静脉营养的临床应用ppt课件

靜脈營養的臨床應用靜脈營養的臨床應用 Parenteral NutritionParenteral Nutrition 營養評估與營養需求營養評估與營養需求 靜脈營養支持注意要點靜脈營養支持注意要點 靜脈營養的適應症靜脈營養的適應症v 全靜脈營養全靜脈營養TPNTPNv 周邊靜脈營養周邊靜脈營養PPNPPN 癌症與營養癌症與營養 龐振宜龐振宜 藥師藥師静脉营养的临床应用1靜脈營養的臨床應用ParenteralNutritioClinical Decision Algorithm營養評估營養評估消化道功能消化道功能YesNo腸道營養腸道營養胃腸功能胃腸功能胃腸功能胃腸功能靜脈營養靜脈營養靜脈營養靜脈營養短期短期長期或須限水時長期或須限水時Peripheral PNPeripheral PNCentral PNCentral PN胃腸功能恢復胃腸功能恢復胃腸功能恢復胃腸功能恢復標準配方標準配方特殊配方特殊配方(Obstruction,peritonitis,intractable vomiting,acute pancreatitis,short-bowel syndrome,ileus)短期短期Nasogastric Nasoduodenal Nasojejunal長期長期Gastrostomy JejunostomyNutrient ToleranceAdequateProgress toOral FeedingsInadequatePN SupplementationAdequateProgress to MoreComplex Diet andOral FeedingsAs ToleratedProgress to Total Enteral FeedingsNormalCompromisedNoYesDecision to Initiate Specialized Nutrition SupportRef：JPEN 17（Suppl 4）：）：7 SA,1993静脉营养的临床应用2ClinicalDecisionAlgorithm營養靜脈營養靜脈營養 建議攝取量建議攝取量Critically Ill Critically Ill(Stress)(Stress)StableFormula Formula g/Lg/L (葡萄糖葡萄糖葡萄糖葡萄糖-A.A.-Fat)-A.A.-Fat)150-50-30150/200-40-30蛋白質蛋白質蛋白質蛋白質g/kg/d1-1.50.81.0糖類糖類糖類糖類mg/kg/min2-3.54-5脂肪脂肪脂肪脂肪g/kg/d11-2總熱量總熱量總熱量總熱量kcal/kg/d253030-35水分水分水分水分mL/kg/dMin.needed30-40ASPENnutritionsupportpracticemanual9-2,1998nMaintenancelevelsofelectrolytesnStandarddosesofmultivitaminsandtraceelements静脉营养的临床应用3靜脈營養建議攝取量CriticallyIllStaProteinRequirements（for Adult Patients）1.1525ofTotalCalories2.Non-proteinCalorietoNitrogenRatio 80-100kcal：1/gm.NSevereStress 150-200kcal：1/gm.NModerateStress3.Nutritional vs.Metabolic Support 22ndClinicalCongress,ASPEN 1998静脉营养的临床应用4ProteinRequirementsGlucose RequirementnInitial TPN:100-150 gm（or 200gm）nCan be increased by 50-75 gm/d (blood glucose levels are stable but less than 200 mg/dl)n the maximum glucose infusion rate be4 mg/kg/min(22-25Kcal/kg/day)Ref：1.TheASPENNutritionSupportPracticeManual.19982.ContemporaryNutritionSupportPractice.19983.ClinicalNutritionParenteralNutrition3Edition;2001静脉营养的临床应用5GlucoseRequirementInitialTPNFat RequirementsnMaximum capacity：1.0-2.0gm/kg/daynCritically ill the maximum recommendedinfusionrate：1.0gm/kg/dayn10-25of total caloriesnRun fat initially at 1 ml/min 15-30 minn2-4of total calories must be from EFA22ndClinicalCongress,ASPEN 1998静脉营养的临床应用6FatRequirementsMaximumcap ElectrolytesRequirements for Adult Patients1.1.Sodium 30 55 mEq/liter2.Potassium6090mEq/day3.Chloride 30 55 mEq/liter4.Calcium612mEq/day5.Magnesium1620mEq/day6.Acetate4570mEq/day7.Phosphorus1828mM/dayRef：a.MaxwellKleeman,sClinicalDisordersofFluidandElectrolyteMetabolism,5th,1994.b.AllinI.Arieff,M.D.Fluid,Electrolyte,andAcid-BaseDisorders.2ndEd1995.