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題名 | 外科重症病人的營養照顧=Nutritional Support for the Surgical Critically Ill Patients |
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作者 | 黃燦龍; Hwang, Tsann-long; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20010100 |
卷期 | 3:1 2001.01[民90.01] |
頁次 | 頁35-46 |
分類號 | 416.351 |
語文 | chi |
關鍵詞 | 支鏈性胺基酸; 中鏈性脂肪酸; 中心靜脈全營養; 免疫加強; Branched chain amino acid; Mid-chain fatty acid; Total parenteral nutrition; Immunomodulation; |
中文摘要 | 外科病人無論在手術前後,或是在加護病房,體內的新陳代謝有相當大的改變。這些改變包括糖質新生作用增加、肌肉分解增加、周邊支鏈性胺基酸氧化增加、肝臟合成蛋白及尿素增加、脂肪分解及乳酸和丙酮生成增加。為了應付上述的變化,病人的營養支持必須給予足夠的能量、增加以支鏈性胺基酸為主的蛋白質給予、以及供應中鏈性脂肪酸為主的必要脂肪酸。重症病患的營養支持應該儘量以腸道營養為主,以減少細菌轉位及感染的機會。如果腸道營養無法供應足夠的能量,就必須給予部份或全靜脈營養。高濃度中心靜脈全營斧可以提供足夠的能量及氮素需求,但也必需注意到相關的併發性,包括血糖過高、肝臟功能異常以及靜脈導管的感染等。此外,增加免疫力的靜脈或腸道營養配方,包括:精胺酸、麩醯胺、核甘酸以及ω-3脂肪酸等,可儘量用於容易感染的老早及低抵抗力的病患。依據上述原則的重症營養給予,將可提高病人的抵抗力,改善體內的代謝異常,減少感染的機會以及提高重症病人的存活率。 |
英文摘要 | There are much changes of metabolism for the postoperative or critically ill surgical patients. These changes include increased gluconeogenesis, increased muscle breakdown, increased oxidation of peripheral branched chair amoino-acids, increased hepatic protein synthesis, increased urea formations, increased lipolysis and formation of lactic acid and ketone body. For the above metabolic changes, the nutritional support should include enough energy supply, increased protein supply with branched chain amino acid and use mid-chain fatty acid as essential fatty acid. Enteral feeding is considered as first of choice, which can reduce the incidence of bacterial translocation. The peripheral or total parenteral nutrition is considered when patient can’t receive enough nutrition from enteral feeding. The total parenteral nutrition may provide the patients with enough energy and nitrogen, but its complications should be cared for, which include hyperglycemia, hepatic dysfunction and infection of central venous line. The immunomodulational diets ehich include arginine, glutamine, nucleotide and ω-3 fatty acid may increased patient’s immunity. The old and immune compromised patients are advised to use immunomodulational diet as possible after following the above general principles of nutritional support in critically in patients, we can improve patients’ resistance for infection, correct their metabolic abnormality, reduce the incidence of infection and improve the patient’s survival. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。