to TPN关于肠外与肠内营养的文献课件.ppt

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to TPN关于肠外与肠内营养的文献课件

Introduction to TPN 新光吳火獅紀念醫院 內科部 胃腸肝膽科 柯威旭 醫師 Nutrition Support Team Physicians Clinical pharmacists Nurse-Clinicians Dietitians Laboratory research technician Ward nursing staff In SKH:主任,執行秘書,各科醫師,藥劑師,營養師 Source of Nutrition Enteral nutrition Parenteral nutrition Central parenteral nutrition (CPN=TPN) Peripheral parenteral nutrition (PPN) Long-term home parenteral nutrition (HPN) Clinical decision algorithm route of nutrition support PPN High risk of thrombophlebitis Osmolarity: less than 800-900 mOsm/kg Short-term: up to 2 weeks Not the optimal choice for significant malnutrition severe metabolic stress large nutrient or electrolyte needs (especially potassium, a strong vascular irritant) fluid restriction the need for prolonged intravenous nutrition support Indications of TPN Impossibility for enteral nutrition Inadequacy for enteral nutrition Increment of the severity of disease by enteral nutrition PLUS Anticipated to have PN for more than 7 days TPN in Internal Medicine Acute pancreatitis Intestinal disease (IBD, NEC, radiation colitis, ileus, intractable diarrhea / vomiting) Cancer Hepatic failure Renal failure Short bowel syndrome Enterocutaneous fistula AIDS Perioperative support TPN should not be used in Malignancy: poor response to R/T or C/T Active stage of IBD Relative preserved GI function Hypertriglyceridemia (TG 400 md/dl) Components of TPN Carbohydrate, Amino acid, Fat, Electrolyte, Water, Vitamin, Trace element Standard solution Dextrose, Amino acid Electrolyte (Na, K, Cl, Mg, Ca, P) Vitamin (A, B1, B2, Niacin, B6, Panthothenic acid, C, D, E, Zn, Cu, Mn, Cr) Lipid emulsion Dextrose-content Solution 1 g glucose = 3.4 Kcal 1 g glucose = 5 mOsm/L Amino acid solution Lipid emulsions TPN formula B: standard solution D: 8% A.A., high BCAA, low AAA; for hepatic disease E: 35% Dextrose, 12% A.A.; for HD and water restriction F: 29% Dextrose, 12% 7% A.A.; for ARF with HD G: 29% Dextrose, 7% A.A.; for ESRD TPN Order Vascular Access for TPN Mecha

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