(Chinese Academy of Medical Sciences, Peking Union Medical College Hopsital, Dept. of Surg)

The complications of patients with parenteral nutrition or enteral nutrition:

- Mechanical complications:

1. Failed tube positioning.

2. Malpositioning of tube.

3. Dislogement of tube.

4. Tube cogging/obstruction.

5. Mechanical damage.

- Infectious complications:

1. Prepacked formula contamination.

2. bact. contamination of mixed, diluted, decanted foods.

3. Aspiration pnueumonia, volume aspiration, subclinical aspiration.

4. Catheter Related Sepsis.

5. Bowel bacteria/endotoxin translocation.

- Gastrointestinal complications:

1. Nausea, vomiting.

2. GFastric retention.

3. Diarrhea.

4. Gastrointestinal bleeding.

5. Abdominal distensions, cramps.

6. Constipation.

7. Bowel muccaa atrophy.

- Metabolic complications:

1. Hypertonic dehydration.

2. Hyperglycaemie non-ketotic dehydration/coma.

3. Overhydration.

4. Hyperglycemia.

5. Hypoglycemia.

6. hypernatremia.

7. Hypoaatremia.

8. Hyperkalemia.

9. hypokalemia.

10. Hyperphosphatemia.

11. hypophosphatemia.

12. Hypomagnesemia.

13. Low blood lever of zinic.

14. Low lever of copper.

15. Vitamine K deficiency.

16. Essential fatty acid deficiency.

17. Liver function disturbance.

18. Glutamine deficiency.

Monitoring of nutritional status:

1. Technical monitoring:catheter location and sterility.

2. Proper preparation of the infusion solution,correct applications.

3. Nutritional and fluid ballanee.

一、肠外、肠内营养支持的主要并发症

1．机械性并发症：肠内、肠外营养置管失败、异位、阻塞、机械性损伤等。

2．感染性并发症：营养制剂及配制、输入系统的污染，肠外营养导管感染、内源性感染，肠内营养误吸性肺炎等。

3．胃肠道并发症：肠内营养时恶心、呕吐、胃潴留、腹泻、腹胀、腹痛、便秘，肠外营养时肠粘膜萎缩、肠道细菌毒素易位等。

4．代谢性并发症：高血糖和低血糖，非酮性高渗性昏迷，肝脂肪变性，肝脏毒性反应，肠外营养时胆汁淤积性肝炎、胆囊炎、胆囊结石。谷氨酰胺缺乏，高／低血钾症，高／低血钠症，高／低血磷症等。

二、营养支持的监测

1．插管后导管位置／导管有关感染的监测；

2．输液系统／输入速率／浓度的监护：除尘滤器，泵及各个连接点。输注管／容器护理清洁更换。

3．营养及体液平衡等监测：水，电解质，氮平衡的监测。