肠外、肠内营养支持的并发症及其管理与平衡监测
作者：于健春
单位：中国医学科学院北京协和医院外科
关键词：
中国临床营养杂志000155The complications and nutritional monitoring for patients with parenteral nutrition or enteral nutrition
YU Jianchun M.D.
(Chinese Academy of Medical Sciences, Peking Union Medical College Hopsital, Dept. of Surg)
The complications of patients with parenteral nutrition or enteral nutrition:
, 百拇医药
- Mechanical complications:
1. Failed tube positioning.
2. Malpositioning of tube.
3. Dislogement of tube.
4. Tube cogging/obstruction.
5. Mechanical damage.
- Infectious complications:
1. Prepacked formula contamination.
, 百拇医药 2. Bact. contamination of mixed, diluted, decanted foods.
3. Aspiration pnueumonia, volume aspiration, subclinical aspiration.
4. Catheter Related Sepsis.
5. Bowel bacteria/endotoxin translocation.
- Gastrointestinal complications:
1. Nausea, vomiting.
2. GFastric retention.
, 百拇医药
3. Diarrhea.
4. Gastrointestinal bleeding.
5. Abdominal distensions, cramps.
6. Constipation.
7. Bowel muccaa atrophy.
- Metabolic complications:
1. Hypertonic dehydration.
2. Hyperglycaemie non-ketotic dehydration/coma.
, 百拇医药 3. Overhydration.
4. Hyperglycemia.
5. Hypoglycemia.
6. Hypernatremia.
7. Hypoaatremia.
8. Hyperkalemia.
9. Hypokalemia.
10. Hyperphosphatemia.
11. Hypophosphatemia.
12. Hypomagnesemia.
, http://www.100md.com
13. Low blood lever of zinic.
14. Low lever of copper.
15. Vitamine K deficiency.
16. Essential fatty acid deficiency.
17. Liver function disturbance.
18. Glutamine deficiency.
Monitoring of nutritional status:
1. Technical monitoring:catheter location and sterility.
, http://www.100md.com
2. Proper preparation of the infusion solution,correct applications.
3. Nutritional and fluid ballanee.
一、肠外、肠内营养支持的主要并发症
1.机械性并发症：肠内、肠外营养置管失败、异位、阻塞、机械性损伤等。
2.感染性并发症：营养制剂及配制、输入系统的污染，肠外营养导管感染、内源性感染，肠内营养误吸性肺炎等。
3.胃肠道并发症：肠内营养时恶心、呕吐、胃潴留、腹泻、腹胀、腹痛、便秘，肠外营养时肠粘膜萎缩、肠道细菌毒素易位等。
4.代谢性并发症：高血糖和低血糖，非酮性高渗性昏迷，肝脂肪变性，肝脏毒性反应，肠外营养时胆汁淤积性肝炎、胆囊炎、胆囊结石。谷氨酰胺缺乏，高/低血钾症，高/低血钠症，高/低血磷症等。
二、营养支持的监测
1.插管后导管位置/导管有关感染的监测；
2.输液系统/输入速率/浓度的监护：除尘滤器，泵及各个连接点。输注管/容器护理清洁更换。
3.营养及体液平衡等监测：水，电解质，氮平衡的监测。, 百拇医药
单位：中国医学科学院北京协和医院外科
关键词：
中国临床营养杂志000155The complications and nutritional monitoring for patients with parenteral nutrition or enteral nutrition
YU Jianchun M.D.
(Chinese Academy of Medical Sciences, Peking Union Medical College Hopsital, Dept. of Surg)
The complications of patients with parenteral nutrition or enteral nutrition:
, 百拇医药
- Mechanical complications:
1. Failed tube positioning.
2. Malpositioning of tube.
3. Dislogement of tube.
4. Tube cogging/obstruction.
5. Mechanical damage.
- Infectious complications:
1. Prepacked formula contamination.
, 百拇医药 2. Bact. contamination of mixed, diluted, decanted foods.
3. Aspiration pnueumonia, volume aspiration, subclinical aspiration.
4. Catheter Related Sepsis.
5. Bowel bacteria/endotoxin translocation.
- Gastrointestinal complications:
1. Nausea, vomiting.
2. GFastric retention.
, 百拇医药
3. Diarrhea.
4. Gastrointestinal bleeding.
5. Abdominal distensions, cramps.
6. Constipation.
7. Bowel muccaa atrophy.
- Metabolic complications:
1. Hypertonic dehydration.
2. Hyperglycaemie non-ketotic dehydration/coma.
, 百拇医药 3. Overhydration.
4. Hyperglycemia.
5. Hypoglycemia.
6. Hypernatremia.
7. Hypoaatremia.
8. Hyperkalemia.
9. Hypokalemia.
10. Hyperphosphatemia.
11. Hypophosphatemia.
12. Hypomagnesemia.
, http://www.100md.com
13. Low blood lever of zinic.
14. Low lever of copper.
15. Vitamine K deficiency.
16. Essential fatty acid deficiency.
17. Liver function disturbance.
18. Glutamine deficiency.
Monitoring of nutritional status:
1. Technical monitoring:catheter location and sterility.
, http://www.100md.com
2. Proper preparation of the infusion solution,correct applications.
3. Nutritional and fluid ballanee.
一、肠外、肠内营养支持的主要并发症
1.机械性并发症：肠内、肠外营养置管失败、异位、阻塞、机械性损伤等。
2.感染性并发症：营养制剂及配制、输入系统的污染，肠外营养导管感染、内源性感染，肠内营养误吸性肺炎等。
3.胃肠道并发症：肠内营养时恶心、呕吐、胃潴留、腹泻、腹胀、腹痛、便秘，肠外营养时肠粘膜萎缩、肠道细菌毒素易位等。
4.代谢性并发症：高血糖和低血糖，非酮性高渗性昏迷，肝脂肪变性，肝脏毒性反应，肠外营养时胆汁淤积性肝炎、胆囊炎、胆囊结石。谷氨酰胺缺乏，高/低血钾症，高/低血钠症，高/低血磷症等。
二、营养支持的监测
1.插管后导管位置/导管有关感染的监测；
2.输液系统/输入速率/浓度的监护：除尘滤器，泵及各个连接点。输注管/容器护理清洁更换。
3.营养及体液平衡等监测：水，电解质，氮平衡的监测。, 百拇医药