营养支持对多器官功能不全综合征的治疗作用
作者：徐鹏远 许世才 谭晶 陈加勇 甘平 孙敏
单位：昆明医学院附属二院普外科
关键词：
中国临床营养杂志000151摘 要：目的为了观察营养支持对多器官功能不全综合征(MODS)治疗的临床作用。 方法对4例多器官功能不全综合征病人进行肠内与肠外营养治疗，其中男性2例，女性2例。4个重要脏器受损2例，3个器官受损2例。原发病因中2例为腹腔内严重感染，2例为重症坏死性胰腺炎。在治疗原发病及必要器械支持的同时给予病人肠内与肠外营养，早期以肠外营养支持为主，其中非蛋白热卡30Kcal·hg-1·d-1，脂肪占40%～50%，氮量0.25g·k8-1.d-1，如伴肾功能衰竭则氮热比降至1g：400Kcal，氮源主要给予必需氨基酸。所有病人均辅以少量肠内营养(口服谷氨酰胺Gln)，并视肠功能情况逐渐向肠内营养过渡。 结果3例病人痊愈出院，1例死亡。营养支持时间最长47天，最短23天。除死亡病例外，其余3例病人随营养支持全身情况和营养指标改善，治愈出院。 讨论①要正确理解和接受MODS这一新的命名，它能更准确地反应此综合征进行性和可逆性的特点，从而指导早期诊断和治疗。②MODS病情凶险，机体处于严重应激，蛋白质分解，机体器官功能和免疫力下降，营养支持能为病人提供足够而合理的营养代谢底物，纠正机体负氮平衡，为MODS的抢救成功奠定基础。③严重应激时肠屏障功能受损，细菌和内毒素移位必将加重MODS，补充Gln和早期少量进食是预防和阻断加重MODS的重要环节，同时早期少量进食还能改善危重病人内脏微循环障碍，加速病人恢复。④保持内环境稳定对MODS的治疗很重要，对呼衰病人要限制糖量，提高脂肪乳比例。氮量的补充除肾衰外应提高支链氨基酸含量，肾衰则给予小量必需氨基酸。 结论合理的营养支持能使MODS渡过危险而漫长的病理过程，改善预后。
, http://www.100md.com
The therapeutic effect of nutrition support in patients with multiple organ dysfunction syndrome (MODS)
XU Pengyuan,XU Shihai,TAN Jing
(Dept. of General Surgery of Kunming Medical College 2nd Affiliate Hospital, Kunming 650101)
Abstract：Objective To estimate the clinical therapeutic effect of nutrition support in patients with Multiple Organ Dysfunction Syndrome (MODS). Methods We studied 4 patients (two male and two female )with MODS who received treatment in our hospital recently. The original pathology was abdominal cavity infection (50%), or the hemorrhagic pancreantitis (50%), half of patients had developed 4 main organ failures, the other two had 3 main organ failures. Besides the active treatment of the original disease, we used parenteral nutrition or enteral nutrition according to different phases of the disease. In early stage, the total parenteral nutrition is primary therapy, we adjusted the formula as the following: non-protein calorie was 30Kcal·kg-1·d-l, fat of which is about 40 %～50 %. The nitrogen is 0.25g·kg-1·d-1, To the patients who have renal failure we adjust the ratio of nitrogen versus calorie to 1g: 400Kcal and the nitrogen mainly comes from necessary amino acids. All the patients are given small accounts of oral glutamine and according to enteral function we change gradually parenteral nutrition to enteral nutrition. Results 3 patients were healed; one was died. The longest supporting days are 47d, the shortest was 23d. Discussion 1. We onghtto accept and understand correctly the conception of MODS, it reflects the reversible and ongoing characteristics of this syndrome and can guide us for early diagnosis and treatment. 2. The MODS is a dangerous syndrome that patients in the state of sever stress, catabolism, immune and other systems dysfunctions. The nutrition support can provide enough nutritious materials, rectify the negative balance of nitrogen, and create favorable conditions for rescuing the patients. 3. Severe stress may destroy the function of intestine mucosal harrier, and the translocation of bacteria and endotoxin will aggravate the illness. The administrations of glutamine and small amount of diet in early stage will prevent and obstruct the above course, the latter can also ameliorate the microcirculation of visceral blood vessels and quicken up the patient's recovery. 4. It's crucial to keep the balance of intern environment of the patients with MODS. We should restrict the percentage of glucose and heighten that of fat emulsion in patients with pulmonary failure, and it's better to use more branched amino acids except for those have renal failure, who should be given small amount of essentials amino acids. Conclusions The rational nutrition support can help the patients with MODS to survive the dangerous periods and improve their prognosis., 百拇医药
