危重症患者的营养管理 PPT课件.pptx

Metabolics and GasExchangeMeasurements (Indirect Calorimetry);Key points:;ICU病人的代谢;在ICU…营养支持不足的后果;在ICU…营养支持过度的后果;营养支持的现况;怎么评估能量需要？;Analysis of Estimation Methods for Resting Metabolic rate in critically ill adults ;Resting energy expenditure in malnourished older patients at hospital admissionand three months after discharge: Predictive equations versus measurements, Clinical Nutrition 31 (2012);Accuracy of prediction equations for calculating resting energy expenditure in morbidly obese patients Ann R Coll Surg Engl 2012 Comparison of Measured Versus Predicted Energy Requirements in Critically Ill Cancer Patients RESPIRATORY CARE ? APRIL 2009 Comparison of Resting Energy Expenditure Prediction Methods With Measured Resting Energy Expenditure in Obese, Hospitalized Adults Journal of Parenteral and Enteral Nutrition March/April 2009 Cumulative Energy Imbalance in the Pediatric Intensive Care Unit: Role of Targeted Indirect Calorimetry Journal of Parenteral and Enteral Nutrition May/June 2009 Determining energy needs in critically ill patients: equations or indirect calorimeters Curr Opin Crit Care 2012 Prediction Equations to Determine Caloric Requirements in Critically Ill Patients RESPIRATORY CARE ? APRIL 2009 ……….. ;临床判断方法错误率高－－WHY？;Basic Harris-Benedict Equations;危重病和应激因素;临床存在的问题;直接测热法;How the principles were established …;间接测热法Indirect calorimetry;IC的原理;IC的原理;IC的原理;E-COVX技术原理;E-COVX技术原理;间接测热法;IC一直是金标准，既往为什么未能广泛推行？;Now more and more popular：;Now more and more popular ：;Engstr?m ：享誉世界的品牌;What can we get from IC?;30例机械通气的病人，随机分为两组，一组以IC评估营养需要，一组以临床评估方式25Kcal/kg评估。以院内死亡率作主要终点;Results:A Kaplan–Meier curve for intention to treat (n = 130) demonstrated a trend toward a lower mortality in the study group (p = 0.058; Fig. 2a). A Kaplan–Meier curve for the ‘‘per protocol’’ group shows that hospital mortality was significantly lower in the study group (16/56 patients, 28.5% vs. 27/56 patients, 48.2%; p = 0.023; Fi