静脉营养的临床应用7ElectrolytesRequirementsVitaminsVitaminsAdult RDA Adult RDA in USAin USAAMA AMA RecommendedRecommendedRecommendatioRecommendation nFor the Critically For the Critically IllIllVitamin AVitamin A（IUIU）Vitamin DVitamin D（IUIU）4000-50004000-500040040033003300200200250010000250010000400400Vitamin EVitamin E（IUIU）Vitamin CVitamin C（mgmg）12-1512-15454510.010.0100.0100.040040010001000Folic acidFolic acid（mcgmcg）NiacinNiacin（mgmg）40040012-2012-20400.0400.040.040.020002000200200Vitamin B2Vitamin B2（mgmg）Vitamin B1Vitamin B1（mgmg）1.11.81.11.81.01.51.01.53.63.63.03.010101010Vitamin B6Vitamin B6（mgmg）Vitamin B12Vitamin B12（mcgmcg）1.62.01.62.03 34.04.05.05.020202020mgPantothenic Pantothenic acidacid（mgmg）BiotinBiotin（mcmcg g）510510150-300150-30015.015.060.060.01001005 5mgVitamin KVitamin K（mgmg）1.1101.110mg/wk2.Antibiotics 10 mg/3-4daysVitaminFormulationForChildrenAged11Years,OlderandAdultsForChildrenAged11Years,OlderandAdults静脉营养的临床应用8VitaminsAdultRDAEssentialTraceElementsAMA/NAG Suggested Daily IV IntakeAMA/NAG Suggested Daily IV IntakeElementStableAcute CatabolicGI LossesZn2.54.0mgAdditional2mgAdd12.2 mg/L small Bowel fluid lost；17.1 mg/kg of stoolorileostomyoutputCu0.51.5mg-Cr1015mcg-20mcgMn1.150.8mg-静脉营养的临床应用9EssentialTraceElementsAMA/NMetabolicComplicationsofPNSteatosisCholestasis,GallbladderStasis,andCholelithiasisGastrointestinalAtrophyGastricHypersecretionandHyperacidityMacronutrientrelatedComplicationsOverfeedingRefeedingsyndrome静脉营养的临床应用10MetabolicComplicationsofPNSMetabolicComplicationsofPNSteatosisWithin1-2weeksafterinitiationofPNElevationsofSerumaminotransferases,alkalinephosphataseandbilirubinFattyinfiltrationoflivercellsContinuousglucoseand/orexcessivecalorieloadsResolvesin10-15days静脉营养的临床应用11MetabolicComplicationsofPNMetabolicComplicationsofPNCholestasis,GallbladderStasis,andCholelithiasisMayoccur2-6wksafterinitiationPNProgressiveincreasetotalbilirubinandserumalkalinephosphataseminimizetheriskCyclicPNRestrictinofcarbohydrate,AvoidanceofoverfeedingEarlyenteralstimulation静脉营养的临床应用