肠外营养支持临床应用七年回顾
作者：徐鹏远 许世才 谭晶 陈加勇 甘平 孙敏
单位：昆明医学院附属二院普外科
关键词：
中国临床营养杂志000152摘 要：目的分析7年来肠外营养支持在我院临床应用的疗效。 方法据不完全统计，从1992年中旬到1999年11月，对2768例病人进行了以肠外营养为主的营养支持。凡严重感染、创伤可能引起之营养不良，不能进食，胃肠道无功能或胃肠道需要休息，以及各种原因引起或即将引起营养不良者均为肠外营养适应症。2768例病人分布于我院普外科，SICU、烧伤、胸外、骨科、干疗科，神经内科，肾内，血液等17个科室，其中外科系统占71.8%，内科仅占28.2%。 结果和结论1.肠外营养是治疗危重病人的重要手段，它使重症胰腺炎，肠瘘，严重感染，严重创伤等病人获得了治愈机会。2.危重病人处于严重应激和代谢紊乱，治疗中应遵循代谢支持原则，减少糖量，增加氮量。3.治疗中应注意保护胃肠粘膜屏障，少量早期进食和口服谷氨酰胺是保护胃肠粘膜屏障简单有效的方法。4.对于严重创伤病人，尽管提供了足够而合理的营养底物，但病人的分解代谢并不因此而减轻，给予代谢调理剂(如生长激素)是有益的。5.肿瘤病人的营养支持应配合化疗或用于围手术期，肝功能差的病人则应提高支链氨基酸含量，肾衰病人应降低氮量，主要提供必需氨基酸。6.一旦肠道能利用就要尽可能利用，肠内营养能保护肠屏障功能，还能改善内脏血液循环障碍，加速重症病人的康复。7.肠外营养的并发症时有发生，要特别注意。
, 百拇医药
A Retrospective study of parenteral nutrition support in 7 years periods
XU Pengyuan ,XU Shihai ,TAN Jing
(Dept. of General Surgery of Kunming Medical College 2nd Affiliate Hospital, Kunming 650101)
Abstract： We performed a retrospective study to assess the therapeutic effect of Parenteral Nutrition (PN) support in our hospital. From may 1992 to November 1999, there are about 2 768 patients received the Parenteral Nutrition. The Patients were varied, such as were limited or unusable of gut, be unable to eat (because of coma, severe anoxia, or mental disturbance), severe trauma and stress and all other diseases that may develop to malnutrition. They come from the Gastrointestinal Surgical Department, SICU, Burn Department, Thorax Surgical Department, Orthopedic Department, Neurology Department, Urology Department, and other 10 departments (71. 8% from Surgical Departemnt and 28. 2% from Medical Department).We sum up our experience as following: 1. PN is the important method to treat the patients in dangerous state as the following: The Acute Hemorrhagic Pancreantitis, intestine fistula, severe sepsis or trauma, and can bring the healed results. 2. Most of the patients suitable for PN are in the condition of sever stress and metabolism disorders, Principle of nutritious metabolic support should be applied, for an example, we should reduce the percentage of glucose and increased that of nitrogen. 3. To protect the gastrointestinal mucosal barrier is crucial, and the simple but effective way can achieve this object is a small amount of diet and the administration of glutamine by mouth. 4. Although we provide the enough and rational nutriment to the severely traumatic patients, their anabolism situation have not been changed, so it's helpful to use the medicaments with anabolic effect such as the growth hormone 5. The administration of nutrition to cancer patients should be together with chemotherapy and radiotherapy or preoperation. The patients with dysfunction of the liver should be given more branched amino acids. In renal failure eases,the amount of nitrogen should be reduced and provide Essential amino acids. 6. Assessing the availability of the gastrointestinal tract is important. It's better to use the Enteral Nutrition (EN) as earlier as it permits. Since the EN can protect the function of intestine mucosal barrier and ameliorate the microcirculation of visceral blood vessels, and may quicken up the patient's recovery. 7. Be carful about the possible complications of the PN. ABove-mentioned viewpoints will be given a minute description., 百拇医药
