surgical_nutrition(正式)外科营养

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Pathophysiology
Proteins and amino acids
Require daily intake 0.8 g kg-1 ie. 56 g for a 70 kg person
Essential: a.a only obtained by dietary source
(estimated normal non-urinary Nitrogen losses about 3-4g/d)
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Pathophysiology
Fatty acids
Short, medium chain FA directly enter portal system
Long chain FA transported as triglycerides Essential FA unable to be synthesised ie.
Minor operation 1.2 x BMR
Trauma
1.3 x BMR
Sepsis
1.6 x BMR
Burns
2.1 x BMR
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Pathophysiology
Vitamins
Key metabolic roles Fat soluable (A, D, E, K) or water soluable
Use of an intact gastrointestinal tract for nutritional support
Benefits : physiologic ; immunologic ; saffety; cost;
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Indications for enteral feeding
7 kcal g-1
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Patho-physiology
Energy requirements:
BMR calculated by Harris-Benedict equation
66.47 + [13.75 x W] + [5 x H] – [6.76xA]
Additional caloric needs calculated by an injury factor, eg.
Non-essential: can be endogenously synthesised ‘conditionally essential’: a.a unable to be
synthesised under certain conditions eg. Stress, surgery
L-alanine, L-glutamate, L-asparate
The body requires an energy source to remain in a steady state.
Calories
Calories can come from glucose or fat. The metabolism of lg glucose yields 3.4kcal. The metabolism of lg fat yields 9. 2kcal. Fat can be used to provide as much as 60% of daily caloric requirements.
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Malnutrition Introduction
Malnutrition occurs in approx.40% of hospitalised patients
Malnutrition can lead to increased post-operative morbidity and mortality
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Although modern practice is to make aggressive use of the gut for nutritional support
intravenous nutrition remains a critical therapy in instances in which enteral support cannot be achieved
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Protein
Protein balance reflects the sum of protein synthesis and protein breakdown. The quality of a protein is related to its amino acid composition. The 20 amino acids are divided into essential amino acids (EAAs) and nonessential amino acids (NEAAs) depending on whether they can be synthesized in the body.
Malnourished patients who have an intact gastrointratinal tract should initially be given enteral feeding.
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Possible contraindications to enteral feeding
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Fatty Acids
Fatty acids are classified as short-chain, medium-chain, or long-chain.
The body is able to synthesize fats from other dietary substrates, but two of the longchain fatty acids (linoleic and –α-linolenic) are essential.
Surgical Metabolism and Nutrition
Dr. Ouyang Jun, MD, PhD
the First Affiliated Hospital of Soochow University
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Questions
What is surgical nutrition？ Benefits of Nutritional Support? Who requires nutritional support? How can we get nutritional support?
Preservation of nutritional status Prevention of complications of protein
malnutrition Post-operative complications
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Nutritional support, along with antibiotics, blood transfusion, critical care monitoring, advances in anesthesia, organ transplantation, and cardiopulmonary bypass, ranks high among advances in surgery achieved in the 20th century。
Linoleic and linolenic acid. Deficiency causes skin, kidney disorders
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Pathophysiology
Energy requirements:
Total daily expenditure – 25-30 kcal kg-1
Impairment of skeletal, cardiac, respiratory muscle function
Impairment of immune function Atrophy of GIT Impaired healing
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Nutritional Pathophysiology
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Pathophysiology
Trace elements
Zinc – wound healing, protein and nucleic acid synthesis
Fe – energy transfer Copper – collagen synthesis Selenium – anti-oxidant enzyme system
Efficient functioning of the immune system depends upon a balance of eicosanoid production between theω-6 and ω-3 PUFA.
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Vitamins
Vitamins are involved in metabolism, wound healing, and immune function.
The gastrointestinal tract can not be used. Two methods: peripheral Parenteral
nutrition and tol tal Parenቤተ መጻሕፍቲ ባይዱeral nutrition
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Benefits of Nutritional Support
Short bowel, gastrointestinal obstruction, gastrointestinal bleeding, ileus, fistulas, diarrhea, protracted vomiting ect.
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Parenteral nutrition
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What is surgical nutrition？
The nutritional problems in surgical diseases
Including enteral and parenteral nutrition
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Enteral nutrition
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Pathophysiology
Changes in Starvation:
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Trace Elements
Trace elements have important functions in metabolism, immunology, and wound healing.
Subclinical trace element deficiencies occur in many common diseases.
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Pathophysiology
Nutritional Balance = N input - N output
1 g N = 6.25 g protein
N input = (protein in g / 6.25)
N output = 24h urinary urea nitrogen + nonurinary N losses
either because the gut cannot be used or because caloric requirements cannot be met by the gut alone and must be supplemented parenterally.
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NUTRIENT REQUIREMENTS AND SUBSTRATES
Resting metabolic rate
Activity energy expenditure
Diet induced energy expenditure
Sources:
Fats
9 kcal g-1
Protein
4 kcal g-1
Carbohydrates
4 kcal g-1
Alcohol