全腸道外營養療法
(Total Parenteral Nutrition, TPN)
是一種將營養直接輸送到靜脈中，繞過消化系統。這種療法通常用於無法或不適合經由口服或鼻胃管攝取足夠營養的患者。
像是有下列問題的個案，通常會使用TPN來給予營養
當患者罹患嚴重消化道疾病，如腸道阻塞、短腸症候群、克隆氏症等，導致腸道無法有效吸收營養，或因嚴重腹瀉、嘔吐而無法進食時，醫師通常會考慮採用全靜脈營養（Total Parenteral Nutrition, TPN）來提供患者所需的營養。
When patients suffer from severe gastrointestinal diseases such as bowel obstruction, short bowel syndrome, or Crohn's disease, resulting in malabsorption or inability to eat due to severe diarrhea or vomiting, physicians often consider total parenteral nutrition (TPN) to provide necessary nutrients.
克隆氏症（Crohn’s disease）患者常使用TNF-α抑制劑adalimumab來抑制過度活化的免疫系統，減輕腸道發炎。同時，對於伴隨嚴重腹瀉的患者，醫師可能開立洛哌米德（loperamide）等藥物，以減緩腸道蠕動，減少水分和電解質的流失。
Patients with Crohn's disease often use the TNF-α inhibitor adalimumab to suppress an overactive immune system and reduce intestinal inflammation. Concurrently, for patients experiencing severe diarrhea, physicians may prescribe loperamide to slow down intestinal motility and reduce fluid and electrolyte loss.
消化道手術後：
大範圍腸道切除或吻合術後，腸道功能尚未恢復。
嚴重營養不良：
癌症、燒傷、嚴重感染等消耗性疾病導致患者營養不良。
燒傷初期血液變化的完整總結
Summary of Initial Hematological Changes in Burn Patients
燒傷後，身體會啟動一系列的複雜生理反應，其中血液系統的變化尤為顯著。由於燒傷導致血管通透性增加，大量體液從血管滲漏到組織間隙，造成嚴重的體液流失。這不僅導致血容量減少，還引起血液濃縮，進而影響各器官的灌流。
Following a burn injury, the body initiates a complex series of physiological responses. Among these, changes in the blood system are particularly pronounced. Due to increased vascular permeability caused by the burn, a significant amount of fluid leaks from the blood vessels into the interstitial tissues, resulting in severe fluid loss. This not only leads to a decrease in blood volume but also causes blood concentration, subsequently affecting the perfusion of various organs.
具體的血液變化包括：
Specific hematological changes include:
血漿蛋白流失： 除了水分流失外，血漿中的蛋白質也會大量滲出，導致血漿膠體滲透壓降低，加劇體液的移出。
Plasma protein loss: In addition to fluid loss, plasma proteins are also lost in large quantities, leading to a decrease in plasma oncotic pressure and exacerbating fluid shift.
紅血球生成減少： 骨髓受到損傷或功能減退，紅血球的生成速度減慢，導致貧血。
Decreased red blood cell production: Bone marrow is damaged or its function is impaired, leading to a decrease in the rate of red blood cell production and anemia.
血紅素濃度降低： 由於血漿流失，血液濃縮，相對而言，血紅素的濃度就會降低。
Decreased hemoglobin concentration: Due to plasma loss, blood becomes concentrated, and the relative concentration of hemoglobin decreases.
血比容升高： 雖然總血量減少，但由於血漿流失更多，使得紅血球佔血液的比例相對增加，所以血比容會升高。
Increased hematocrit: Although total blood volume decreases, the proportion of red blood cells in the blood increases relative to plasma loss, resulting in an increased hematocrit.
輸液治療的重要性Importance of Fluid Resuscitation
為了補充因燒傷而流失的體液，維持血容量，並改善組織灌流，燒傷患者需要進行大量的輸液治療。
To replenish the fluid lost due to burns, maintain blood volume, and improve tissue perfusion, burn patients require large volumes of fluid resuscitation.
由於燒傷會導致血管通透性增加，大量體液從血管滲漏到組織間隙，造成嚴重的體液流失。
Due to the increased vascular permeability caused by burns, a significant amount of fluid leaks from the blood vessels into the interstitial tissues, resulting in severe fluid loss.
常用的輸液公式有帕克蘭公式，該公式根據患者的體表面積燒傷面積和體重來估算24小時內所需的總輸液量。
The Parkland formula is a commonly used formula to estimate the total fluid requirement within 24 hours based on the patient's body surface area burn percentage and weight.
輸液治療的關鍵點：
Key points of fluid resuscitation:
早期快速輸液： 燒傷初期是體液流失最快的階段，因此需要在第一個8小時內補充完成50%的輸液量，以防止血容量進一步下降，維持重要器官的灌流。
Early and rapid fluid resuscitation: The initial phase after a burn is when fluid loss is most rapid, so 50% of the total fluid requirement should be administered within the first 8 hours to prevent further decreases in blood volume and maintain adequate organ perfusion.
監測： 在輸液過程中，需要密切監測患者的 vital signs（生命徵象）、尿量、中心靜脈壓等指標，及時調整輸液速度和液體種類。
Monitoring: During fluid resuscitation, it is essential to closely monitor the patient's vital signs, urine output, central venous pressure, and other indicators, and to adjust the infusion rate and fluid type as needed.
個體化治療： 輸液治療需要根據患者的具體情況進行個體化調整，考慮到患者的年齡、燒傷深度、合併症等因素。
Individualized treatment: Fluid resuscitation should be individualized based on the patient's specific condition, considering factors such as age, burn depth, and comorbidities.
其他需要考慮的因素：
Other factors to consider:
電解質紊亂： 燒傷患者容易發生電解質紊亂，如鈉、鉀離子失衡，需要及時補充。
Electrolyte imbalance: Burn patients are prone to electrolyte imbalances, such as sodium and potassium imbalances, which require timely supplementation.
酸鹼平衡失調： 燒傷可導致代謝性酸中毒，需要糾正酸鹼平衡。
Acid-base imbalance: Burns can lead to metabolic acidosis, which needs to be corrected.
感染風險： 大面積燒傷患者易發生感染，需要積極預防和治療。
Infection risk: Patients with large burn areas are susceptible to infection, which requires active prevention and treatment.
無法經口進食：
昏迷、口腔疾病、吞嚥困難等導致無法進食。
新生兒疾病：
早產兒、先天性腸道畸形等新生兒可能需要TPN。
TPN的優點：
精準營養： 可以根據患者的個別需求，精準配製營養液，提供所需的能量、蛋白質、維生素和礦物質。
TPN的缺點和風險：
中心靜脈導管感染是TPN最常見的併發症之一。
血糖控制困難、電解質紊亂、肝功能異常等。
TPN的製備和管理費用較高。
長期依賴TPN可能導致腸道萎縮，影響腸道功能。
在更換輸液管路時，空氣可能混入輸液系統。
對於腸道絨毛的影響
TPN本身不會直接導致腸道絨毛增生。 然而，長期接受TPN的患者，由於腸道長期處於休息狀態，可能導致腸道結構和功能的改變，包括絨毛萎縮。
當患者恢復經口進食時，腸道絨毛可能會出現一定程度的增生，這是腸道為了適應新的營養攝入方式而做出的生理性反應。
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