静脉营养的临床应用PPT课件.ppt

Metabolic Complications of PN Steatosis Cholestasis, Gallbladder Stasis, and Cholelithiasis Gastrointestinal Atrophy Gastric Hypersecretion and Hyperacidity Metabolic Complications of PN Steatosis Within 1-2 weeks after initiation of PN Elevations of Serum aminotransferases, alkaline phosphatase and bilirubin Fatty infiltration of liver cells Continuous glucose and/or excessive calorie loads Resolves in 10-15 days Metabolic Complications of PNCholestasis, Gallbladder Stasis, and Cholelithiasis May occur 2-6 wks after initiation PN Progressive increase total bilirubin and serum alkaline phosphatase minimize the risk Cyclic PN Restrictin of carbohydrate, Avoidance of overfeeding Early enteral stimulation Metabolic Complications of PNGastrointestinal Atrophy Lack of enteral stimulation cause villus hypoplasia Colonic mucosal atropy Decrease gastric function Impaired GI immunity Bacterial overgrowth Bacterial translocation Initiate enteral feedings as soon as possible Metabolic Complications of PNGastric Hypersecretion and Hyperacidity Gastric secretions directly related to the amount of small bowel resected Peptic ulcerations and hemorrhagic gastritis Histamine H2 receptor antagonists are used to decrease gastric output Added directly to the PN solution Systemic Inflammatory Response Syndrome (SIRS) 抑制central Insulin action Increase gluconeogenesis Peripheral insulin resistance Reduce uptake of glucose Significant hyperglycemia 胰島素於玻璃瓶PVC及靜脈管的吸附作用 The Potential Hazards of OverfeedingGlucose The Potential Hazards of OverfeedingLipid The Potential Hazards of OverfeedingAmino Acid Metabolic Complications and TreatmentHyperglycemia Refeeding Syndrome TPN or PPN ? 無法或不必要用下腔頸靜脈插管 提供高滲透壓溶液時 因菌血症而須將中心靜脈插管拆除 下腔靜脈先前的插管引起靜脈炎 無專業人員 周邊靜脈營養 Peripheral Parenteral Nutrition PPN 輕度至中度營養缺乏 無法經口服或不易經由中央靜脈輸入 或不需要時的一種有效的營養支持療法 Protein Sparing Effect 胰島素 葡萄糖 肝醣 胺基酸 蛋白質 酮體 脂肪酸 脂肪 ADP 能量 ATP 能量代謝 氧氣O2 二氧化碳, 水, 尿素 升糖激素 Epin,Norepin, GH 類固醇 Blackburn; Am. J Clin Ntutr, 1