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通过营养支持、提高机械通气病人的脱机成功率。对 36例机械通气病人 ,同时采用全营养混合液支持 ,经右颈内静脉穿刺插管 2 9例 ,股静脉插管 7例 ,输注时间 5~ 6 1天 ,平均 19.2天。结果 :经合理的全营养混合液支持后 ,病人营养状况明显改善 ,增强了呼吸肌的作功能力 ,减少对呼吸机的依赖 ,提高了脱机成功率。 36例中有 31例 1次脱机成功 ,2例 2次脱机成功 ,1次脱机成功率达 86 .1% ,总脱机成功率达 91.7% ,仅 3例因 MSOF而死亡。结论 :全营养混合液输注方便、安全 ,是机械通气病人摄取全营养和能量的理想方法。全营养混合液在机械通气病… 相似文献
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研究经外周静脉输注全营养混合液安全性和适应证。随机选择 5 0例普外科大手术后病人 ,经外周静脉输注全营养混合液约 2周。结果 3例轻度静脉炎 ,更换穿刺部位后继续营养支持 ,1例严重血栓性静脉炎终止输注营养液外 ,均顺利完成营养支持治疗 ,无严重并发症。结论 :通过外周静脉输注全营养混合液进行营养支持是安全、可行的 ,适用于需短期进行营养支持的病人 ,但需防治血栓性静脉炎。经外周静脉输注全营养混合液的安全性和适应证@姜海平$暨南大学医学院第一附属医院普外科
@容松$暨南大学医学院第一附属医院普外科
@杨雪华$暨南大学医… 相似文献
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全营养混合液(TNA)静脉输注是临床肠功能障碍、营养不良和营养不足病人营养支持的重要方法之一。临床实践显示,反复多次周围浅静脉穿刺所造成的静脉炎有增加趋势,加之因TNA的渗透浓度变化,对外周浅静脉直接刺激,引起局部静脉化学炎性反应,发生静脉炎。这不仅给病人在原发病的 相似文献
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胰岛素直接加入全营养混合液对肠外营养病人血糖水平的影响 总被引:1,自引:0,他引:1
目的:观察胰岛素直接加入全营养混合液中进行肠外营养对病人血糖浓度的影响. 方法:在53例共647例次肠外营养中,胰岛素直接加入全营养混合液输注,胰岛素与葡萄糖开始配比为1:10,在肠外营养期间,观察营养液中胰岛素与葡萄糖配比均值和平均输注速度,营养液输注前1 h、输注后6 h及12 h的各时段血糖变化值,并根据血糖测定值调整胰岛素与葡萄糖配比. 结果:所有病人均顺利完成肠外营养治疗,无一例发生低血糖昏迷及非酮症性高渗性糖尿病昏迷.营养液中胰岛素与葡萄糖的平均比值为1:8;输注速度为140 mL/h;输注前1 h血糖值为(6.043±1.210)mmol/L,输注后6 h为(6.470±1.359)mmol/L,12 h为(6.262±0.966)mmol/L,营养液输注后,各时段所测血糖水平变化差异无显著性意义(P>0.05).结论:将胰岛素直接加入全营养混合液中输注,能有效地维持病人的血糖水平. 相似文献
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李永娟 《今日健康(家庭版)》2014,(5):279-279
目的:为了确保全静脉营养液(TPN)在临床的正确配置和应用的安全性。方法:通过对我院普外科380袋全静脉营养制剂的配置和临床应用的观察。TPN配制前由药师审核处方,配制过程严格无菌操作规程,配制后进一步核对,三重把关。浅谈医院静脉药物配置中心配置的全静脉营养制剂在临床应用的安全、合理、有效性。结果:我院静脉药物配置中心配置的全静脉营养制剂在临床应用中无明显的不良反应,临床应用安全,有效。克服过去在病区治疗室配置的全静脉营养液的不安全性。结论:开展静脉药物配置中心才能提高全静脉营养制剂在临床应用的安全、合理、有效性。以确保TPN配置安全,更好的为临床服务。 相似文献
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营养支持是治疗危重病人的重要手段。我科于1996年5月~1998年12月采用3L袋输注全营养混合液的方法,对65例围手术期或危重病人实施胃肠外营养支持(Parenteral Nutrition 相似文献
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Feasibility and safety of needle catheter jejunostomy for enteral nutrition in surgically treated severe acute pancreatitis 总被引:1,自引:0,他引:1
Weimann A Braunert M Müller T Bley T Wiedemann B 《JPEN. Journal of parenteral and enteral nutrition》2004,28(5):324-327
BACKGROUND: The role of the gut in the development of septic complications and promising clinical results have led to a shift from the parenteral to the enteral route for nutrition support of patients with acute pancreatitis. In patients undergoing surgery for severe necrotizing pancreatitis, the application of a needle catheter jejunostomy might be useful. However, there is a shortage of clinical data on its feasibility and possible harmful effect. METHODS: Between January 1999 and December 2002, 13 patients were operated for severe acute necrotizing pancreatitis. At the time of surgery, needle catheter jejunostomy was performed using a standard technique. Enteral nutrition was initiated without a strict protocol by feeding small amounts of a standard diet and carefully monitoring patient tolerance. As long as necessary, patients were also fed parenterally in order to achieve target caloric goals. RESULTS: No major tube- or feeding-related complications were observed. A single case of tube dislodgement caused by manipulation during relaparotomy for lavage occurred and was rectified during the same operation. CONCLUSIONS: In patients undergoing surgery for severe acute pancreatitis, needle catheter jejunostomy for long-term enteral nutrition can be applied with no additional risk. 相似文献
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Bader SG Balke P Jonkers-Schuitema CF Tas TA Sauerwein HP 《Clinical nutrition (Edinburgh, Scotland)》2007,26(1):141-144
