Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
ICU患者营养支持护理
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Hill GL. JPEN,1992,16:197
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
流行病学(营养不足）
❖住院患者营养不良发生率40-60% ❖ 年龄>75岁住院患者营养不良发生率65%
Heyland DK et al, JPEN 2003; 27(5):355-373.
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Today
对营养支持的更深刻认识
营养不良
营养不足
营养过剩
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
❖ 营养支持基本概述 ❖ ICU患者代谢特点 ❖ ICU患者营养评估与风险筛查 ❖ ICU患者营养需要 ❖ 肠内营养治疗的途径 ❖ ICU患者的血糖及代谢应激调理 ❖ ICU患者营养支持的护理
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
营养不良在ICU患者中的发生率
~ 40%
0%
10%
20%
30%
40%
50%
营养不良在ICU患者中非常常见，曾报道发生率最高可达到 40%，并且与发病率和死亡率的增加相关。
Malnutrition is prevalent in intensive care unit (ICU) patients, has been reported as being as high as 40% and is associated with increased morbidity and mortality.
❖呼吸道疾病营养不良发生率45% ❖恶性肿瘤营养不良发生率85%
❖ ICU患者营养不良发生率40-100%
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
❖ 营养支持基本概述 ❖ ICU患者代谢特点 ❖ ICU患者营养评估与风险筛查 ❖ ICU患者营养需要 ❖ 肠内营养治疗的途径 ❖ ICU患者的血糖及代谢应激调理 ❖ ICU患者营养支持的护理
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
2006年ESPEN的概念
营养不足：通常描述蛋白质-能量营养不良,为能量或蛋白 质摄入不足或吸收障碍者，常常造成特异性的营养缺乏 症状。
重度营养风险：描述因疾病或手术造成的急性或潜在的营 养代谢受损，可能因有或无营养支持带来更好或更差的 临床结局
H. Lochs, S.P. Allison, R. Meier et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics ,Clinical Nutrition, Volume 25, Issue 2, April 2006, 180-186
免疫功能损害
ICU患者 营养不良
换气动力损害
换气依赖延长
呼吸肌衰弱
发病率死亡率 上升
需要营养支持治疗
Heyland DK et al, JPEN 2003; 27(5):355-373.
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time
改善消化道结构
促进伤口愈合
营养支持 治疗的意义
减少损伤的 分解代谢反应
降低并发症率
改善临床结果
缩短住院期
减少相关花费
Heyland DK et al, JPEN 2003; 27(5):355-373.
创伤 感染（细菌，内毒素）
细胞因子产生增加 （IL-1 IL-2 IL-6 IL-8 TNF）
营养支持
应用于20世纪上半叶
发展于20世纪下半叶
60年代末， Stanley Dudrick等 成功经深静脉置管 提供营养物质
❖临床营养支持为ICU治疗的三大支柱技术之一，与ICU技 术、器官移植并称20世纪医学发展里程碑
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time