如何合理实施肠外营养支持-吴国豪

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1、如何合理实施临床营养支持HowtoImplementRationalClinicalNutritionTherapy吴国豪复旦大学附属中山医院普外科复旦大学普通外科研究所为什么需要营养支持?那些病人需要营养支持?如何进行合理的营养支持？第一部分PrevalenceofmalnutritionTheGermanhospitalmalnutritionstudyMatthiasPirlich，ClinicalNutrition(2006)25,563–572癌性恶病质的发生率NAStephens;MEDICINE2007;36:(2):78-81Mal

2、nutritioniscommonincancerpatientsMalnutritionoccursin30-87%ofcancerpatientsShillsME;etal:CancerRes1977;37:2366NixonDWetal:AmJMed1980;68:683TchekmedyianNSetal:Oncology1995;9:79Andreyevetal:EurJCancer1998;34:503MonittoCLetal:AmJPhysiol2001;281:E289StephensNAetal:Medicine2007;36:

3、(2):78-81营养不良的危害免疫机能下降脏器功能异常预后不良CumulativeMortality:Protein-EnergyMalnutritionCederholmetal,AmJMed1995.Mortality%MonthsafteradmissionP<0.01MalnutritionIsAssociatedwithIncreasedComplicationsNumerousstudieshavedemonstratedcomplicationsofmalnourishedpatientstobe2-20timesgreatert

4、hanthoseofwellnourishedpatients.Buzbyetal,AmJSurgical1980.Hickmanetal,JPEN1980.Klidjianetal,JPEN1982.MalnutritionIsAssociatedwithIncreasedComplications42%ofpatientswithseveremalnutritionexperiencemajorcomplications9%ofpatientswithmoderatemalnutritionexperiencemajorcomplicatio

5、nsSeverelymalnourishedpatientsarefourtimesaslikelytohavepost-operativecomplicationsaswell-nourishedpatientsDetskyetal,JPEN1987.Detskyetal,JAMA1994.ClinicalOutcomesofmalnutritionTewariN，etal:LungCancer(2007)57,389—394ClinicalOutcomesofmalnutritionPirlichM，ClinicalNutrition(2006

6、)25,563–572ClinicalOutcomesofmalnutritionp<0.001;SchiesserMetal:ClinicalNutrition2008;27:565-570608patientsadmittedforelectivegastrointestinalsurgery.NutritionalriskwasdefinedbyNRS2002andcorrelatedtotheincidenceofpostoperativecomplicationsClinicalOutcomesofmalnutritionNRS2002p

7、<0.001;SchiesserMetal:ClinicalNutrition2008;27:565-570P<0.001PJRoss；BritishJournalofCancer(2004)90,1905–1911ClinicalOutcomesofmalnutritionBachmannJ，JGastrointestSurg(2008)12:1193–1201作用与目标:调整病人的代谢改变及内稳态失衡,改善营养状态与免疫机能降低医院获得性感染发生率缩短住ICU时间最终改善病死率营养支持在疾病治疗中的作用营养支持对营养状态的影响*P=0.04Kl

8、einS,JPEN1997,21:133NutritionalTherapyAffectsOutcomesBraganAr