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????????? Noruishment and metabolism of surgical patients

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Title: Immunonutrition Author: Medical Center User Last modified by: lq642 Created Date: 3/6/2002 4:05:48 PM Document presentation format: – PowerPoint PPT presentation

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Title: ????????? Noruishment and metabolism of surgical patients

1
?????????Noruishment and metabolism of surgical
patients
? ? ?????????????
2
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?????????????????????????
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3
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from Sabiston Textbook of Surgery

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4
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5
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?????
?????(EAA)
??????(NEAA)
???????(??????????????????????)
??????,??????aa????,??????

6
????(Gln)

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???????????
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?????????????????????? ????,????????????????
Gln??????????,???????????????????

7
???

??????????????,????????
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8
???????

????????????????????????
????????,????????
????????(???)???0.81.0g/(kg.d),?????0.15g/(kg.d)
?
????????????
1.21.5g/(kg.d),???0.20.25 g/(kg.d)?

9
(?)???????

???????????????????
?? ?3765.6KJ,??900kcal,???1/2?
???????,??????????,?????????????
??????????(?15Kg),?????????,?????????????

10
????????

??????(basal energy expenditure,BEE)?????????????
??,???????????????????????????????????????(BMR)???
Harris Benedict?????BEE?
Men 66 (13.7x weight) (5x height) (6.8 x
age).
Women 65 (9.6 x weight) (1.7 x height) (4.7
x age)
Most require 25-35 kcal/kg/day.
Stress increases these values.

??????(Resting Energy Expenditure,REE)??????????
?,???????,???????30???????????????
In hospitals these conditions are not ideal.
Therefore REE BMR 1.1
????????????104.6kJ(25kal)?????15?????,85?????
??????????????????1001501

12
????

Prevalence 30-55 of hospitalized patients.
Do you know it when you see it?

13
(No Transcript)
14
Nutritional assessment

Clinical assessment
Weight loss
10 mild malnutrition ????
30 severe malnutrition
Body mass index ??(??)????(?)??
Anthropometric assessment ????
Triceps skin fold thickness
Mid arm circumference
Hand grip strength
Blood indices
Reduced serum albumin, prealbumin or transferrin
Lymphocyte count

???????(?gt10mm,?gt13mm) ????(?gt20.2mm,?gt18.6mm)
???lt????10
????????,lt1.5109/L???????
15
Laboratory values

Albumin (t1/221 days)
Hypoalbuminemia associated with mortality and
post-op complications.
Poor indicator of nutritional status (can be
normal in malnourished states and low in
well-nourished states)
Transferrin (t1/29 days)
Has not been extensively studied
Affected by iron metabolism
Pre-albumin (t1/2 2-3 days)
Increased in renal failure, steroids decreased
in liver failure, infection (negative acute phase
reactant)
?????????????.

16
???????
?? ?? ??
???? ()lt10 10-20 gt20 ?????
gt3.5mg/dl 2.5-3.5 lt2.5 ??????
gt200mg/dl 125-200 lt125 ?????
lt1200 800-1200 lt800
17
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18
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19
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20
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21
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