儿科病人营养支持的新进展
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中国临床营养杂志000129Pediatric nutrition support for Y2K:an update
John R. Wesley, MD.
(Adjunct professor of surgely northwestern univrsity Medical School, Medical Director & vice president baxter healthcare international (USA))
As the medical profession enters Y2K, the pediatric population is commanding increased attention. Medical centers of excellence, demonstrating best practice techniques, are being copied more frequently due to increased communication and better education. The team approach to nutrition support has been refined to include the importance of standards for care, and the importance of hospitalwide protocols. Outcome studies under these improved conditions are demonstrating increased efficiency, with reduced expense, reduced complications,and shorter hospital stay. Nutrition assessment at the time of the patient's admission is important. Global assessment works weel with emphasis on simplicity. It is important to establish baseline parameters, and Administering nutrition support requires appropriate escalation. Enteral is the preferred route (if the gut works, use it!) and when the gut cannot absorb sufficient calories, a combination of enteral and parenteral is effective. Total parenteral nutrition is utilized less frequently now than previously, and, even when essentially all calories must be given intravenolusly, a background patter of enteral nutrition should be sustained. Vascular access used to be a much more challenging problem than it is today. Due to advances in access techniques and improved catheter materials, there is almost always a way to establish vascular access. Changes for Y2K include an increased emphasis on physiology and metabolism, disease-specific nutrition support, and organ-specific nutrition support including the appropriate use of growth hormone and glutamine. The importance of activity and exercise is more widely recognized, and both patient and family have become more engaged in healthcare and the process of wellness. The contribution of alternative forms of medical care is more widely recognized, and the effects of "managed care" are increasingly focused on the importance of preventive medicine,and healthcare as a social priority.
, http://www.100md.com
随着医学进入21世纪，儿科病人需要更多的关注。由于通讯和教育系统的进步，很多先进的治疗手段很快得到推广应用。从事营养支持的人员都经过严格的训练，包括强调制订统一的治疗标准和治疗方案的重要性。在这种情况下完成的研究结果表明提高疗效，同时降低花费和并发症，缩短住院时间。病人入院时的营养评定很重要，普遍被应用的评定方法都简单易行。建立基础参数很重要。在营养不良的儿科病人中进行的研究显示，营养情况的好转改善了伤口愈合、免疫功能，减少死亡率。营养支持的管理需要有适当的调整。肠内营养是最佳途径(如果胃肠道有功能，就应该使用它)，如果胃肠道不能吸收足够的热卡，应该同时供给肠内和肠外营养。目前肠外营养较以前已经较少使用，即使在全部的必需热卡均需要由肠外途径提供时，就应为肠内营养做好准备。在过去，血管的穿刺往往是很大的问题，现在由于穿刺技术和导管材料的进步，使建立静脉通路不再是一个问题。
2000年营养支持的进步应包括：更强调生理和代谢，针对某些疾病进行特殊的营养支持，针对不同器官的营养支持，包括生长激素和谷氨酰胺的应用。运动和锻炼的重要性受到更多的重视，越来越多的病人和家庭参与到健身运动中来，同时预防医学的重要性也越来越受到重视。, http://www.100md.com
单位：
关键词：
中国临床营养杂志000129Pediatric nutrition support for Y2K:an update
John R. Wesley, MD.
(Adjunct professor of surgely northwestern univrsity Medical School, Medical Director & vice president baxter healthcare international (USA))
As the medical profession enters Y2K, the pediatric population is commanding increased attention. Medical centers of excellence, demonstrating best practice techniques, are being copied more frequently due to increased communication and better education. The team approach to nutrition support has been refined to include the importance of standards for care, and the importance of hospitalwide protocols. Outcome studies under these improved conditions are demonstrating increased efficiency, with reduced expense, reduced complications,and shorter hospital stay. Nutrition assessment at the time of the patient's admission is important. Global assessment works weel with emphasis on simplicity. It is important to establish baseline parameters, and Administering nutrition support requires appropriate escalation. Enteral is the preferred route (if the gut works, use it!) and when the gut cannot absorb sufficient calories, a combination of enteral and parenteral is effective. Total parenteral nutrition is utilized less frequently now than previously, and, even when essentially all calories must be given intravenolusly, a background patter of enteral nutrition should be sustained. Vascular access used to be a much more challenging problem than it is today. Due to advances in access techniques and improved catheter materials, there is almost always a way to establish vascular access. Changes for Y2K include an increased emphasis on physiology and metabolism, disease-specific nutrition support, and organ-specific nutrition support including the appropriate use of growth hormone and glutamine. The importance of activity and exercise is more widely recognized, and both patient and family have become more engaged in healthcare and the process of wellness. The contribution of alternative forms of medical care is more widely recognized, and the effects of "managed care" are increasingly focused on the importance of preventive medicine,and healthcare as a social priority.
, http://www.100md.com
随着医学进入21世纪，儿科病人需要更多的关注。由于通讯和教育系统的进步，很多先进的治疗手段很快得到推广应用。从事营养支持的人员都经过严格的训练，包括强调制订统一的治疗标准和治疗方案的重要性。在这种情况下完成的研究结果表明提高疗效，同时降低花费和并发症，缩短住院时间。病人入院时的营养评定很重要，普遍被应用的评定方法都简单易行。建立基础参数很重要。在营养不良的儿科病人中进行的研究显示，营养情况的好转改善了伤口愈合、免疫功能，减少死亡率。营养支持的管理需要有适当的调整。肠内营养是最佳途径(如果胃肠道有功能，就应该使用它)，如果胃肠道不能吸收足够的热卡，应该同时供给肠内和肠外营养。目前肠外营养较以前已经较少使用，即使在全部的必需热卡均需要由肠外途径提供时，就应为肠内营养做好准备。在过去，血管的穿刺往往是很大的问题，现在由于穿刺技术和导管材料的进步，使建立静脉通路不再是一个问题。
2000年营养支持的进步应包括：更强调生理和代谢，针对某些疾病进行特殊的营养支持，针对不同器官的营养支持，包括生长激素和谷氨酰胺的应用。运动和锻炼的重要性受到更多的重视，越来越多的病人和家庭参与到健身运动中来，同时预防医学的重要性也越来越受到重视。, http://www.100md.com