如何合理实施肠外营养支持

Detsky et al, JPEN 1987.
Detsky et al, JAMA 1994.
10
Clinical Outcomes of malnutrition
Tewari N，et al:Lung Cancer (2007) 57, 389—394 11
Clinical Outcomes of malnutrition
P<0.001
normal score
Schiesser M et al:Clinical Nutrition 2008;27:565-570 14
PJ Ross；British Journal of Cancer (2004) 90, 1905 – 1911
15
Clinical Outcomes of malnutrition
Pirlich M，Clinical Nutrition (2006) 25, 563–572 12
Clinical Outcomes of malnutrition
p < 0.001;
608 patients admitted for elective gastrointestinal surgery. Nutritional risk was defined by NRS 2002 and correlated to the incidence of postoperative complications
并发症发生率
50%
45%
*P=0.04
40%
35%
30%
25%
20%
15%
10%
5%
0% TPN
Control
Klein S, JPEN 1997,21:133
18
Nutritional Therapy Affects Outcomes
Buzby et al, Am J Surgical 1980. Hickman et al, JPEN 1980. Klidjian et al, JPEN 1982.
9
Malnutrition Is Associated with Increased Complications
• 42% of patients with severe malnutrition experience major complications
Schiesser M et al:Clinical Nutrition 2008;27:565-570 13
Clinical Outcomes of malnutrition
complication rate (%)
100
90
80
NRS 2002
70
60
50
p < 0.001;
40
30
20
10
0 nutritional risk
• Malnutrition occurs in 30-87% of cancer patients –Shills ME;et al: Cancer Res 1977; 37: 2366 –Nixon DW et al: Am J Med1980; 68: 683 –Tchekmedyian NS et al: Oncology 1995; 9: 79 – Andreyev et al:Eur J Cancer 1998;34:503 –Monitto CL et al: Am J Physiol 2001; 281: E289 –Stephens NA et al: Medicine 2007;36:(2):78-81
6
营养不良的危害
免疫机能下降 脏器功能异常
预后不良
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www.nordridesign.c7om
Cumulative Mortality: Protein-Energy Malnutrition
50
PEM
40
Non-PEM
30
P<0.01
Mortality %
20
10
0
0
1
2
3
4
5
6
7
8
9
Months after admission
如何合理实施临床营养支持
How to Implement Rational Clinical Nutrition Therapy
吴国豪
复旦大学附属中山医院普外科 复旦大学普通外科研究所
1
如何进行合第理一的部营分养支持？
为什么需要营养支持? 那些病人需要营养支持?
2
Prevalence of malnutrition
Bachmann J，J Gastrointest Surg (2008) 12:1193–1201 16
营养支持在疾病治疗中的作用
作用与目标:调整病人的代谢改变及内 稳态失衡, 改善营养状态与免疫机能
➢降低医院获得性感染发生率 ➢缩短住ICU时间 ➢最终改善病死率
17
ห้องสมุดไป่ตู้
营养支持对营养状态的影响
14PRCTs（1250胃肠道肿瘤病人）
• 9% of patients with moderate malnutrition experience major complications
• Severely malnourished patients are four times as likely to have post-operative complications as well-nourished patients
The German hospital malnutrition study
Matthias Pirlich，Clinical Nutrition (2006) 25, 563–572 3
4
癌性恶病质的发生率
N A Stephens; MEDICINE 2007;36:(2):78-81 5
Malnutrition is common in cancer patients
Cederholm et al, Am J Med 1995.
8
Malnutrition Is Associated with Increased Complications
Numerous studies have demonstrated complications of malnourished patients to be 2-20 times greater than those of well nourished patients.