12MetabolicComplicationsofPNMetabolicComplicationsofPNGastrointestinalAtrophyLackofenteralstimulationcausevillushypoplasiaColonicmucosalatropyDecreasegastricfunctionImpairedGIimmunityBacterialovergrowthBacterialtranslocationInitiateenteralfeedingsassoonaspossible静脉营养的临床应用13MetabolicComplicationsofPNMetabolicComplicationsofPNGastricHypersecretionandHyperacidityGastricsecretionsdirectlyrelatedtotheamountofsmallbowelresectedPepticulcerationsandhemorrhagicgastritisHistamineH2receptorantagonistsareusedtodecreasegastricoutputAddeddirectlytothePNsolution静脉营养的临床应用14MetabolicComplicationsofPN適當靜脈營養支持注意要點適當靜脈營養支持注意要點v 預防高血糖症預防高血糖症 血糖的穩定血糖的穩定v 電解質的平衡電解質的平衡 鉀鉀、鎂、磷、鎂、磷 的監測的監測v 酸鹼平衡酸鹼平衡Nutrition Support Overfeeding Respiratory AcidosisParenteral Nutrition Acidosis Metabolic Acidosisv 避免靜脈營養停止時的低血糖症避免靜脈營養停止時的低血糖症J.Nutrition 1999:129.290S-294S静脉营养的临床应用15適當靜脈營養支持注意要點預防高血糖症J.NutritiSystemic Inflammatory Response Syndrome(SIRS)Current Opinion in Clinical Nutrition and Metabolic Care 1999,2:69-78 抑制抑制抑制抑制c central Insulin actionentral Insulin action Increase gluconeogenesisIncrease gluconeogenesis Peripheral insulin Peripheral insulin resistanceresistance Reduce uptake of glucoseReduce uptake of glucose Significant hyperglycemiaSignificant hyperglycemiaOPOP246810 12 14 16 18 20Postoperative DayRelative insulin sensitivity(%)10080604020静脉营养的临床应用16SystemicInflammatoryResponse胰島素於玻璃瓶胰島素於玻璃瓶PVC及靜脈管的吸附作用及靜脈管的吸附作用Anesthesiology 40:4,400-404,1974RL GLASSRL PVCD5RL GLASSD5RL PVC0 0 0 05 5 5 5101010101515151520202020MINUTESMINUTES2020202030303030404040405050505060606060%INSULIN LOSSINSULIN LOSS静脉营养的临床应用17胰島素於玻璃瓶PVC及靜脈管的吸附作用AnesthesiolnHyperglycemiaa.Hyperosmolarstateb.Osmoticdiuresisc.Dehydrationd.ImmunosuppressionnHepatic steatosisnVentilatory alterationsnIncreased resting energy expenditureRef：1.NutritionSupportTheoryandTherapeutics1stEd,P471；19972.TheMetabolicHazardsofOverfeedingCriticallyIllPatients,ASPEN,1997.The Potential Hazards of OverfeedingGlucoseGlucose静脉营养的临床应用18HyperglycemiaRef：1.NutritiThe Potential Hazards of OverfeedingLipidLipidnTG250mg/dl4hrsafterlipidinfusionforpiggybackedlipidsand400mg/dlforcontinuouslipidinfusionvv Immunosuppression Immunosuppression（RES BlockadeRES Blockade）vv Increased prostaglandin production Increased prostaglandin productionvv Hypercholesterolemia Hypercholesterolemiavv Hyperlipidemia Hyperlipidemiavv Impaired liver function Impaired liver function vv Ventilatory alterations Ventilatory alterationsn nReducing the dose and/or lengthening the infusion timeRef：1.TheMetabolicHazardsofOverfeedingCriticallyIllPatients,ASPEN,1997.