静脉营养的临床应用

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1、靜脈營養的臨床應用ParenteralNutrition營養評估與營養需求靜脈營養支持注意要點靜脈營養的適應症全靜脈營養TPN周邊靜脈營養PPN癌症與營養龐振宜藥師ClinicalDecisionAlgorithm營養評估消化道功能YesNo腸道營養胃腸功能靜脈營養短期長期或須限水時PeripheralPNCentralPN胃腸功能恢復標準配方特殊配方(Obstruction,peritonitis,intractablevomiting,acutepancreatitis,short-bowelsyndrome,ileus)短期NasogastricNasoduoden

2、alNasojejunal長期GastrostomyJejunostomyNutrientToleranceAdequateProgresstoOralFeedingsInadequatePNSupplementationAdequateProgresstoMoreComplexDietandOralFeedingsAsToleratedProgresstoTotalEnteralFeedingsNormalCompromisedNoYesDecisiontoInitiateSpecializedNutritionSupportRef：JPEN17（Suppl4）：7SA

3、,1993靜脈營養建議攝取量CriticallyIll(Stress)StableFormulag/L(葡萄糖-A.A.-Fat)150-50-30150/200-40-30蛋白質g/kg/d1-1.50.8–1.0糖類mg/kg/min2-3.54-5脂肪g/kg/d11-2總熱量kcal/kg/d25–3030-35水分mL/kg/dMin.needed30-40ASPENnutritionsupportpracticemanual9-2,1998MaintenancelevelsofelectrolytesStandarddosesofmultivitaminsan

4、dtraceelementsProteinRequirements（forAdultPatients）1.15–25﹪ofTotalCalories2.Non-proteinCalorietoNitrogenRatio80-100kcal：1/gm.NSevereStress150-200kcal：1/gm.NModerateStress3.Nutritionalvs.MetabolicSupport22ndClinicalCongress,ASPEN1998GlucoseRequirementInitialTPN:100-150gm（or200gm）Canbeincre

5、asedby50-75gm/d(bloodglucoselevelsarestablebutlessthan200mg/dl)themaximumglucoseinfusionratebe4mg/kg/min(22-25Kcal/kg/day)Ref：1.TheASPENNutritionSupportPracticeManual.19982.ContemporaryNutritionSupportPractice.19983.ClinicalNutritionParenteralNutrition3Edition;2001FatRequirementsMaximumca

6、pacity：1.0-2.0gm/kg/dayCriticallyillthemaximumrecommendedinfusionrate：1.0gm/kg/day10-25﹪oftotalcaloriesRunfatinitiallyat1ml/min×15-30min2-4﹪oftotalcaloriesmustbefromEFA22ndClinicalCongress,ASPEN1998ElectrolytesRequirementsforAdultPatients1.Sodium30–55mEq/liter2.Potassium60–90mEq/day3.Chlo

7、ride30–55mEq/liter4.Calcium6–12mEq/day5.Magnesium16–20mEq/day6.Acetate45–70mEq/day7.Phosphorus18–28mM/dayRef：a.Maxwell＆Kleeman,sClinicalDisordersofFluidandElectrolyteMetabolism,5th,1994.b.AllinI.Arieff,M.D.Fluid,Electrolyte,andAcid-BaseDisorders.2ndEd1995.VitaminsAd