BACKGROUND & AIMS: Central venous catheter occlusion is a frequently occurring complication during home parenteral nutrition (HPN). The aim of the study was to investigate the effectiveness of sodium hydroxide (NaOH) administration to clear an occluded central venous catheter especially in HPN. METHOD: Retrospective study to the use of NaOH in partially occluded central venous catheters. About 45 patients with HPN treated in the Academic Medical Center of the University of Amsterdam (AMC) were included in this study between January 1997 and April 2003. Excluded from the study were patients under the age of 18 at the start of HPN and/or patients who use parenteral nutrition for less than 3 months. Partial catheter occlusion was defined as a spontaneous flow less than 60 drops/min. RESULTS: In total, 130 occlusions were registered in 29 HPN patients. The other 16 HPN patients did not report any occlusion. The incidence of occlusions in fat containing total parenteral nutrition (TPN) was 1 occlusion in 167 feeding days. TPN without fat showed only one occlusion (incidence 1 in 7126 feeding days). The use of a lipid emulsion proved an important risk factor for catheter occlusion in this study (P<0.05, RR=43). Ninety-five central venous catheter occlusions were treated with NaOH 0.1M. The remaining occlusions were total or mechanical occlusions making NaOH treatment impossible. In 73 out of 95 partial occlusions treatment with NaOH was effective (P<0.05). Using NaOH extended the use of 32 catheters (range 7-1592 days, mean 328). Twenty-one out of 32 catheters could be used for more than 3 months after using NaOH (P<0.05). CONCLUSION: We conclude that perfusion of a partial occluded central venous catheter (defined as 25-60 drops/min) used for parenteral nutrition with 0.1N NaOH is safe and shows a significant long term improvement in catheter care, by preventing total occlusion and operative removal. 相似文献
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Lerebours E Ducable G Francheschi A Saour N Colin R 《Clinical nutrition (Edinburgh, Scotland)》1985,4(3):135-138
Catheter obstruction is a serious incident during prolonged parenteral nutrition (PN). This retrospective study was carried out in order to compare the frequencies of catheter obstruction with nutritive mixtures in bags according to whether or not lipids were mixed with the entire 24 h nutritional supply (Group I, n=33) or infused separately (Group II, n=30). Our results show that obstructions are significantly more frequent in Group I (11 13 ) than in group 2 (3 10 ), appearing within a mean interval of 29 days after inserting the catheter. The global percentages of patients undergoing cyclic PN were the same in both patient groups. In group I, however, the percentage of patients on cyclic PN was significantly higher for the obstructed catheters (100%) than for the unobstructed catheters (59%). In conclusion, the mixture of lipids with the remainder of the nutrients in the conditions of this study is the prime cause of catheter obstruction, although the exact mechanism is not elucidated. The role of cyclic PN appears to be accessory. 相似文献
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K A Kudsk C Powell J M Mirtallo P J Fabri R L Ruberg 《JPEN. Journal of parenteral and enteral nutrition》1985,9(3):348-349
Although it is recognized that the addition of heparin to total parenteral nutrition solutions reduces subclavian vein thrombosis from percutaneous polyethylene catheters, it does not affect the low thrombosis rate associated with polyurethane catheters. It has been suggested that heparin also reduces catheter sepsis during total parenteral nutrition. We reviewed the sepsis rate in 86 patients randomized to receive iv nutrition with or without heparin through polyethylene, polyvinyl, and polyurethane catheters. Blood was drawn from febrile patients for culture; if positive, catheters were removed and the tips cultured. Catheters were considered infected if blood and catheter tips were positive, or if fever disappeared within 48 hr after catheter removal, even if cultures were negative. Catheter sepsis occurred in two patients in both groups. It appears that heparin does not reduce sepsis from percutaneous subclavian vein catheters. Although its use may be indicated to reduce thrombosis associated with polyethylene catheters, there is no indication for its use to reduce sepsis with either type of catheter. 相似文献