静脉营养的临床应用19ThePotentialHazardsofOverfThe Potential Hazards of OverfeedingAmino AcidAmino AcidnUreagenesisnHyperchloremicacidosisnVentilatoryalterationsnIncreasedrestingenergyexpenditure1.NutritionSupportTheoryandTherapeutics1stEd,P471；19972.TheMetabolicHazardsofOverfeedingCriticallyIllPatients,ASPEN,1997.静脉营养的临床应用20ThePotentialHazardsofOverfMetabolic Complications and TreatmentHyperglycemian1.Slowinfusionraten2.Giveinsulin0.1Uofinsulin/gofdextrose/litern3.Increasefatemulsiontherapy静脉营养的临床应用21MetabolicComplicationsandTrRefeedingSyndromenCardiac insuficiency peripheral edema hyertensionnExcess glucoseHyperglycemia HypokalemiaHypophosphatemiahypomagnesemiaRef：NutritioninCriticalCare.1994静脉营养的临床应用22RefeedingSyndromeCardiacinsuTPNorPPN?静脉营养的临床应用23TPNorPPN?静脉营养的临床应用23全靜脈營養全靜脈營養的適應症的適應症Total Parenteral Nutrition營養有危機的人營養有危機的人體重過輕的病人體重過輕的病人短時間內體重下降超過短時間內體重下降超過10%10%有有1010天以上無法經口進食天以上無法經口進食胃腸道消化吸收有困難胃腸道消化吸收有困難嚴重外傷、燒傷嚴重外傷、燒傷嚴重敗血症嚴重敗血症静脉营养的临床应用24全靜脈營養的適應症TotalParenteralNut Hicaliq I TeruAmino 12X Hicaliq II TeruAmino 12XStress-II 一天一天1.51.5袋袋 總總液液量量ml120012001200120018001800 總總熱熱量量Kcal8078071027102715411541 Glucose gm140140206206309309 Xylitol gm2525252537.537.5 Amino Acid gm56.856.856.856.885.285.2Na mEq75757575112.5112.5K mEq303030304545Ca mEq8.58.58.58.512.7512.75Mg mEq101010101515Cl mEq75757575112.5112.5Acetate mEq2525252537.537.5P mM4.854.854.854.857.287.28Zn mg0.70.70.70.71.051.05併併總總液液量量ml1025010250ml 14501025010250ml 14501025010250ml 2050 ml用用總總熱熱量量Kcal108010801302130218161816脂脂Non-Protein Kcal8558551075107514751475肪肪Non-P Kcal/N9494118118108108静脉营养的临床应用25HicaliqIT STD-ISTD-II 總總液液量量ml19001900一日一日22袋袋19001900一日一日11袋袋 總總熱熱量量Kcal1287128717271727 Glucose gm282282411411 Xylitol gm25252525 Amino Acid gm56.856.856.856.8 Non-Protein Kcal1060106015001500 Non-Protein K/N117117165165Na mEq75757575K mEq60606060Ca mEq17171717Mg mEq20202020Cl mEq75757575Acetate mEq50505050P mM9.79.79.79.7Zn mg1.41.41.41.4併併總總液液量量ml2025020250ml 21501025010250ml 2150用用總總熱熱量量Kcal1787178720022002脂脂Non-Protein Kcal1560156017751775肪肪Non-Protein