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1、单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,外科营养医学知识,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,外科营养医学知识,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,外科营养医学知识,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,外科营养医学知识,#,外科营养医学知识,2,Questions,What is surgical nutrition,？,Benefits of Nutritional Suppor
2、t?,Who requires nutritional support?,How can we get nutritional support?,外科营养医学知识,3,What is surgical nutrition,？,The nutritional problems in surgical diseases,Including,enteral,and,parenteral,nutrition,外科营养医学知识,Enteral nutrition,Use of an intact gastrointestinal tract for nutritional support,Benefit
3、s:physiologic;immunologic;saffety;cost;,4,外科营养医学知识,Indications for enteral feeding,Malnourished patients who have an intact gastrointratinal tract should initially be given enteral feeding.,5,外科营养医学知识,Possible contraindications to enteral feeding,Short bowel,gastrointestinal obstruction,gastrointest
4、inal bleeding,ileus,fistulas,diarrhea,protracted vomiting ect.,6,外科营养医学知识,Parenteral nutrition,The gastrointestinal tract can not be used.,Two methods:peripheral Parenteral nutrition and total Parenteral nutrition,l,7,外科营养医学知识,8,Benefits of Nutritional Support,Preservation of nutritional status,Prev
5、ention of complications of protein malnutrition,Post-operative complications,外科营养医学知识,9,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 2
6、0th century,。,外科营养医学知识,10,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,either because the gut cannot be used or because caloric requirements cannot be me
7、t by the gut alone and must be supplemented parenterally.,外科营养医学知识,11,NUTRIENT REQUIREMENTS AND SUBSTRATES,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 9.2kca
8、l.Fat can be used to provide as much as 60%of daily caloric requirements.,外科营养医学知识,12,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)a
9、nd nonessential amino acids(NEAAs)depending on whether they can be synthesized in the body.,外科营养医学知识,13,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 long-chain fatty acids(linoleic a
10、nd-linolenic)are essential.,Efficient functioning of the immune system depends upon a balance of eicosanoid production between the-6 and-3 PUFA.,外科营养医学知识,14,Vitamins,Vitamins are involved in metabolism,wound healing,and immune function.,外科营养医学知识,15,Trace Elements,Trace elements have important functi
11、ons in metabolism,immunology,and wound healing.,Subclinical trace element deficiencies occur in many common diseases.,外科营养医学知识,16,Malnutrition Introduction,Malnutrition occurs in approx.40%of hospitalised patients,Malnutrition can lead to increased post-operative morbidity and mortality,Impairment o
12、f skeletal,cardiac,respiratory muscle function,Impairment of immune function,Atrophy of GIT,Impaired healing,外科营养医学知识,17,Nutritional Pathophysiology,外科营养医学知识,18,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
13、 source,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,外科营养医学知识,19,Pathophysiology,Nutritional Balance=N,input,-N,output,1 g N=6.25 g protein,N,input,=(protein in g,/6.25),
14、N,output,=24h urinary urea nitrogen+non-urinary N losses,(estimated normal non-urinary Nitrogen losses about 3-4g/d),外科营养医学知识,20,Fatty acids,Short,medium chain FA directly enter portal system,Long chain FA transported as triglycerides,Essential FA unable to be synthesised ie.Linoleic and linolenic a
15、cid.,Deficiency causes skin,kidney disorders,Pathophysiology,外科营养医学知识,21,Pathophysiology,Energy requirements:,Total daily expenditure 25-30 kcal kg,-1,Resting metabolic rate,Activity energy expenditure,Diet induced energy expenditure,Sources:,Fats9 kcal g,-1,Protein4 kcal g,-1,Carbohydrates4 kcal g,
16、-1,Alcohol 7 kcal g,-1,外科营养医学知识,22,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.,Minor operation 1.2 x BMR,Trauma1.3 x BMR,Sepsis 1.6 x BMR,Burns2.1 x BMR,外科营养医学知识,23,Pathophysiology,Vitamins,Key metabolic roles,Fat soluable(A,D,E,K)or water soluable,外科营养医学知识,24,Pathophysiology,Trace elements,Zinc wound healing,protein and nucleic acid synthesis,Fe energy transfer,Copper co
