• / 136
  • 下载费用:25 金币  

肿瘤与外科病人营养课件

关 键 词:
肿瘤 外科 病人 营养 课件
资源描述:
Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第九章 肿瘤 第一节 营养与肿瘤的关系 流行病学专家Richard Doll和 RichardPeto提出 癌症引起的死亡之中约有35 与 膳食有关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 营养素与肿瘤的关系 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 蛋白质 过高过低均有可能诱发肿瘤 过低 食管癌和胃癌的发病率增高 过高摄入蛋白质 增加到正常量的2 3倍 可增加化学物质诱发肿瘤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 脂类 膳食中的脂肪含量 乳腺癌 肠癌 呈正相关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肠癌 初级胆酸 脱氧胆酸 石胆酸 高脂膳食 厌氧菌增多 胆酸 脂肪 二酰甘油酯 致癌 致癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 乳腺癌 高脂膳食 雌激素 雌酮 雌二酮 致乳腺癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 高脂膳食可能与下列癌症也有关 前列腺癌 肺癌 子宫内膜癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 碳水化合物和膳食纤维 碳水化合物本身无促癌作用 过多摄入精制的淀粉食物 特别是蔗糖 增加结肠癌和直肠癌的危险性 膳食纤维有预防结肠癌和直肠癌的作用 多糖类碳水化合物摄入量与结肠癌发生率呈负 相关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 膳食纤维抑癌作用 1 膳食纤维具有吸水性 使大肠内容物体积增加 刺激肠道蠕动 缩短代谢产物或废物及有害物质在肠内停留的时间 减少这些物质对肠道的刺激作用时间和再吸收的时 间 可溶性纤维素 如果胶 树胶等 的这种作用更强 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 纤维素可与胆汁酸和胆汁酸代谢产物 胆固醇的结合 减少初级胆汁酸和次级胆汁酸对肠黏膜 的刺激作用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 进入肠内的多糖类碳水化合物通过发 酵产生短链脂肪酸 产生的大量丁酸有抑制DNA合成和刺激 细胞分化的作用 每天膳食纤维的摄入量 一般以每消耗 1000kcal能量 摄取10 13g为宜 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 维生素 目前认为能抗癌的维生素有三种 VitA或 胡萝卜素 VitC VitE Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 VitA和 胡萝卜 动物实验证实VitA缺乏的动物易受化学 致癌物诱发 黏膜 皮肤和腺体肿瘤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial VitA及其衍生物防癌的机理 1 有人认为VitA对上皮细胞分化起调节作用 从而达到 防癌作用 如对气管 支气管上皮的作用是抑制DNA过度合成和 基底细胞增生 使之保持良好的状态 2 也有人认为VitA对癌变细胞的影响主要是动员溶酶 体的作用 增强溶酶体的脆性 使其中的水解酶释放 入细胞浆 增加肿瘤细胞的退化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胡萝卜素的抗氧化和防 癌机理 一是通过清除活性和自由基而发挥抗氧化作用 二是促进细胞间隙连接点传导和刺激免疫功能 的作用 细胞间隙连接点传导是保证细胞正常生长和分 化的重要因素 一旦破坏可导致细胞恶变 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 VitC 1 胃癌 血清VitC水平低 冰岛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial VitC在体外或体内都能阻断亚硝胺所致 食管癌 肝癌和胃癌 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial VitC的抗癌机理 可能是它的抗氧化作用 阻断致癌物亚硝基化合物形成的作用 促进肝脏 清除毒素的作用 加强机体免疫系统对肿瘤的监视作用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 VitE 在肺癌及乳腺癌病人血液中VitE的水平 低于对照组 而VitE含量高的膳食有可能降低这两种 癌症的危险性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial VitE抗癌机理 VitE的主要功能是抗氧化 具有清除自由基的能力 保护细胞膜免受过氧化物的损害 阻断体内 体外亚硝基化合物的形成 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 五 无机盐 经研究发现 镍 