K/N172172195195静脉营养的临床应用26STD-ISTD-II總液量Guidelines for Nutritional Therapy in Liver DiseaseProteingm/kg/dEnergyKcal/kg/dCHOFatNutritional GoalHepatitsacuteorchronic1.0-1.51.0-1.530-4067-8020-33Prevent malnutritionEnhance regenerationCirrhosisuncomplicated1.0-1.51.0-1.530-4067-8020-33Same as aboveCirrhosis-complicatedMalnutritionCholestasis1.0-1.81.0-1.81.0-1.51.0-1.540-5030-407273-802820-2720-27Restore normal nutritional statusPrevent malnutritionTreat fat malabsorptionEncephalopathyGrade 1 or 2 Grade 3 or 40.5-1.20.5-1.20.50.525-4025-40757525252525Provide nutritional needs without precipitating encephalopathy静脉营养的临床应用27GuidelinesforNutritionalTheRecommendedmacronutrientintakeforpatientswithARFCRFrequiringNSARF or CRF Patients（HD treatments about three times/week）CVVH/CVVHD（inhypercatabolicARF or CRF patients）Protein or Amino acidAbout1.2 g/kg/dofmixedessentialandnonessentialaminoacidsorprotein1.52.51.52.5g/kg/dofmixedessentialandnonessentialaminoacidsorproteinEnergy30453045kcal/kg/d3045kcal/kg/dFat（oftotalenergy）20-30ifnotseptic20-30ifnotsepticWaterAstoleratedAstolerated静脉营养的临床应用28Recommendedmacronutrientinta 病人預期病人預期NPO 5-7NPO 5-7天天 不適當的胃腸功能維持在不適當的胃腸功能維持在5-75-7天天 轉移至口服管灌期轉移至口服管灌期 中央靜脈輸入是禁忌時中央靜脈輸入是禁忌時 營養不良病患營養不良病患 預期須給予數日的預期須給予數日的NPONPO 高新陳代謝性病患高新陳代謝性病患 使用使用PPNPPN即可符合病患熱量及蛋白質的須求時即可符合病患熱量及蛋白質的須求時PPNPPN的適應症的適應症静脉营养的临床应用29病人預期NPO5-7天PPN的適應症静脉营养的临床应用全靜脈營養與周邊靜脈營養全靜脈營養與周邊靜脈營養n5.7%嚴重的併發症嚴重的併發症n包括動脈出血及氣胸包括動脈出血及氣胸n9%導管性併發症導管性併發症n包括導管移除的未注意及中央靜脈栓包括導管移除的未注意及中央靜脈栓塞塞n6.5%與中央靜脈導管有關的菌與中央靜脈導管有關的菌血症血症Payne-James,JPEN 1993;17:468-478TPN的問題的問題全靜脈營養的第一選擇：周邊靜脈營養路徑全靜脈營養的第一選擇：周邊靜脈營養路徑静脉营养的临床应用30全靜脈營養與周邊靜脈營養5.7%嚴重的併發症Payne-Jag 無法或不必要用下腔頸靜脈插管無法或不必要用下腔頸靜脈插管 提供高滲透壓溶液時提供高滲透壓溶液時g 因菌血症而須將中心靜脈插管拆除因菌血症而須將中心靜脈插管拆除g 下腔靜脈先前的插管引起靜脈炎下腔靜脈先前的插管引起靜脈炎g 無專業人員無專業人員周邊靜脈營養周邊靜脈營養Peripheral Parenteral NutritionPeripheral Parenteral NutritionPPNPPN輕度至中度營養缺乏輕度至中度營養缺乏無法經口服或不易經由中央靜脈輸入無法經口服或不易經由中央靜脈輸入或不需要時的一種有效的營養支持療法或不需要時的一種有效的營養支持療法静脉营养的临床应用31無法或不必要用下腔頸靜脈插管周邊靜脈營養PPN静脉营养的临Protein Sparing EffectProtein Sparing Effect胰島素胰島素胰島素胰島素葡萄糖葡萄糖肝醣肝醣胺基酸胺基酸蛋白質蛋白質酮體酮體脂肪酸脂肪酸脂肪脂肪ADP能量ATP能量代謝氧氣O2二氧化碳二氧化碳二氧化碳二氧化碳,水水水水,尿素尿素尿素尿素升糖激素Epin,Norepin,GH類固醇Blackburn;Am.J Clin Ntutr,1974:27:175-187静脉营养的临床应用32ProteinSparingEffect胰島素葡萄糖肝醣The Importance:hypocaloric PPN Support Sufficient Protein in Postoperativen nThe regimen of partial PN support is better in The