单位：昆明医学院附属二院普外科
关键词：
中国临床营养杂志000151摘 要：目的为了观察营养支持对多器官功能不全综合征(MODS)治疗的临床作用。 方法对4例多器官功能不全综合征病人进行肠内与肠外营养治疗，其中男性2例，女性2例。4个重要脏器受损2例，3个器官受损2例。原发病因中2例为腹腔内严重感染，2例为重症坏死性胰腺炎。在治疗原发病及必要器械支持的同时给予病人肠内与肠外营养，早期以肠外营养支持为主，其中非蛋白热卡30Kcal·hg-1·d-1，脂肪占40%～50%，氮量0.25g·k8-1.d-1，如伴肾功能衰竭则氮热比降至1g：400Kcal，氮源主要给予必需氨基酸。所有病人均辅以少量肠内营养(口服谷氨酰胺Gln)，并视肠功能情况逐渐向肠内营养过渡。 结果3例病人痊愈出院，1例死亡。营养支持时间最长47天，最短23天。除死亡病例外，其余3例病人随营养支持全身情况和营养指标改善，治愈出院。 讨论①要正确理解和接受MODS这一新的命名，它能更准确地反应此综合征进行性和可逆性的特点，从而指导早期诊断和治疗。②MODS病情凶险，机体处于严重应激，蛋白质分解，机体器官功能和免疫力下降，营养支持能为病人提供足够而合理的营养代谢底物，纠正机体负氮平衡，为MODS的抢救成功奠定基础。③严重应激时肠屏障功能受损，细菌和内毒素移位必将加重MODS，补充Gln和早期少量进食是预防和阻断加重MODS的重要环节，同时早期少量进食还能改善危重病人内脏微循环障碍，加速病人恢复。④保持内环境稳定对MODS的治疗很重要，对呼衰病人要限制糖量，提高脂肪乳比例。氮量的补充除肾衰外应提高支链氨基酸含量，肾衰则给予小量必需氨基酸。 结论合理的营养支持能使MODS渡过危险而漫长的病理过程，改善预后。
, http://www.100md.com
The therapeutic effect of nutrition support in patients with multiple organ dysfunction syndrome (MODS)
XU Pengyuan,XU Shihai,TAN Jing
(Dept. of General Surgery of Kunming Medical College 2nd Affiliate Hospital, Kunming 650101)
Abstract：Objective To estimate the clinical therapeutic effect of nutrition support in patients with Multiple Organ Dysfunction Syndrome (MODS). Methods We studied 4 patients (two male and two female )with MODS who received treatment in our hospital recently. The original pathology was abdominal cavity infection (50%), or the hemorrhagic pancreantitis (50%), half of patients had developed 4 main organ failures, the other two had 3 main organ failures. Besides the active treatment of the original disease, we used parenteral nutrition or enteral nutrition according to different phases of the disease. In early stage, the total parenteral nutrition is primary therapy, we adjusted the formula as the following: non-protein calorie was 30Kcal·kg-1·d-l, fat of which is about 40 %～50 %. The nitrogen is 0.25g·kg-1·d-1, To the patients who have renal failure we adjust the ratio of nitrogen versus calorie to 1g: 400Kcal and the nitrogen mainly comes from necessary amino acids. All the patients are given small accounts of oral glutamine and according to enteral function we change gradually parenteral nutrition to enteral nutrition. Results 3 patients were healed; one was died. The longest supporting days are 47d, the shortest was 23d. Discussion 1. We onghtto accept and understand correctly the conception of MODS, it reflects the reversible and ongoing characteristics of this syndrome and can guide us for early diagnosis and treatment. 2. The MODS is a dangerous syndrome that patients in the state of sever stress, catabolism, immune and other systems dysfunctions. The nutrition support can provide enough nutritious materials, rectify the negative balance of nitrogen, and create favorable conditions for rescuing the patients. 3. Severe stress may destroy the function of intestine mucosal harrier, and the translocation of bacteria and endotoxin will aggravate the illness. The administrations of glutamine and small amount of diet in early stage will prevent and obstruct the above course, the latter can also ameliorate the microcirculation of visceral blood vessels and quicken up the patient's recovery. 4. It's crucial to keep the balance of intern environment of the patients with MODS. We should restrict the percentage of glucose and heighten that of fat emulsion in patients with pulmonary failure, and it's better to use more branched amino acids except for those have renal failure, who should be given small amount of essentials amino acids. Conclusions The rational nutrition support can help the patients with MODS to survive the dangerous periods and improve their prognosis., 百拇医药