肠道外营养支持在外科危重病人中的应用

CLINICAL USE OF TOTAL PARENTAL NUTRITION SUPPORT IN SURGICAL CRITICAL PATIENTS

４８例普外科危重病人在术前、术后使用了深静脉肠道外营养（ＴＰＮ）。ＴＰＮ使用时间最长８７天，最短１５天，绝大多数病人用ＴＰＮ后达到了或基本达到了正氮平衡，体重和血清白蛋白不同程度地增加或无明显下降。我们认为对病人营养状况的评价按体重、肪三头肌皮皱厚度、上臂中点肌周径、血清白蛋白、转铁蛋白、血淋巴细胞总数，并结合氮平衡试验在临床上具有重要的实用价值；ＴＰＮ途径以穿刺法上腔静脉置管为佳；热源用糖－脂肪混合物较为合适；氮源用高支链氨基酸溶液为主较满意。同时对ＴＰＮ期间代谢紊乱及微量元素缺乏的防治措施进行了讨论。

otal parental nutrition (TPN) was performed pre and postoperatively for 48 surgicalcritical patients. The longest time of TPN was 87 days and the shortest was 15 days. Mostpatients achieved positive nitrogen balance demonstrated by stability or increase of weight orserum protien. The authors recommend that measurement of weight, triceps skinfold thick-ness (TSF) , upper arm muscle circumference (AMC), serum protien, transferrin and totallymphocytes are of practical value for the nutrition evaluation. The satisfactory way of sup-plying energy is infusion of glucose-fat emulsion compound and branched chain amino acidenriched solution (BCAA). The appropriate catheterization is via superior vena cava. Thisarticle also discussed the management of electrolytes disorder and metabolic imbalance thatmay happen during TPN.