预防医学期末总结.docx
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预防医学期末总结.docx
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预防医学期末总结
营养学部分
【lipid】
1.形式:
游离:
游离脂肪酸、游离胆固醇
freeform:
freefattyacid,freecholesterol
酯化:
单/双/三甘油酯,磷脂,胆固醇酯
Esterifiedform:
mono-/di-/tri-glycerides,phospholipids,cholesterolesters
2.甘油三酯作用triglycerides:
①提供能量:
provideenergyforthebody
②储存能量:
storingenergyforlateuse
③绝缘、保护身体:
insulatingandprotectingthebody
④运输脂溶性维生素:
transportingfat-solublevitamin
3.磷脂作用phospholipid:
①细胞膜和脑的组成部分componentofcellmembraneandbrain
②乳化剂:
亲水基-P/N疏水基-脂肪酸
emulsifiers:
lovingwater-phosphorusandnitrogen;fearwater-fattyacid
4.固醇作用sterol
①激素:
皮质激素,雌激素,雄激素,Vd
Hormone:
corticosteroid,estrogen,testosterone,vitaminD
②身体每天产生700mg胆固醇,400用于合成胆汁酸(bileacid),50用于合成激素
5.分类:
1)链的长度:
长链:
12-26C
2)饱和程度:
饱和-棕榈酸酯,硬脂酸酯palmitate,stearate
不饱和:
多不饱和-w3PUFA:
DHA,ALAα-亚麻酸,EPA
w6PUFA:
AA,LA亚油酸,γ-亚麻酸linolenicacid
可降低冠心病
单不饱和-油酸-棕榈油酸oleicacid,palmitoleicacid
W3:
w6最好在1:
1~1:
4
6.必需脂肪酸essentialfattyacid
人体不可缺少而自身又不能合成,必须通过食物供给,包括亚油酸,α-亚麻酸
Fattyacidsthathumansandotheranimalsmustingestbecausethebodyrequirethemforgoodhealthbutcannotsynthesizethem.Eg.α-linolenicacid,linolicacid
ConditionallyessentialFAs:
w3:
二十二碳六烯酸docosahexaenoicacidw6:
γ-亚麻酸
7.反式脂肪酸transfattyacid:
直线快餐心血管疾病↑
94DanishNutritionCouncil首次提出
2002intituteofmedicinereport强调应尽量减少trans摄入
2004USdietaryguidelinesadcisorycommittee说摄入小于能量的1%
1)促进AS等cariovasculardisease,prostate/breastcancer及diabetes,obesity,Alzheimer’sdisease,infertility
2)降低HDL,升高LDL
8.选择怎样的脂类?
通常:
低饱和FA,高不饱和
高w-3USFA,低w-6USFA
少或无transFA
9.脂肪转运:
fattransporters:
乳糜颗粒chylomicrons
VLDL
LDL
HDL(好,从组织运到肝脏,应↑)
10.心血管疾病的危险因素riskfactorsforcardiovasculardiseases
1)总固醇totalchol>200mg/d,LDL>130mg/d
2)HDL<35mg/d
3)Age
4)Smoking
5)Obesity
6)inactivity
11.如何降低LDL
1)↓饱和脂肪酸和胆固醇
2)↓血中甘油三酯triglycerides
3)↑单不饱和和多不饱和
4)↑膳食纤维
5)↑HDL(exercising,adequatealcohol)
【protein】
1.八种必须氨基酸:
“借一两本,带色书来”:
缬氨酸Valine、异亮氨酸Isoleucine、亮氨酸Leucine、苯丙氨酸Phenylalanine、蛋氨酸(甲硫氨酸)Methionine、色氨酸tryptophan、苏氨酸Threonine、赖氨酸lysine
组氨酸Histidine是婴儿时期必需氨基酸
2.蛋白质作用
1人体组成成分vitalbodyconstituents
2激素和酶hormonesandenzyme
3免疫功能-免疫球蛋白
4运输
5体液、酸碱平衡
6转化为糖
7提供能量15%的能量
3.Protein-energymalnutrition蛋白质能量营养不良症
1消瘦marasmus:
严重缺乏severeenergyandproteindeficit
无皮下脂肪subcutaneousfat
2恶性营养不良病PEM、Kwashiorkor:
中度moderateenergydeficitwithsevereproteindeficit
感染、无精打采listlessness、水肿、长不高不重
3混合型
4.预防和治疗
1提供足够营养,尤其是蛋白质摄入
2主要预防措施:
头六个月母乳喂养breastfeeding
3对于Kwashiorkor病人,应逐渐补充蛋白质gradually
4对于消瘦Marasmus病人,不仅仅治病还要治疗并发症,包括感染、脱水、循环疾病(这些易致死且易被忽略)
