肠内营养的临床应用-(瑞代、瑞能）

1、 e971631 s10 2 e971631 s10 3 e971631 s10 4 e971631 s10 5 e971631 s10 6 传统观念：传统观念： e971631 s10 7 e971631 s10 8 吴国豪等吴国豪等 中国临床营养杂志中国临床营养杂志 19971997 吴国豪等吴国豪等 中国临床营养杂志中国临床营养杂志 19971997 蒋朱明等蒋朱明等 中国临床营养杂志中国临床营养杂志 1999 * p=0.03 briassoulis g, et al: nutrition 2001;17:548-557 *p0.0001 briassoulis g, et al: n

2、utrition 2001;17:548-557 *p0.0001 * p=0.002 *p0.001 hochwald am j surg 1997;325 kudsk et al: surgery 1994;516 takagi k, et al: nutrition 2000;16:355-360 takagi k, et al: nutrition 2000;16:355-360 briassoulis g, et al: nutrition 2001;17:548-557 * * 手术后手术后 2h2h内未见内未见mmcmmc相波形，相波形， 仅可见微弱仅可见微弱 的小振幅的收缩的小

3、振幅的收缩 * * 手术后手术后 早期早期mmcmmc波形特点，波形特点，mmc mmc 相消失，相消失，相与相与相交替出现相交替出现 * * 给予肠内营养后给予肠内营养后 mmcmmc波形的变化特点：转变为餐后形式波形的变化特点：转变为餐后形式 * * 对照组病人对照组病人mmcmmc传导速度传导速度 v=0.02cm/sv=0.02cm/s * * 肠内营养组病人肠内营养组病人mmcmmc传导速度传导速度 v=0.08cm/sv=0.08cm/s e971631 s10 22 30 days 76 days windsor et al gut 42:431-5 1998) e971631

4、s10 24 e971631 s10 25 e971631 s10 26 e971631 s10 27 e971631 s10 28 e971631 s10 29 位位 广谱抗生素广谱抗生素肠道菌群失调肠道菌群失调致病菌繁致病菌繁 殖殖 e971631 s10 30 、 e971631 s10 31 e971631 s10 32 e971631 s10 33 e971631 s10 34 e971631 s10 35 e971631 s10 36 e971631 s10 37 蒋朱明等蒋朱明等 中国临床营养杂志中国临床营养杂志 2000 * p=0.004 0 5 10 15 20 25 30

5、 35 ent pnt percent of patients pneumoni a (p.02) intra- abdominal abscess (p.04) line sepsis (p.05) e971631 s10 41 e971631 s10 42 briassoulis g, et al: nutrition 2001;17:548-557 * briassoulis g, et al: nutrition 2001;17:548-557 * e971631 s10 45 e971631 s10 46 e971631 s10 47 e971631 s10 49 e971631 s

6、10 50 e971631 s10 51 e971631 s10 52 e971631 s10 53 e971631 s10 54 e971631 s10 55 -40-40 -20-20 0 0 2020 4040 6060 8080 100100 0 06060120120180180240240 time (minutes)time (minutes) blood glucoseblood glucose std. for.std. for. formulaformula e971631 s10 56 0 0 2 2 4 4 6 6 8 8 1010 1212 1414 1616 181

7、8 2020 0 0303060609090 time (minutes)time (minutes) insulin concentrationinsulin concentration std. for.std. for. formulaformula e971631 s10 57 e971631 s10 58 e971631 s10 59 e971631 s10 60 e971631 s10 61 e971631 s10 62 e971631 s10 63 糊糊精精 - 麦麦芽芽糖糖合合剂剂 果果糖糖 0 10 20 30 40 50 60 70 80 90 100 glycemic i

8、ndex = gi 全淀粉 miller fp; am j clin nutr 1995; 62:871s-93s sturmer w; et al: clinical nutrition (1994) 13:221-227 bg mmol/l sturmer w; et al: clinical nutrition (1994) 13:221-227 otto c, et al: clin investing (1993) 71:290-293 otto c, et al: clin investing (1993) 71:290-293 otto c, et al: clin invest

9、ing (1993) 71:290-293 stiller r, et al: krnahr med 18:1993 stiller r, et al: krnahr med 18:1993 e971631 s10 72 e971631 s10 74 21% moderately malnourished 69% well nourished 10% severely malnourished 肿瘤患者营养不良发生率肿瘤患者营养不良发生率 65%65% 65%65% 61%61% 59%59% 36%36% 33%33% 29%29% 23%23% 0%0%10%10%20%20%30%30%

10、40%40%50%50%60%60%70%70% abd caabd ca pancreaspancreas esophagusesophagus gastricgastric colorectumcolorectum liver-gallliver-gall gu-gyngu-gyn lymphomalymphoma -35-35 -30-30 -25-25 -20-20 -15-15 -10-10 -5-5 0 0 结肠结肠前列腺前列腺肺肺胰腺胰腺胃胃 6个月内体重丢失6个月内体重丢失 体重丢失百分比（% ）体重丢失百分比（% ） e971631 s10 78 e971631 s10 79

11、 e971631 s10 80 e971631 s10 81 e971631 s10 82 months after admission 0 10 20 30 40 50 0123456789 pem non-pem p0.01 e971631 s10 83 1st hospitalization2nd hospitalizationat 6 months with without e971631 s10 84 -0.2-0.2 0 0 0.20.2 0.40.4 0.60.6 0.80.8 1 1 1.21.2 synthesissynthesiscatabolismcatabolismox

12、idation netoxidation net balancebalance net balancenet balance umol leu/kg/minumol leu/kg/min ivfivf feedfeed e971631 s10 85 without peg (n=76) with peg(n=27) radiotherapy * * p -0.038 e971631 s10 86 30 days 76 days e971631 s10 87 e971631 s10 88 e971631 s10 89 肿瘤细胞的能量主要来源于葡萄糖 e971631 s10 90 e971631

13、s10 91 e971631 s10 93 e971631 s10 94 -4-4 -3-3 -2-2 -1-1 0 0 1 1 2 2 3 3 prestudyprestudy3 weeks3 weeks7weeks7weeks weight change (kg)weight change (kg) barber et al: br j cancer 1999 e971631 s10 96 barber et al: j nutr 1999 gogos et al: cancer 1998 moses et al: cancer res 2001 e971631 s10 97 e97163

14、1 s10 98 korber j, et al: anasthesie 1993:534 meray jg; 2001 espen 0 0 0.050.05 0.10.1 0.150.15 0.20.2 0.250.25 0.30.3 day -8day -8day -1day -1day 1day 1day 8day 8 prealbumin (g/l)prealbumin (g/l) supportansupportan controlcontrol 0 0 2 2 4 4 6 6 8 8 1010 1212 1414 1616 1818 day -8day -8day -1day -1day 1day 1day 8day 8 ig g (g/l)ig g