铅及其化合物可能是直接和潜在的致癌物 高盐饮食与胃癌发病有关 微量元素中碘 硒 锌 钼则有防癌作用 在碘缺乏地区或长期过多摄入碘的情况下都会使甲状 腺癌的发生率增高 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 硒的防癌机制 是它的抗氧化作用 硒是谷胱甘肽过氧化物酶的组成成分 催化有 机过氧化物分解而预防组织细胞受损 硒能调节VitA C E K的吸收与消化 参与辅酶A和辅酶Q1O的合成 对有些致癌物质有拮抗作用 硒还能增强与抗肿瘤有关的免疫反应 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 锌与肿瘤 很多癌症病人 食管癌 肝癌 胃癌 骨癌等 出现血清锌低于正常人的情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 锌缺乏可能与食管癌发生 有关 食管癌患者血锌 12 0 2 3 mol L 正常人为 15 8 2 8 mol L 食管癌患者发锌 166 33 g g 正常人为 195 29 g g Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 钼与食管癌 钼缺乏可增加食管癌的发病率是因为食管癌高 发区 河南林县 土壤中缺钼 当施以钼肥后 谷类 蔬菜中钼和维生素含量 增加 硝酸盐及亚硝酸盐的浓度降低 食管癌发病率也随之降低 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 膳食因素与肿瘤的关系 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 饮食习惯 良好的饮食习惯可预防肿瘤的发生 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 如喜食葱属类蔬菜可预防胃癌 喜食蔬菜水果 杂粮 喝绿茶者可预防 上皮癌 特别是与消化管和呼吸道肿瘤 的危险性呈负相关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 不良的饮食习惯和嗜好可以导致肿瘤的 发生 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 如喜食腌渍 熏烤 过咸的食物 过量饮酒 与消化管肿瘤的危险性呈正相关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 大蒜或洋葱类可能的抗癌 机理 在大蒜或洋葱产量很高的地区人群的胃 癌死亡率很低 1 可能是因为葱属类化合物能通过诱导 酶的解毒作用而产生抗癌性 2 也可能是葱属类化合物通过抗胃幽门 杆菌的生长而达到防癌的目的 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 植物化学素的抗癌作用 蔬菜 水果 茶叶和杂粮等植物性食物 除含维生素 无机盐和膳食纤维外 还含有多种具有生物活性的物质 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 如类萜烯化合物存在于柑橘中 类黄酮类存在于水果 蔬菜 茶叶 咖 啡中 酚类存在于新鲜蔬菜和水果中 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 类萜化合物可能的机理 类萜化合物的抗癌作用在癌症形成的起 始阶段 和促进阶段都有效 它既是癌症 的阻断剂 也是抑制剂 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 黄酮类化合物 多种黄酮类化合物具有抗癌作用 如芦 丁 桑黄素能抑制苯并芘对小鼠皮肤的 致癌作用 芹黄素 山萘酚 槲斗素对黄曲霉毒素 B1与DNA加成物的形成有抑制作用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 黄酮类化合物抗癌机理 黄酮类化合物的抗突变 抗癌机理 一方面是化学预防作用 另一方面是抑制肿瘤细胞DNA合成 达 到抑制肿瘤细胞生成的作用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 亚硝基化合物 食管癌 肝癌及鼻咽癌 与亚硝基化合物的含量有关 喜食盐腌酸菜 其中所含的亚硝胺及前体硝酸盐 亚硝 酸盐和仲胺均较高 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一些地区胃癌高发与当地居民经常食用 家庭自制的熏肉等食品中含苯并 芘较 高有关 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 嚼槟榔习惯 国内调查发现 在嚼槟榔习惯人群中口腔 喉 食管和 胃肿瘤发生率增高 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 食物中含过多的盐被认为与胃癌有关 食盐对胃黏膜有刺激作用 可破坏胃黏膜层 使胃上皮细胞直接接触胃内容物中的致 癌物质 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 饮酒与肿瘤 结肠 直肠 乳腺和肝脏发生肿瘤的危 险性随饮酒量增加而增高 酒精可与其他致癌因素有协同作用 如在肝癌发生中乙醇与黄曲霉毒素B1或 乙肝病毒存在协同性 在口腔癌和食管癌发生中乙醇和烟草的 共同作用使危险性成倍增长 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 