regimen of partial PN support is better in achievingachieving1.Lessnegativenitrogenbalance2.Improvedvisceralproteinlevels3.GreatertotallymphocytecountProtein source contribution at least 1g/kg/dayRef：Tsann-LongHwangetal,JPEN：1993；Vol17,No.3P254-256静脉营养的临床应用33TheImportance:hypocaloricPPGlycal-AminGlycal-Amin(3%Amino Acid and 3%Glycerin injection(3%Amino Acid and 3%Glycerin injection(3%Amino Acid and 3%Glycerin injection(3%Amino Acid and 3%Glycerin injection with Electrolytes)with Electrolytes)with Electrolytes)with Electrolytes)静脉营养的临床应用34Glycal-Amin静脉营养的临床应用34P0.02氮平衡氮平衡/4日日 Glycal-AminGlycal-Amin 一般氨基酸加電解質一般氨基酸加電解質0-55-1010顯著的正氮平衡顯著的正氮平衡Freeman:Surgery,Gyn&Obs.Vol.156:p625-631,19833%3%Amino Acid and 3%Glycerin injection Amino Acid and 3%Glycerin injection with Electrolyteswith Electrolytes静脉营养的临床应用35P0.02氮平衡/4日Glycal-Amin一般氨基3211 12 23 34 45 51 12 23 34 45 54080120160200240胰島素胰島素依賴型糖尿病依賴型糖尿病非胰島素非胰島素依賴型糖尿病依賴型糖尿病一般氨基酸一般氨基酸+葡萄糖葡萄糖Glycal-AminGlycal-Amindaysdaysdaysdays1 12 23 34 45 51 12 23 34 45 5Plasma Glucose,mg/dlPlasma Glucose,mg/dlDose of insulin I.V.,U/hDose of insulin I.V.,U/hF 不依賴胰島不依賴胰島素素FF 抗酮體抗酮體FF 穩定血糖穩定血糖FF 避免體液流失避免體液流失FF 減少併發症減少併發症Glycal-AminA.LevRan:JPEN 11:271-274,1987Peripharal TPNPeripharal TPN静脉营养的临床应用3632112345123454080120160200240胰686827271818N=41P0.001葡萄糖葡萄糖基劑的基劑的PPNPPNGlycal-AminGlycal-Amin 一般靜脈注射一般靜脈注射一般靜脈注射一般靜脈注射(生理食鹽水生理食鹽水生理食鹽水生理食鹽水)靜脈炎之比較靜脈炎之比較靜脈炎之比較靜脈炎之比較50505050100100100100Eric B.Rypin:The Am.J.of Surg.159,p222-225,19903%3%Amino Acid and 3%Glycerin injection Amino Acid and 3%Glycerin injection with Electrolyteswith Electrolytes静脉营养的临床应用37682718N=41葡萄糖Glycal-Amin一般靜脈注碳水化合物的代謝障礙碳水化合物的代謝障礙37%37%的癌症病人的癌症病人血糖不耐性問題血糖不耐性問題CachexiaCachexia不正常葡萄糖耐受性不正常葡萄糖耐受性飢餓狀態下的血糖飢餓狀態下的血糖可以上昇維持至可以上昇維持至110-120 110-120 mg/dlmg/dl控制葡萄糖利用的控制葡萄糖利用的GLUT-4 TransporterGLUT-4 Transporter受損受損持續減低的葡萄糖利用率持續減低的葡萄糖利用率NutritionalOncology1999Chapter36p.519-536静脉营养的临床应用38碳水化合物的代謝障礙37%的癌症病人Nutritional癌症惡體質的糖類代謝癌症惡體質的糖類代謝J.Am,College of Nutrition 445-456,1992静脉营养的临床应用39癌症惡體質的糖類代謝J.Am,CollegeofNut葡萄糖利用性不良葡萄糖利用性不良A.S.P.E.N.23rd Clinical Congress p.244,1999静脉营养的临床应用40葡萄糖利用性不良A.S.P.E.N.23rdClinic宿主宿主宿主宿主CytokineCytokineCytokineCytokineProductionProductionProductionProduction腦腦無食慾無食慾?