单位：昆明医学院附属二院普外科
关键词：
中国临床营养杂志000152摘 要：目的分析7年来肠外营养支持在我院临床应用的疗效。 方法据不完全统计，从1992年中旬到1999年11月，对2768例病人进行了以肠外营养为主的营养支持。凡严重感染、创伤可能引起之营养不良，不能进食，胃肠道无功能或胃肠道需要休息，以及各种原因引起或即将引起营养不良者均为肠外营养适应症。2768例病人分布于我院普外科，SICU、烧伤、胸外、骨科、干疗科，神经内科，肾内，血液等17个科室，其中外科系统占71.8%，内科仅占28.2%。 结果和结论1.肠外营养是治疗危重病人的重要手段，它使重症胰腺炎，肠瘘，严重感染，严重创伤等病人获得了治愈机会。2.危重病人处于严重应激和代谢紊乱，治疗中应遵循代谢支持原则，减少糖量，增加氮量。3.治疗中应注意保护胃肠粘膜屏障，少量早期进食和口服谷氨酰胺是保护胃肠粘膜屏障简单有效的方法。4.对于严重创伤病人，尽管提供了足够而合理的营养底物，但病人的分解代谢并不因此而减轻，给予代谢调理剂(如生长激素)是有益的。5.肿瘤病人的营养支持应配合化疗或用于围手术期，肝功能差的病人则应提高支链氨基酸含量，肾衰病人应降低氮量，主要提供必需氨基酸。6.一旦肠道能利用就要尽可能利用，肠内营养能保护肠屏障功能，还能改善内脏血液循环障碍，加速重症病人的康复。7.肠外营养的并发症时有发生，要特别注意。
, 百拇医药
A Retrospective study of parenteral nutrition support in 7 years periods
XU Pengyuan ,XU Shihai ,TAN Jing
(Dept. of General Surgery of Kunming Medical College 2nd Affiliate Hospital, Kunming 650101)
Abstract： We performed a retrospective study to assess the therapeutic effect of Parenteral Nutrition (PN) support in our hospital. From may 1992 to November 1999, there are about 2 768 patients received the Parenteral Nutrition. The Patients were varied, such as were limited or unusable of gut, be unable to eat (because of coma, severe anoxia, or mental disturbance), severe trauma and stress and all other diseases that may develop to malnutrition. They come from the Gastrointestinal Surgical Department, SICU, Burn Department, Thorax Surgical Department, Orthopedic Department, Neurology Department, Urology Department, and other 10 departments (71. 8% from Surgical Departemnt and 28. 2% from Medical Department).We sum up our experience as following: 1. PN is the important method to treat the patients in dangerous state as the following: The Acute Hemorrhagic Pancreantitis, intestine fistula, severe sepsis or trauma, and can bring the healed results. 2. Most of the patients suitable for PN are in the condition of sever stress and metabolism disorders, Principle of nutritious metabolic support should be applied, for an example, we should reduce the percentage of glucose and increased that of nitrogen. 3. To protect the gastrointestinal mucosal barrier is crucial, and the simple but effective way can achieve this object is a small amount of diet and the administration of glutamine by mouth. 4. Although we provide the enough and rational nutriment to the severely traumatic patients, their anabolism situation have not been changed, so it's helpful to use the medicaments with anabolic effect such as the growth hormone 5. The administration of nutrition to cancer patients should be together with chemotherapy and radiotherapy or preoperation. The patients with dysfunction of the liver should be given more branched amino acids. In renal failure eases,the amount of nitrogen should be reduced and provide Essential amino acids. 6. Assessing the availability of the gastrointestinal tract is important. It's better to use the Enteral Nutrition (EN) as earlier as it permits. Since the EN can protect the function of intestine mucosal barrier and ameliorate the microcirculation of visceral blood vessels, and may quicken up the patient's recovery. 7. Be carful about the possible complications of the PN. ABove-mentioned viewpoints will be given a minute description., 百拇医药