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ID:20464550
大小:1.14 MB
页数:62页
时间:2018-10-09
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1、NutritionincriticalcarePratthanaSrisangthong,MDScopeMetabolicresponseincriticalillnessAssessmentofnutritionalstatusEnteralnutritionParenteralnutritionImmunonutritionandantioxidantBackgroundAdequatenutritionisessentialtothecriticallyillpatient.Ithelpssupportanabolismunc
2、ontrolledcatabolismmaintainacompetentimmunesystemimprovepatientoutcome.Severetrauma,burns,sepsis,andheadinjuryareassociatedwithmarkedhypermetabolismandhypercatabolism,metabolicalterations.Metabolicresponseincriticalillness2principalmetabolicresponse1responsetostarvati
3、on2responsetostressProceedingsoftheNutritionSociety(2007),66,16–24MetabolicresponsetostarvationTypicalsettingpatientwithchronicdiseaseDuringthefirst12–24hrofacutestarvationmobilizationofhepaticglycogenstores24–72hrstimulationofgluconeogenesisAfter72hr-increaseinhepati
4、cketonebodiesproduction-reductionofgluconeogenesis-decreasedproteinbreakdownSubsequently,asstarvationprogressesdecreaseleanbodymassandBMRNutrition13(Supp1):45S-51S,1997MetabolicresponsetostarvationSeveralfeaturesdistinguishthemetabolicresponseofstarved,criticallyillpat
5、ients.Asstarvationprogressesincreasedlossofleanbodymassenergyexpenditureisnotdecrease.Continuationofstarvationbeyond3dnotaccompaniedbyastimulationofbothketogenesisandketonebodyoxidation(withtheirnormallyconcomitantsuppressionofgluconeogenesisandproteinbreakdown)Metabol
6、icresponsetostarvationStarvationincriticallyillpatientsleadstoacceleratedprotein-caloriemalnutrition.Thesealterationscausedbyinflammatorymediators.Metabolicresponsetostress1energymetabolism-increasedREEMetabolicresponsetostressFactorinfluencedenergyexpenditure1effectof
7、illness-stageandlengthofillness-fever-pain,physicalactivity,agitation,abnormalposturing,increasemuscletone,seizureMetabolicresponsetostress2.effectoftreatment-cathecholamineEE-betablockerEE-sedativedrugEESupportivetreatmentcanlimitlevelofm
8、etabolismMetabolicresponsetostress2proteinmetabolism-proteincatabolism>proteinsynthesisnetnegativenitrogenbalance-lo
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