食用被致癌物污染的食物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 黄曲霉毒素与肿瘤 被黄曲霉菌和寄生曲霉菌产生的代谢产 物黄曲霉毒素污染 黄曲霉毒素对 动物有强烈的致癌性 可诱发动物肝癌 肾癌 结肠癌 乳腺 癌及卵巢癌等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial N一亚硝基化合物对食品的污染 以鱼类食品为最高 其次是肉类制品 发酵食品等 动物实验证明N一亚硝基化合物是致癌 性很强的一类化合物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 多环芳烃类对食物的污染 除熏烤食物 直接污染外 还有环境中苯并 芘经大气飘尘 沥青路面晾晒粮食 不良包装材料等污染食物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 苯并 芘对各种动物的致癌性是肯定的 有实验证明 其可诱发 胃 食管 肠肿瘤等 并可经胎盘使其后代发生肿瘤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 致癌食品添加剂 致癌食品添加剂对食品的污染 奶油黄可致肝癌 过量使用糖精钠可致膀胱癌 发色剂亚硝酸钠是致癌物亚硝胺的前体 过量食用也会对人体有害 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第二节 常见恶性肿瘤的营 养防治措施 一 肿瘤病人的营养治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 癌症患者死亡的主要原因是 营养不良引发的合并症 因此提早作营养评估 供给必要与足够的营养 维持最佳体力与免疫功能就能延长寿命 降低死亡率 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 肿瘤患者对营养素的 需求 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 能量 增加能量的摄入 可弥补因代谢增加而耗损的 能量并减少体重的丧失 每日能量需要量为35 50 kcal kg Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 蛋白质 选择优质而足量的蛋白质 可促进细胞 的建造与修复 每日蛋白质的需要量为 1 5 2 g kg Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 碳水化合物 为提供足够能量以补充能量消耗 并可 节省蛋白质 每日碳水化合物需要量为250 300g 体重消瘦者可提高到400g Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 脂肪 摄入量以不超过总热量的30 为原则 应多选用必需脂肪酸含量高的植物油 避免摄入胆固醇较高的食物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 维生素与无机盐 可调节人体生理机能 并促进蛋白质与热量的有效利用 因此肿瘤患者每日还应适量补充维生素 和无机盐 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 目前认为具有抗癌效果的 VitA C E 胡萝卜素 叶酸 番茄红素 锌 硒 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 6 水分 按一般正常状况 每日应摄入水分1500 mL左右 如有使用药物或化学治疗剂时 每日应 增加到2000 3000 mL Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 营养治疗方案 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 术前营养治疗 肿瘤患者术前营养状态的改善是良好的 术前准备之一 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 对体重丢失15 20 者 继发于营养 不良的并发症危险性显著增加 应提供 积极的营养治疗 除经口外 还可经肠内和肠外途径提供 营养 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胃肠道功能存在或治疗允许时 应首选经口饮食 肠内营养 若因局部病变或治疗限制不能利用胃肠 道时 才考虑肠外营养治疗 术前肠内营养治疗可经鼻胃管或胃 空 肠造瘘提供 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 术后营养治疗 估计术后需较长时间禁食或一周不能恢复正常饮食者 可在术后时作胃或空肠造瘘 术后早期 24 48 h内 开始肠内营养治疗 亦可在术后第一 二天待患者内环境 稳定后 开始 肠外营养治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 另外 对术前体重丢失小于5 或无体重 丢失 并且又提供了足够饮食营养的患者 术 后只需常规补液和补充电解质 尽早恢复经口饮食或肠内营养 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 但是如果出现严重并发症或5 7 d内肠 功能不能恢复者 应考虑肠外营养治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 