论文部分内容阅读
外科病人在围术期合并急性肾损伤会带来治疗的难度及增加病死率。对这类病人进行营养治疗虽有必要,但难度很大。持续肾脏替代治疗除了能为外科重症病人提供器官功能的支持外,由于可主动调节病人的进出容量,因而使这类病人的营养治疗成为可能。外科血液净化病人多存在蛋白质能量营养不良,其代谢率的增高与基础疾病及基础营养状态有关。营养治疗宜从小量开始,营养素全面,并兼顾合适的热氮比,保证足够的氮摄入量,应该将持续床边血液净化治疗(continuous renal replacement therapy,CRRT)对机体氮、糖类、电解质、微量营养素的清除考虑在内,适当补充一些肾功能障碍时可能有益的营养素,如左旋卡尼汀、谷氨酰胺、鱼油脂肪乳剂等。外科血液净化病人的营养治疗途径仍首选经口或肠内营养,即使在开始治疗时需选用肠外营养,也应将最终能够经口或经肠道内营养方式作为治疗的目标。
Surgical patients with acute kidney injury during perioperative treatment will bring the difficulty and increase mortality. Nutritional treatment of such patients is necessary, but difficult. Continuous renal replacement therapy, in addition to providing support for organ function in critically ill surgical patients, has enabled the nutritional treatment of such patients by actively adjusting the patient’s access volume. Surgical blood purification of patients with protein energy malnutrition, the higher metabolic rate and underlying diseases and basic nutritional status. Nutrient therapy should be started from small quantities, comprehensive nutrients, and take into account the appropriate ratio of heat to nitrogen, to ensure adequate nitrogen intake should be continuous bed blood purification treatment (continuous renal replacement therapy, CRRT) on the body of nitrogen, carbohydrates, electrolytes , Micronutrient clearance considerations, including appropriate supplementation of some renal dysfunction may benefit nutrients, such as L-carnitine, glutamine, fish oil fat emulsion and so on. Surgical blood purification Patient nutrition treatment is still the first choice of oral or enteral nutrition, even when the beginning of treatment need to use parenteral nutrition, but also should eventually be oral or enteral nutrition as a treatment target.