蛋白质－能量营养不良.ppt

PROTEIN-ENERGYMALNUTRITION(PEM),Purposeandrequirement,TomastertheclinicalmanifestationofPEM.TomasterthewaysofpreventionandtreatmentofPEM.TomasterthecomplicationsofPEM.TobefamiliarwiththeetiologyandpathophysiologyofPEM.,能量和/或蛋白质缺乏(energyandproteindeficiency)所致的一种营养缺乏症。多见于3岁以下的婴幼儿,体重减轻(lossofbodyweight),皮下脂肪减少(decreaseofsubcutaneousfat),水肿(edema),器官功能紊乱(disturbanceofthefunctionofvisceralorgansandtissues)。,Definition,长期摄入不足(insufficientintakeofproteinandenergyinlongperiods)消化吸收障碍(thedisturbanceofdigestionandabsorption)需要量增多(requirementsincreasing)消耗量过大(consumptionenlarging),Etiology,Reasonablefeeding,toadvocatebreastfeedingReasonableregimePreventandtreatdiseases,correctdeformityMonitorthegrowthanddevelopment,prevention,新陈代谢异常1、蛋白质：低蛋白血症水肿（edema)2、脂肪：消瘦(emaciation)，肝脏脂肪浸润及变性(fattyinfiltrationanddegeneration)3、碳水化合物：糖原不足低血糖（hypoglycemia)4、水、盐代谢：脱水、低血钾、低血钙等5、体温调节,病理生理,各系统功能低下消化系统食欲不振(Anorexia),腹泻(diarrhea)循环系统血压下降、脉搏细弱、肢凉泌尿系统多尿、低比重尿神经系统表情淡漠、智力低下、学习困难免疫功能易感染,病理生理,Marasmus:totalcaloriedeficiencyEdema:proteindeficiencyMarasmusedema,clinicaltypes,marasmus,edema,manifestations,体重不增为最早症状体重减轻(Initiatedwithfailuretogainweight,followedbylossofweight)皮下脂肪减少、消失顺序：abdomentruckbuttocklimbsface器官功能紊乱(disordersofmultipleorgansandtissues),临床分度(消瘦型）,3岁以下儿童营养不良特点体重低于正常15-25%25-40%40%腹壁皮褶厚度0.8-0.4cm30%,NutritionalmicrocyticanemiaAllkindsofvitaminsdeficiencyInfectionsSpontaneoushypoglycemia,Complications,体重低下（underweight）生长迟缓（stunting）消瘦（wasting）,Diagnosis,Ages：ItusuallyaffectstheinfantunderthreeyearsoldofageHistory:FeedinghistoryandahistoryofinfectionandsystemicdiseaseClinicalmanifestations:lossofweight,decreaseanddisappearanceofsubcutaneousfatAssistantexamination：IGF-1，Prealbumin,Diagnosis,ExcludingcausesAdjustingdietscaloriesmild：6080kcal/kg.dmid-severe：4055kcal/kg.dprotein1.52.0g/Kg.dmultiplevitaminsandmineralssupplying,Treatment,FacilitatingdigestionThetherapyofcomplicationsIntensivecare,Treatment,各系统功能低下,免疫功能,消化系统,泌尿系统,循环系统,神经系统,各种感染,食欲不振、腹泻,多尿、低比重尿,血压下降、脉弱、肢凉,表情淡漠、学习困难、智力低下,饮食不当,疾病因素,营养不良,低蛋白血症,脂肪消耗,糖原累积不足,水肿,细胞外液