重症肺结核呼衰营养管理

本文通过四个方面针对呼衰营养管理进行论述。(1)呼衰监测与营养评价。(2)呼衰营养障碍的原因，从代谢角度看，呼吸肌疲劳是由于能量消耗超过能量供给，部分患者的静息能量消耗量升高，且与负氮平衡有关。气道阻力增大以及呼吸肌的换气效率下降是静息能量消耗(REE)主要原因。(3)吸氧能提高肺泡氧分压，增加内呼吸的氧弥散量，纠正组织细胞缺氧状态。消除无氧代谢、改善心脑细胞代谢，降低肺动脉压，增加肾血流量，有利于解除支气管痉挛，提高抗生素疗效。倘若病人体重下降10%以下，明显衰弱消耗，血清蛋白<30g/L，总淋巴细胞计数<1.2×10６，血清转铁蛋白<1.5g/L，氮平衡持在-3g/天时，就应该给营养支持。一般供给能量原则是碳水化合物占50%～60%，蛋白质占15%～29%，脂肪20%～30%。高热量混合奶1000ml，白蛋白、血浆、脂肪乳剂500ml。(4)营养管理与展望鉴于肺结核病合并呼衰的病理机制与营养障碍的密切关系，营养治疗有可能成为TB呼衰治疗的有效措施之一。营养管理的主要问题是补多少。鉴于慢性TB呼衰时营养不良发生机制的复杂性，今后应向综合治疗方向努力。营养管理与治疗紧密结合，可降低死亡率。冯新华

The nutrition managementof the respiratory failure in the severe lung TB

Respiratory failure(RF) is a symptom to which the lung cleseasesor some others leacl.Especially RF of the severa lung TB happens the harm of the function of respiration much easier,It causes less O２ and CO2 retention fo oranism.Clincal Syndronse of physiology and the disorder of physiology and the clisorder of metabolism is the result of that.RF can easier cause the obstract of the mtabolize and the mctrition of protein,the function of amino acid.Because of RF,the function of respiration increases,organism netabolize is negative balance.If tince is long,it will decreae immunity function Easy infection.That increases the major reason of the death rate This RF nutrition management is important too much.This text is divided five parts that to be directed against RF nutrition management is in progress discusing.(1)RF monitor and nutrition evaluation “RF nine cares norm”airway clear,O2 care suport circutation,antishock.resisting heart failire,contol infection.correcting acid-alkai balance and electrolytes.Artery gas analyse,moisture atmospheric dissoving therapy,monitro serions room.nutrition evaluation and management ncesity:adopting physical and biochemistry examination evaluating nutrition conclution:(2)Thereason of RF nutrition obstaction:what metabolic analyse,rspiratory musculer faitigue is cased by energy consuning is more than that of offering,that consumed quietity of the rest quietly enorgy of some patients rises relates to negative balance.Airway obstruetion to increase and the inefficient of taking a breath of respiratory muscle is the main reson of the rest quietly energy consuming(REE).(3)Inhale O２ can improve the quanity spreading with oxygen of inxide respiration,to correct lack oxyten state is the cell to remove metabolize without oxygen,to improve cardiac and cerebral cell metabolize,to decrease lung Artery press,toincrease Rednty lood renning volume,so that relietve bronches spasm.If the weight body of the patient decreases to 10 percent,When serm protein<30g/L,total lymphocyte<1.2 3g/d,It consunes clear.That must give nutrition suport.(4)Nutrition management and forecast:In view of severe lung TB nurged RF pathogenesis and nutrition obstraction related closed.Nutition treat ment may become one of the efficacious one is TB failure.The question is nutrition manugement is how much enrich.Since pathogenseis complex,We should be hard to synthesize treatment later.It can reduce mortality the closed mutrition management and nudical treatment combinex.