蛋白质能量营养不良课件_1

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1、PROTEIN-ENERGYMALNUTRITION(PEM)PurposeandrequirementTomastertheclinicalmanifestationofPEM.TomasterthewaysofpreventionandtreatmentofPEM.TomasterthecomplicationsofPEM.TobefamiliarwiththeetiologyandpathophysiologyofPEM.能量和/或蛋白质缺乏(energyandproteindeficiency)所致的一种营养缺乏症

2、。多见于3岁以下的婴幼儿,体重减轻(lossofbodyweight),皮下脂肪减少(decreaseofsubcutaneousfat),水肿(edema),器官功能紊乱(disturbanceofthefunctionofvisceralorgansandtissues)。Definition长期摄入不足(insufficientintakeofproteinandenergyinlongperiods)消化吸收障碍(thedisturbanceofdigestionandabsorption)需要量增多(requir

3、ementsincreasing)消耗量过大(consumptionenlarging)EtiologyReasonablefeeding,toadvocatebreastfeedingReasonableregimePreventandtreatdiseases,correctdeformityMonitorthegrowthanddevelopmentprevention新陈代谢异常1、蛋白质：低蛋白血症水肿（edema)2、脂肪：消瘦(emaciation)，肝脏脂肪浸润及变性(fattyinfiltrationan

4、ddegeneration)3、碳水化合物：糖原不足低血糖（hypoglycemia)4、水、盐代谢：脱水、低血钾、低血钙等5、体温调节病理生理各系统功能低下消化系统食欲不振(Anorexia),腹泻(diarrhea)循环系统血压下降、脉搏细弱、肢凉泌尿系统多尿、低比重尿神经系统表情淡漠、智力低下、学习困难免疫功能易感染病理生理Marasmus:totalcaloriedeficiencyEdema:proteindeficiencyMarasmus－edemaclinicaltypesmarasmusedemamani

5、festations体重不增为最早症状体重减轻(Initiatedwithfailuretogainweight,followedbylossofweight)皮下脂肪减少、消失顺序：abdomentruckbuttocklimbsface器官功能紊乱(disordersofmultipleorgansandtissues)临床分度(消瘦型）3岁以下儿童营养不良特点ⅠⅡⅢ体重低于正常15-25%25-40%>40%腹壁皮褶厚度0.8-0.4cm<0.4cm消失身长正常稍低明显低消瘦不明显明显皮包骨样皮肤正常苍白松弛苍白无弹

6、性精神正常轻度萎靡抑制烦躁交替肌张力正常降低低下临床分度(消瘦型）3岁以上儿童营养不良分度轻度重度体重低于正常15%－30%>30%NutritionalmicrocyticanemiaAllkindsofvitaminsdeficiencyInfectionsSpontaneoushypoglycemiaComplications体重低下（underweight）生长迟缓（stunting）消瘦（wasting）DiagnosisAges：Itusuallyaffectstheinfantunderthreeyearso

7、ldofageHistory:FeedinghistoryandahistoryofinfectionandsystemicdiseaseClinicalmanifestations:lossofweight,decreaseanddisappearanceofsubcutaneousfatAssistantexamination：IGF-1，PrealbuminDiagnosisExcludingcausesAdjustingdietscaloriesmild：60－80kcal/kg.dmid-severe：40－55

8、kcal/kg.dprotein1.5－2.0g/Kg.dmultiplevitaminsandmineralssupplyingTreatmentFacilitatingdigestionThetherapyofcomplicationsIntensivecareTreatment各系统功能低下免疫功