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目的总结胰十二指肠切除术后患者肠外营养(PN)和肠内营养(EN)的护理体会。方法回顾性分析了57例接受胰十二指肠切除术患者的临床资料,所有患者均于术前接受中心静脉置管,术中行空肠造瘘,术后给予PN和EN支持。结果PN中位时间为8天(5~24天),EN中位时间为21天(5~69天),平均术后肛门排气时间(72.5±19.8)小时,术后住院的中位时间为24天(17~74天)。57例患者中,1例于围手术期死亡,2例因严重腹胀、腹泻中止EN;41例出现腹胀,17例发生腹泻;中心静脉导管脱出和堵塞各2例,空肠造瘘未出现导管并发症;29例出现糖代谢严重异常,2例伤口裂开,19例次发生术后感染。结论胰十二指肠切除术后需要联合PN和EN,治疗中应坚持无菌配液、严格管路护理、注意血糖变化和加强心理治疗。 相似文献
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An infection rate was calculated for all subclavian catheters inserted during a 12-month period. The overall, single lumen, and triple lumen infection rates were 1.7% (42/2,431), 0.4% (8/1,936), and 6.9% (34/495), respectively. After excluding single lumen catheters in patients in a surgical cardiovascular unit who appeared to have a decreased risk of infection, the overall, single lumen, and triple lumen rates were 3.7% (42/1,140), 1.2% (8/645), and 6.9% (34/495), respectively. Within this group, 11.8% (28/237) of the catheters used for total parenteral nutrition (TPN) were infected, whereas 1.6% (14/903) of the non-TPN catheters were infected. Of patients receiving total parental nutrition through a triple lumen catheter, 14.5% (25/172) became infected, whereas 4.6% (3/65) of the patients receiving total parental nutrition through a single lumen catheter became infected. Single and triple lumen patient groups appeared comparable based on average age, death rate, immunosuppression, underlying disease, and duration of catheterization, but the risk of infection was approximately three times greater for patients receiving total parental nutrition through a triple lumen catheter. 相似文献
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Subsequent to pancreatoduodenectomia with pylorus retention on 12 patients suffering from chronic pancreatitis we analysed the effect of artificial nutrition on pancreas-secretion by examining the pancreatic juice extracted directly from the Wirsung duct. We used post-operative nutrition administered by fine-needle catheter jejunostomy in 7 patients and 5 patients received postoperative support by total parenteral nutrition as a control-group. We analysed the pancreatic juice collected in four hour fractions for volume, direct protein, amylase, chymotrypsin, bicarbonate. It has been found that on the first two days after the operation we can see a slow increase in the measured values and on the third postoperative day after an abrupt rise the pancreas secretion became steady. Between the two methods of artificial nutrition applied it was impossible to prove an observable difference concerning their effect on the pancreas. According to our observations the two methods are equivalent in the postoperative therapy of patients operated on because of chronic pancreatitis. 相似文献
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P J Fabri J M Mirtallo M L Ebbert K A Kudsk C Powell R L Ruberg 《JPEN. Journal of parenteral and enteral nutrition》1984,8(6):705-707
