营养支持的质控管理.pptx

会计学1 2内容提要???重症患者营养支持存在的问题规范营养支持，指南要求我们做什么？建立质控标准，加强临床营养规范实施第1页/共48页 3? Nutrition Therapy in the Critical Care Setting: What is Best Achievable Pratice?2007 年 1 月 - 6 月，20 个国家 158 个 ICU 参加了此次调查?仅 14 个（8.9%）和 18 个 ICUs （11.4%）提供了充分的（目标量的80%）热量和蛋白质 Naomi E. Cahill, et al. Crit Care Med, 2010, 38(2): 395-401第2页/共48页 4TypeChinaNon-ChinaTotalEN only101(25.9%)1795(72.4%)1896(66.1%)PN only89(22.8%)134(5.4%)223(7.8%)EN+PN186(47.7%)298(12.0%)484(16.9%)None14(3.6%)253(10.2%)267(9.3%)2008 INTERNATIONAL CRITICAL CARE NUTRITION SURVEY ICU患者的营养支持方式 P0.001Cahill N, Narasimhan S, Dhaliwal R. Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: aninternational survey of critical care physicians and dietitians.[J]. Journal of Parenteral and Enteral Nutrition, 2010, 34(6): 685-696.第3页/共48页 5Chinan=390Non-China n=2480 Totaln=2870Prior to ICU admission30(10.5%)141(6.7%)171(7.2%)0-24118(41.1%)865(41.3%)983(41.3%)24-4855(19.2%)474(22.6%)529(22.2%)48-7234(11.8%)273(13.0%)307(12.9%)7250(17.4%)340(16.2%)390(16.4%)2008 INTERNATIONAL CRITICAL CARE NUTRITION SURVEY EN的启动 P=0.15Cahill N, Narasimhan S, Dhaliwal R. Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: aninternational survey of critical care physicians and dietitians.[J]. Journal of Parenteral and Enteral Nutrition, 2010, 34(6): 685-696.第4页/共48页 6?我国三级医院ICU对营养支持有一定认识????需要性早期供给营养肠内营养的应用添加肠外营养?存在问题 延迟开始营养支持 ?????营养支持实施的管理：评估工具营养供给量：目标量的确定与调整EN不耐受的对策优化EN管理方案2008 INTERNATIONAL CRITICAL CARE NUTRITION SURVEY THE RESULTS OF SURVEYCahill N, Narasimhan S, Dhaliwal R. Attitudes and beliefs related to the Canadian critical care nutrition practice guidelines: aninternational survey of critical care physicians and dietitians.[J]. Journal of Parenteral and Enteral Nutrition, 2010, 34(6): 685-696.第5页/共48页 7Engel, Clin Nutr 2003;22:187-92 Stapleton RD et al. CCM;2007:35 Rice et al. Nutrition 21 (2005) 786-792Kyle et al. Clinical Nutrition (2006) 25, 727-735? 问题：ICU患