【vitamins】
1.身体能合成的:
Vd、Vk、niacin(烟酸)←色氨酸(tryptophan)合成
2.脂溶性fat-soluble:
A(retinol视黄醇)/D/E(tocopherol生育酚)/K
3.水溶性water-soluble:
B/C(抗坏血酸ascorbicacid)
1易吸收absorbedeasily
2不易储存cannotberetainedforalongperiodbythebody(除Vb12)
3易分泌easilyexcretedintheurinewheneverplasmalevelsexceedre
4易被烹饪损害
4.维生素A的功能
1维持正常视觉vision
2促进细胞生长、分化cellulargrowthanddifferentiation
3增强免疫immunity
4细胞表面功能cellsurfacefunction
5其他:
生殖、骨骼发育、抗癌reproductive/bonedevelopmentandmaintenance/anti-cancer
5.维生素D来源
1食物获取D3,主要有动物性食品及鱼肝油制剂(fish/egg/milk/soybeverages/margarinefortifiedwithVd)
2在阳光照射下,皮肤合成producednaturallyfromsunlightbyskin’sepidermis
6.维生素D的功能
1骨骼:
钙磷平衡;合适的矿化bone:
calciumandphosphatehomeostasis;requiredforpropermineralization
2甲状旁腺激素PTH:
homeostasis
3肌肉:
钙运输;蛋白合成;肌肉收缩动力学
calciumtransport;proteinsynthesis;keneticsofmusclecontraction
4免疫:
内源性免疫promotesinnateimmunity
5胰脏:
胰岛素↑promotesinsulinsecretion
6心血管:
负性调节肾素血管紧张素系统negativeregulatoroftherennin-angiotensinsystem
7细胞周期:
抑制增殖,刺激分化
Cellcycle:
inhibitscellproliferation;stimulatesdifferentiation
7.膳食参考摄入量dietaryreferenceintakes
1平均需求量Estimatedaveragerequirement(EAR)
2膳食许可量Recommendeddietaryallowance(RDA)
3适宜摄入量Adequateintake(AI)
4可耐受最高摄入量Tolerableupperintakelevel(UL)
8.IOMadequateintake
●5μg(200IU)infant→50
●10μg(400IU)51→70
●15μg(600IU)>70
9.Serum25-OHDcut-off
●<25-27.5nmol/L→Deficient
●<37.5nmol/L→Inadequacyforbonehealth
●<75-80nmol/L→Insufficient*
●>220nmol/L→“noobservedadverseeffects”(10,000IU)**
●>375–500nmol/L→potentiallyToxic
【water】
【minerals】
1.特性properties
1体内不能合成
2粪、尿分泌,食物供给
3安全范围窄,易超标造成毒性
4中国人易缺钙、铁、锌、碘
2.分类
1Macromineral常量元素:
K/Ca/Na/Mg/S/Cl/P钾钙钠镁硫氯磷
2Traceelement微量元素:
必需微量元素:
铜、铁、锌、碘、硒
Essentialmiroelements:
copper,iron,zinc,iodine,selenium
可能必需微量元素:
潜在毒性但低剂量有必需功能:
铅、砷
Mineralspotentialtoxicity:
lead,arsenic
3.钙:
占体重5%~2%,99%是骨和牙齿,与甲状腺激素、甲状旁腺激素、Vd有关
RNI1000mg/d
作用:
1骨和牙齿的矿化作用mineralization
2酶调节→凝血enzymeregulation—clottingofblood
3神经传导nerveconduction
4肌肉收缩musclecontraction
5膜渗透性membranepermeability
【营养调节】
1.patientcare:
teamapproach
内科医师Physician
注册营养师RegisteredDietitian
注册/领照护士RegisteredNurse,LicensedVocationalNurse,CertifiedNursingAssistant
药剂师Pharmacist
语言治疗师SpeechTherapist
职业疗法专家OccupationalTherapist
社工SocialWorker
2.thenutritioncareprocess:
Identifyingandmeetingaperson’snutrientandnutritioneducationneds.
Fivesteps:
1.AssessAssessmentofnutritionalstatus评定营养等级
2.AnalyzeAnalyzeassessmentdatatodeterminenutrientrequirements
分析评估数据→决定营养需要
3.DevelopDevelopanutritioncareplantomeetpatient’snutrientandeducationneeds.