Radiographic evidence of subclavian vein thrombosis has been shown to occur in 33% of total parenteral nutrition patients. This incidence can be significantly reduced to 8% when heparin is administered concomitantly in total parenteral nutrition solutions. To evaluate the thrombotic risk of a newly developed polyurethane catheter, 20 concurrent patient pairs were prospectively cannulated with either a standard polyethylene catheter plus heparin or a polyurethane catheter without heparin in a sequential statistical study. Radionuclide venograms (Tc99m) were performed within 72 hr of catheterization, at biweeky intervals, and at termination of total parenteral nutrition administration. No patient in either group developed clinical (pain, arm swelling, collateral veins) or venogram evidence of thrombosis after catheterization during an overall cannulation period of 820 days. Use of polyurethane catheters and elimination of heparin in total parenteral solutions may be particularly important since contraindications to heparin use are common. Additionally, heparin elimination can decrease admixture work and confusion (ie, subcutaneous heparin double dosing) without increasing the risk of subclavian vein thrombosis. 相似文献
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G P Young M Alexeyeff D M Russell R J Thomas 《JPEN. Journal of parenteral and enteral nutrition》1988,12(4):365-370
A prospective controlled study of the safety of various catheter dressing protocols was carried out in 168 patients receiving parenteral nutrition via an infraclavicular central venous catheter. Four protocols were compared: 36 patients received gauze dressings changed three times per week; 31 received OpSite dressings changed every 7th day (OpS-7), 32 received OpSite changed every 10th day (OpS-10), and 69 received OpSite changed twice weekly (OpS-ICU). Mean duration of parenteral nutrition was approximately 2 weeks and all groups were well matched except that OpS-ICU patients suffered more frequently from an acute illness. Catheter-related sepsis was identified by clinical signs of systemic sepsis, positive peripheral venous blood and catheter-tip cultures and/or defervescence of fever after catheter removal. Catheter-related sepsis rates were low in all groups: 1/36 for Gauze, 0/31 for OpS-7, 1/32 for OpS-10, and 2/69 for OpS-ICU. Septicemia attributable to causes apart from catheter sepsis occurred in two, two, three, and four patients, respectively. Bacterial colonization of skin beneath OpSite was no more common in the OpS-10 than in the other groups. Signs of inflammation at catheter insertion sites were common in all groups but did not relate closely to skin colonization. OpSite can be safely applied to central venous catheters inserted under strict aseptic conditions, even in patients with open septic drainage. Dressings can be left in place for 7 days with a margin of safety lasting to 10 days, thus saving on cost of materials and nursing time. 相似文献
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Practical aspects of peripheral parenteral nutrition 总被引:1,自引:0,他引:1
Culebras JM Martin-Peña G Garcia-de-Lorenzo A Zarazaga A Rodriguez-Montes JA 《Current opinion in clinical nutrition and metabolic care》2004,7(3):303-307
PURPOSE OF REVIEW: The purpose of this review is to provide an update on the advantages and disadvantages of using peripheral parenteral nutrition, including the techniques, indications and results. RECENT FINDINGS: The new catheters, together with a better knowledge of intermediate metabolism, permit the use of peripheral parenteral nutrition in many clinical situations during short periods of time. SUMMARY: Peripheral parenteral nutrition is an alternative to total parenteral nutrition, and is a complement to enteral nutrition and the oral route. Progress in catheter design and materials, infusion techniques and an improved knowledge of the optimal nutriments has made peripheral parenteral nutrition a safe, efficient and useful method to treat patients over certain periods of time. 相似文献