁，共一百零四頁。,2006/09/09,14,NRS 2002,Final screening (Impaired nutritional status) Absent Score 0 = Normal nutritional status Mild Score 1 Wt loss 5% in 3 months or Food intake below 50 75% normal requirement in preceeding week Moderate Score 2 Wt loss 5% in 2 months or BMI 18.5 – 20.5 + impaired general condition or Food intake 2550% normal requirement in preceeding week Severe Score 3 Wt loss 5% in 1 mo (15% in 3 mo) or BMI 18.5 + impaired general condition or Food intake 025% normal requirement in preceeding week,第十四頁，共一百零四頁。,2006/09/09,16,NRS 2002,Impaired nutritonal status weight loss