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題名 | 敗血症病人營養支持的最新臨床實證發展=New Evidence-Based Nutritional Support in Sepsis |
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作者 | 楊雀戀; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 6:3 民93 |
頁次 | 頁250-257 |
分類號 | 416.351 |
關鍵詞 | 營養支持; 免疫營養; 營養素需要量; 敗血症; Nutritional support; Immunonutrition; Nutrient requirement; Sepsis; |
語文 | 中文(Chinese) |
中文摘要 | 敗血症所造成的體內代謝紊亂及營養素利用障礙情形,雖然與外傷或術後的狀況相似,但常因後續的衝擊更顯複雜,因此營養或代謝支援,必須依臨床情況之不同而調整。初期體內環境不穩定時,過早給予複雜的營養支持,可能使正常的營養物質變成代謝性毒物,反而會加重代謝的紊亂,但當病情稍為穩定後,應積極給予營養支持,逐漸增加腸道營養而減少靜脈營養,並適時配合使用強化免疫營養素,如麩醯胺酸及n-3脂肪酸,以緩和組織耗損、調控炎症反應及避免發生續發性院內感染。適當的營養療法配合積極的臨床處置,有助於感染控制;然而不當的營養支持及其併發症也可能導致敗血症的發生及影響病程,本文綜合評述敗血症病患營養支持原則及臨床實證最新的發展。 |
英文摘要 | Sepsis is associated with profound catabolism and hypermetabolism as trauma or injury, but it is more often complicated by subsequent insults, which is why nutritional or metabolic support should be modulated according to different post-inflammatory states. As long as the hemodynamic and respiratory status remains unstable, nutritional interference, mainly via the parenteral route, can do more harm than good. During the later phases, a gradual increase in enteral nutrition, at the expense of parenteral nutrition, combined with the administration of nutraceuticals such as glutamine and w-3 fatty acids, can counteract wasting and modulate the complex inflammatory response and immunosuppression associated with sepsis. The optimal nutritional regimens associated with aggressive measures to control the sepsis. However, nutritional therapy and its complications may also affect the incidence and course of sepsis. The purpose of this review is to provide updated practical guidelines for nutritional management of critically ill patients with sepsis or septic shock, and to present recent development of particular interest. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。