家庭营养治疗 对于伴有严重厌食 但不准备再做进一步抗肿瘤治疗的患者 若胃肠功能存在 可提供家庭肠内营养治疗 以期改善生活质量 对有持续肠梗阻或严重胃肠功能障碍 不能应用肠内营养及各种 治疗措施均无效的患者 可以明确告知患者或其家属 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 膳食防治肿瘤 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 有助于免疫能力及预防癌 症的食物 1 目前一般认为有木耳 洋菇 草菇 香菇 海带 慈菇 胡萝卜 番茄 人参 灵芝 茼翦 麦麸 薏 仁 大豆 绿叶蔬菜 川七 丝瓜 丝瓜露 丝瓜花 奇异果 柑橘 柚子 柠檬 木瓜 山楂 葱 蒜 芽菜类 洋葱 刺梨 猕猴桃 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 放射线治疗或化学治疗 后 可选用的食物 有清热 滋润 生津及止渴作用 有西瓜 水梨 葡 萄 苹果 藕粉 水蜜桃 杨桃 杨梅 柿子 西红 柿 酸梅 李 杏 奇异果 菠萝 甘蔗 柑橘 枇 杷 蜂蜜 苦瓜 鲜藕 莴苣 荸荠 萝卜 薏仁 山药 杏仁 菱角 冬瓜 饴糖 慈菇 蘑菇 香蕈 苦瓜 丝瓜 黄瓜 黑或白木耳 茭白笋 绿豆汤 白菜 小养麦 大麦 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 伴有发热水肿时 可选 用之食物 有清热 利尿及消肿作用 有 蛤蜊 泥鳅 鲤鱼 鲫 鱼 田鸡 蛤蚌 鲍鱼 干贝 空心菜 黄瓜 海带 海藻 薏仁 红豆 苋菜 丝瓜 茼 蒿 白菜 芽菜类 丝瓜 冬瓜 荸荠 慈 菇 莴苣 金针 菱角 菠菜 柴菜 茭白笋 香 瓜 苹果 香蕉 西瓜 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 案例分析 患者女 48岁 2个月前因子宫内膜癌行子 宫全切及双侧附件切除术 化疗后出现恶心 呕吐 并逐渐加重 于13天前入院 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 营养评估 1 体位测量 身高160cm 入院体重45kg 平常体重60kg BMI 17 6 AC 28cm 三 头肌皮层厚度为15 5 cm 上臂肌肉AMC 17 6 cm Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 生化检验 Na 131mmol L K 1 51mmol L Cl 98 9mmol L ALB33 4 g L Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 临床检查 患者精神差 表情淡漠 进食少 大便五日一次 小便每日400 mL T36 P100次 min 70 40mmHg 诊断为低血溶量性休克 重度低钾 低钠血症 营养 不良 入院后对患者行24 h心电监护曾出现心律失常 心电图显示 阵发性室上速 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 饮食评估 病人平时胃口不太好 化疗后更差 每 天约能量4186 8kJ 蛋白质50g 近 1周几乎不能进食 入院后采用营养 支持疗法 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 饮食处方 氮11 7g d 氮热比为1 150 糖 脂肪为6 4 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 6 营养支持方法 以支链氨基酸为氮源 以10 50 葡萄糖和20 30 脂肪乳剂双能源 供热 按1 10加入正规胰岛素 同时根据电解质的监测情况调整电解质用量 适当补 充多种维生素和微量元素 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 液体量根据患者每日出入量情况进行调挚 采用中心静脉输注 根据液体量滴速为30 50滴 min 共进行13d 患者生理体征趋向平稳 精神明显好转 并能经口进 食 好转出院 Five weeks of practice ended in this way and my feelings can only
展开阅读全文
  麦档网所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
0条评论

还可以输入200字符

暂无评论,赶快抢占沙发吧。

关于本文
本文标题:肿瘤与外科病人营养课件
链接地址:https://www.maidoc.com/p-16697821.html

当前资源信息

范文库

编号: 20181015155103729181

类型: 共享资源

格式: PPT

大小: 177.50KB

上传时间: 2020-05-24

关于我们 - 网站声明 - 网站地图 - 资源地图 - 友情链接 - 网站客服 - 联系我们

[email protected] 2018-2020 maidoc.com版权所有  文库上传用户QQ群:3303921 

麦档网为“文档C2C模式”,即用户上传的文档所得金币直接给(下载)用户,本站只是中间服务平台,本站所有文档下载所得的金币归上传人(含作者)所有。
备案号:蜀ICP备17040478号-3  
川公网安备:51019002001290号 

本站提供办公文档学习资料考试资料文档下载


收起
展开