文档介绍：神经重症疾病合并低蛋白血症的治疗神经重症疾病营养支持?神经重症疾病合并低蛋白血症的危害?神经重症疾病合并低蛋白血症的发生原因?神经重症疾病合并低蛋白血症的治疗方法何实施营养支持急性中风患者营养不良研究275(9%)21942955人人数易发生肺炎、其他感染及消化道出血37%营养不良20%营养正常总人数并发症死亡率FOOD TrialCollaboration Poor Nutritional Status on Admission Predicts Poor es After Stroke Observational Data From the FOOD TrialStroke. 2003;34:1450-1456.)营养不良对预后的影响6一49 d(平均17 d)9 -86 d(平均28 d)住院时间15死亡(人数)%%1个月GCS评分<54%17%褥疮24%50%尿路或呼吸道感染营养正常营养不良Dennis M. Nutrition after stroke. Br Med Bull, 2000, 56: 466一475Salah E Gariballa, Stuart G Parker, Nick Taub, and C Mark Castleden. Influence of nutritional status on clinical e after acute Stroke. Am J Clin Nutr 1998;68:275–81. Stroke patients with serum albumin concentrations ≤34 g/L during hospitalization had a greater risk of dying within the first 3 mo after the stroke than those with serum albumin concentrations ≥35 g/?低白蛋白血症或低前白蛋白血症通常伴随营养不良、功能残疾、预后不良。?加重急性期神经功能缺损程度?增加内科并发症:感染、消化道出血、腹泻等?卒中后恢复期(出院后3个月)死亡率的重要独立预测指标Johnnson AC,et al;Stroke 2008,39:918-923?低蛋白血症对预后的影响具有剂量依赖性?血清白蛋白浓度每下降10g/L,死亡率增加137%,发病率增加89%,住ICU时间延长28%,住院时间延长71% ?血清白蛋白浓度升至30g/L时,并发症明显减少Vincent, Jean-Louis MD, PhD, FCCM*; Dubois, Marc-Jacques MD*; Navickis, Roberta J. PhD?; Wilkes, Mahlon M. PhD?Hypoalbuminemia in Acute Illness: Is There a Rationale for Intervention?: A Meta-Analysis of Cohort Studies and Controlled Trials2003 Lippincott Williams & Wilkins, Inc. Volume 237(3)Marc2003pp 319-334 蛋白质热量营养不良?体重指数(BODY MASS INDEX,BMI) BMI=体重KG/身高2(M2)?正常 <=BMI<25?蛋白质-热量营养不良I级 -?蛋白质-热量营养不良II级 -?蛋白质-热量营养不良III级 <16