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编号:10500054
全肠外营养在腹部外科围手术期的应用体会
http://www.100md.com 中国临床营养杂志 2000年第1期第8卷 专题报告及营养支
     作者:陈焕伟 甄作均 潘文松

    单位:佛山市第一人民医院普外科

    关键词:

    中国临床营养杂志000164摘 要:目的自1998年12月以来对53例腹部大、中手术的病人,在围手术期辅以全肠外营养支持治疗(TPN)的作用。 方法均用双能源供能,“全合一”形式输注。非蛋白质热能为105~150kJ·kg-1·d-1,氮量为0.16~0.35g·ks-1·d-1,脂肪占总热量的30%~40%。 结果53例病人的血浆蛋白在TPN支持结束后接近或超过术前水平,体重稳定或有不同程度增加(0.5~3kg),术后5~7天获得正氮平衡。TPN使患者的营养状况得到改善,加速术后的恢复,减少并发症的发生。 结论①适宜的TPN支持能使腹部外科危重病人渡过凶险而漫长的病程,提高治愈率。②术前对有明显营养不良,估计对手术耐受力差的病人,进行5~7d的营养支持,是十分必要的;而术后的TPN支持,一般不应少于1周。③营养物质的输入应遵循“代谢支持”的原则。④肠外营养支持不仅可改善胃肠道肿瘤病人的营养状况,提高机体免疫力,而且结合化疗可增强抗癌作用。⑤对肠瘘病人TPN支持具有减少肠液漏出,促进瘘道愈合及防治感染等多重作用。⑥对重症胰腺炎病人TPN支持能适当补充机体所需的营养,减少胰腺外分泌。
, 百拇医药
    Experience of total parenteral nutrition during perioperative period in abdominal surgery

    CEHN Huanwei ,ZHEN Zuojun ,PAN Weusong

    (Department of General Surgery, the First People' s Hopsital of Foshan, Guangdong)

    Abstract: 53 cases who underwent major and moderate abdominal surgery were administered total paraenteral nutrition(TPN) by double energy resources and "all in one" irffusion way since December 1998. Non-protein energy was 105~150KJ/kg·d. Nitrogen was 0.16 ~0.35g/kg·d, Fat was 30%~40% of total energy. Serum protein of the cases were approximately or exceeded preoperative level. Body weight remained stable or increased (0.5~3kg). Positive nitrogen equilibrium was achieved 5~7d postoperatively. TPN improved the patients nutritional status, facilitated postoperative recovery and reduced the occurence of complications. We have the experience: (1) Appropriate nutrition support helps the critical patients of abdominal surgery tide over the long critical course and enhance curative rate. (2) It is necessary for the patients of obvious malnutrition and poor tolerance for operation to receive nutritional support for 5~7d. Postoperative TPN support should not be less than 1 week. (3)Infusion of nutritional ingredients should follow the principle of "metabolic support". (4)TPN can improve not only nutritional condition and immunity,but anticaneerous function of patients with gastrointestinal tract tumor combined with chemotherapy. (5)TPN support can reduce intestinal fluid leakage, facilitae fistua healing and prevent infection for patients with intestinal fistula. (6)TPN support can supply appropriately body needed nutrition and reduce exocrine secretion of pancreas for patients with severe pancreatitis., 百拇医药