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湘雅儿科课件-PROTEIN-ENERGY MALNUTRITIONPROTEIN-ENERGYMALNUTRITION PEMDepartment Of PediatricsLiqun Liu第五章第六节1中南大学儿科学教研室To master the clinical manifestation of PEM To master the ways of prevention andtreatment of PEMTo master the complications of PEM To be familiar with the etiology andpathophysiology of PEM 能量和或蛋白质缺乏energy and protein deficiency所致的一种营养缺乏症多见于3岁以下的婴幼儿体重减轻loss of body weight皮下脂肪减少decrease of subcutaneous fat水肿edema器官功能紊乱disturbance ofthe function of visceral organs andtissuesDefinition长期摄入不足 insufficient intakeof protein and energy in long periods消化吸收障碍the disturbanceofdigestion and absorption需要量增多requirements increasing消耗量过大consumption enlargingEtiologyReasonable feeding to advocate breast feeding Reasonable regimePrevent and treat diseases correct deformityMonitor the growth and developmentprevention新陈代谢异常蛋白质低蛋白血症水肿edema脂肪消瘦emaciation肝脏脂肪浸润及变性fattyinfiltration and degeneration碳水化合物糖原不足低血糖hypoglycemia水盐代谢脱水低血钾低血钙等体温调节病理生理各系统功能低下消化系统食欲不振Anorexia 腹泻diarrhea循环系统血压下降脉搏细弱肢凉泌尿系统多尿低比重尿神经系统表情淡漠智力低下学习困难免疫功能易感染病理生理Marasmus total calorie deficiencyEdema protein deficiencyMarasmus - edemaclinical typesmarasmus edema体重不增为最早症状体重减轻 Initiated with failure to gain weight followed by loss of weight皮下脂肪减少消失顺序abdomen truck buttocklimbs face 器官功能紊乱disorders of multiple organs and tissues 临床分度消瘦型3岁以下儿童营养不良特点ⅠⅡⅢ体重低于正常 15-25 25-40 40腹壁皮褶厚度 08-04cm 04cm消失身长正常稍低明显低消瘦不明显明显皮包骨样皮肤正常苍白松弛苍白无弹性精神正常轻度萎靡抑制烦躁交替肌张力正常降低低下临床分度消瘦型3岁以上儿童营养不良分度轻度重度体重低于正常15-30 30Nutritional microcytic anemiaAll kinds of vitamins deficiencyInfectionsSpontaneous hypoglycemiaComplications 体重低下underweight生长迟缓stunting消瘦wastingDiagnosisAgesIt usually affects the infant underthree years old of ageHistory Feeding history and a history of infection and systemic diseaseClinical manifestations loss of weight decrease and disappearance of subcutaneous fatAssistant examinationIGF-1PrealbuminDiagnosisExcluding causesAdjusting dietscalories mild60-80kcalkgdmid-severe40-55kcalkgdprotein 15-20gKgdmultiple vitamins and minerals supplyingTreatmentFacilitating digestionThe therapy of complicationsIntensive careTreatment各统功能低下免疫功能消化系统泌尿系统循环系统神经系统各种感染食欲不振腹泻多尿低比重尿血压下降脉弱肢凉表情淡漠学习困难智力低下饮食不当疾病因素营养不良低蛋白血症脂肪消耗糖原累积不足细胞外液容量增加肝脂肪浸润及变性消瘦低血糖低渗性脱水低钾血症低钠血症皮下脂肪减少近消失体重减轻并发症贫血维生素缺乏营养不良病理生理临床表现以及并发症之间的关系病因临床表现并发症新陈代谢异常。
