【医学精品课件】胃肠外营养 (Parenteral nutrition, PN ).pptx

胃肠外营养 (Parenteral nutrition, PN )浙江大学医学院附属邵逸夫医ICU 潘孔寒1986年2月，上海周绮思女士因患急性肠扭转切除全部小肠，华瑞决定长期无偿向提供生存所需的全套全静脉营养产品. 1992年4月8日，历史将记住这一天。蔡惟成为世界上完全依靠人工全静脉营养孕育的第一人。周绮思母女的事例也因此被载入吉尼斯世界纪录。 References History of parenteral nutrition. JPEN， 27:225-232, 2003 A.S.P.E.N. Board of Directors and the Clinical Guidelines Taskforce: Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN， 26(Suppl):1–138,2002Canadian Clinical Practice Guidelines for Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients. JPEN， 27:355–373, 2003危重患者营养支持指导意见（草案）(中华医学会重症医学分会).中国危重病急救医学,10(18)：582－590,2006 住院患者肠外营养支持的适应证（草案)(中华医学会肠外肠内营养学分会).中国危重病急救医学,10(18)：591－594,2006 循证医学：证据分级A级 以良好研究为基础的证据来支持指南 (前瞻、随机试验)B级 以较好研究为基础的证据来支持指南 (设计较好但无随机化)C级 依据专家观点和共识来制订指南ContributorsJonathan Evans Rhoads, MD, Surgical Nutritionist the Harrison Department of Surgery at the University of Pennsylvania Stanley Dudrick, MD, Henry Vars, PhD, Douglas Wilmore, MD, and others at the University of Pennsylvania The full development of parenteral nutrition, as we know it today, was dependent on endless hours of effort by dedicated nurses, pharmacists, and dietitians.HistoryComplete parenteral or IV nutrition is a therapeutic method that has been available for approximately 50 years The successful development of this mode of therapy, in a modern sense, was initiated in the late 1930s, but its practical clinical use did not emerge until the 1960s. History1The discovery of the circulation of the blood by William Harvey in 1628 formed the basis for the rationale for IV injections and infusions. A decade later, an important contribution to the development of IV infusions was made during the severe cholera epidemic of 1831 to 1832 by the Scottish physician Latta.He was the first to infuse water and salts (saline) into a patient, who quickly recovered and survived. History2Edward Hodder, in Canada in 1873, infused fat in the form of milk into 3 cholera patients. Two of the patients