脂肪酸脂肪酸脂肪脂肪脂肪酸脂肪酸 甘油甘油 釋出釋出脂肪儲存脂肪儲存腫瘤腫瘤生長生長乳酸乳酸葡萄糖葡萄糖氨基酸氨基酸三酸甘油脂三酸甘油脂肝臟肝臟葡萄糖生成葡萄糖生成蛋白質合成蛋白質合成肌肉肌肉合成合成合成合成分解分解分解分解氨基酸氨基酸脂肪酸脂肪酸氨基酸氨基酸?Proposed mechanism of cancer cachexia無氧反應無氧反應(-2(-2ATP)Cori cycle(-4 ATP)TCA Cycle(-36 ATP)Loss more 300Kcal/dayKern&Norton:JPEN;1988.12:287静脉营养的临床应用41宿主腦無食慾?脂肪酸脂肪脂肪酸甘油釋出腫瘤乳酸葡萄糖肝 Premixed,ready-to use,Premixed,ready-to use,peripheral IV nutrition support peripheral IV nutrition support 使用甘油而非葡萄糖為熱量來源使用甘油而非葡萄糖為熱量來源 提供氨基酸、碳水化合物及電解質提供氨基酸、碳水化合物及電解質 (包括鈉、鉀、鎂、鈣、鏻等包括鈉、鉀、鎂、鈣、鏻等)735 735 mOsm/LmOsm/LGlycal-Amin3%amino acid 3%glycerol with electrolytes3%amino acid 3%glycerol with electrolytes静脉营养的临床应用42Premixed,ready-touse,Glyca2 2L+500mL10%10%脂肪乳脂肪乳3 3L/+500mL20%20%脂肪乳脂肪乳總熱量總熱量1,0401,0401,7351,735蛋白質蛋白質(克克)58588787脂肪脂肪(克克)5050100100鈉鈉(mEq)7070105105鉀鉀(mEq)48487272鎂鎂(mEq)10101515鈣鈣(mEq)6 69 9氯氯(mEq)8282123123磷磷(mmol)14.514.51818醋酸醋酸(mEq)9494141141提供類似提供類似TPNTPN的完整靜脈營養的完整靜脈營養Kenneth Waxman:JPEN 16:p374-378,1992静脉营养的临床应用432L+500mL10%脂肪乳3L/+500mL20%脂肪乳安全、方便、經濟J.Payne-James:JPEN 1993;17:468-478J.Payne-James:JPEN 1993;17:468-478First Choice for Total Parenteral Nutrition:The Peripheral Route全靜脈營養的第一選擇：周邊靜脈營養路徑全靜脈營養的第一選擇：周邊靜脈營養路徑静脉营养的临床应用44安全、方便、經濟J.Payne-James:JPEN1Glycal-AminGlycal-Amin 3%3%3%3%Amino Acid and 3%Glycerin Injection With ElectrolytesAmino Acid and 3%Glycerin Injection With ElectrolytesAmino Acid and 3%Glycerin Injection With ElectrolytesAmino Acid and 3%Glycerin Injection With Electrolytes v已預混合已預混合PPNPPNv減少藥局調製時間減少藥局調製時間v減少汙染的發生減少汙染的發生v容易處方容易處方v醫護人員操作方便醫護人員操作方便v經濟經濟 較較TPNTPN少併發症少併發症 較較TPNTPN價格便宜價格便宜 減低高血糖素症減低高血糖素症 有無有無infusion pumpinfusion pump均可均可 使用使用 不須要不須要taperingtapering安全、方便、經濟安全、方便、經濟静脉营养的临床应用45Glycal-Amin已預混合PPN較TPN少併發症安全 糖尿病與癌症病患糖尿病與癌症病患 維持與穩定血糖維持與穩定血糖 COPDCOPD病患病患 避免避免Pulmonary stressPulmonary stress 避免因避免因SIRSSIRS引起的高血糖症引起的高血糖症 避免避免TPNTPN結束時的低血糖症結束時的低血糖症Glycal-AminGlycal-AminGlycal-AminGlycal-Amin 3%3%3%3%Amino Acid and 3%Glycerin injection with ElectrolytesAmino Acid and 3%Glycerin injection with ElectrolytesAmino Acid and 3%Glycerin injection with ElectrolytesAmino Acid and 3%Glycerin injection with Electrolytes静脉营养的临床应用46糖尿病與癌症病患Glycal-Amin静脉营养的临床应藥師 龐振宜營養是生命的泉源營養是生命的泉源永遠是要考慮到永遠是要考慮到必須給予病患必須給予病患足夠的營養以維持其生命足夠的營養以維持其生命静脉营养的临床应用47藥師龐振宜營養是生命的泉源永遠是要考慮到静脉营养的临床应永遠是要考慮到必須給予病患永遠是要考慮到必須給予病患足夠的營養以維持其生命足夠的營養以維持其生命Echenique MM;Nutrition in Clinical Practice 1999;14:p36-37Echenique MM;Nutrition in Clinical Practice 1999;14:p36-37静脉营养的临床应用48永遠是要考慮到必須給予病患EcheniqueMM;Nut