制定营养计划
4.Implement:
Implementcareplan实施
5.Evaluate:
Evaluateeffectivenessofcareplan:
ongoingfollow-up,reassessment,andmodificationofcareplan.评价疗效和修订
3.assessingnutritionalstatus
HistoricalInformation
PhysicalExamination
1体重Weightstatus
2移动度Mobility
3营养不良症状Signsofnutrientdeficiencies/malnutrition:
hair,skin
4体液平衡Fluidbalance(dehydration/fluidretention)
AnthropometricData人体测量数据
间接测量身体成分和发展
Indirectassessmentofbodycompositionanddevelopment
营养评估UsedinNutritionAssessment:
–测量身高体重Measuresusingheightandweight:
BMI
–测量身体成分Measuresofbodycomposition(fatvs.leantissue)
●体脂测量:
皮肤褶,腰臀比,水下称重,生物电阻抗
Bodyfatmeasurements:
fatfold(skinfold),waist-to-hipratios,hydrodensitometry(hydrostaticweighing),bioelectricalimpedance
●中臂肌肉围度+三头肌皮褶Midarmmusclecircumference+tricepsfatfold
–FunctionalMeasures
LaboratoryAnalyses
–蛋白质:
体/血清蛋白
Protein:
somatic~
Serum~:
liverfunction/albumin/prealbumin/nitrogenbalance(UUN)
–免疫功能:
白细胞、淋巴细胞
Immunefunction:
WBC,totallymphocytecount
–血液评估
Hematologyassessment:
Hb,HCT,MCV
–其他:
glucose,creatinine,sodium
Ppt-Airpollutionandhumanhealth
1.【airpollution】①theintroductionintothe atmosphere of chemicals, particulates,or biologicalmaterials thatcausediscomfort,disease,ordeathtohumans,damageotherlivingorganismssuchasfoodcrops,ordamagethe naturalenvironment or builtenvironment.②anysubstancepresentinorreleasedtotheatmospherethatadverselyaffectsenvironmentalorhumanhealthisconsideredanairpollutant③categories:
primary/secondary
①大气中化学、颗粒、生物材料/给人类造成不适、疾病、死亡,或损伤其他微生物,或损伤自然/建设环境②任何存在于或释放到大气的会对环境和人类健康造成不良影响的物质③分为初级和次级污染
【primarypollutant】
1emitteddirectlyintotheatmospherewheretheyexertanadverseinfluenceonhumanhealthorenvironment.
2suchasashfromavolcaniceruption,thecarbonmonoxidegasfromamotorvehicleexhaustorsulfhurdioxidereleasedfromfactories.
3Ofparticularconcernaresixprimarypollutantsemittedinlargequantities:
carbondioxide,carbonmonoxide,sulfuroxides,nitrogenoxides,hydrocarbons,andparticulates.
1直接释放到大气,给人类健康和环境造成不良影响
2比如:
火山喷发-CO,汽车尾气-硫氧化物
36种基本污染物:
CO,CO2,硫氧化物,氮氧化物,碳氢化合物,颗粒
【secondarypollutant】
1Onceintheatmosphere,primarypollutantsmayreactwithotherprimarypollutantsoratmosphericcompoundssuchaswatervaportoformsecondarypollutants,eg.acidprecipitation
初级污染物一旦排入大气会与其他初级污染物或大气成分(水蒸气)反应而形成,比如酸雨
2asecondarypollutantformedwhensulfurornitrogenoxidesreactwithwatervaporintheatmosphere.
次级污染物通常为硫氧化物和氮氧化物与水蒸气结合
【photochemicalsmog】
▪anoxioussmogproducedbythereactionofnitrogenoxideswithvolatileorganiccompounds(VOCs)inthepresenceofultravioletlightfromthesun.
有害气体:
氮氧化合物与VOCs在太阳紫外线照射下产生
▪thereactionisverycomplex反应复杂
▪Theproductsincludeozone,peroxylnitrates(PANs)andaldehydes
产物包括臭氧、PANs和甲醛
▪morethan85%oftheproductsisozone
85%是臭氧
▪isalsoknownasbrownsmogbecauseofitscharacteristiccolor,giventoitbynitrogendioxide,abrowngas
又称为棕色烟雾,因为其颜色,源于二氧化氮的颜色
▪Theincompletecombustionoffossilfuels,particularlyfromautomobiles,isprimaryman-madesourceofvolatileorganiccompounds
VOCs的人为主要来源为汽车化石燃料的不完全燃烧
【globalwarming】
▪anincreaseintheaveragetemperatureoftheearth'satmosphere(especiallyasustainedincreasethatcausesclimaticchanges)
平均温度上升尤其是持续的改变
▪Themostlikelyandmostworrisomeeffects
Øchangesinrainfallpatterns(someplaceswillbecomemuchdryerandothersmuchwetter)降雨格局的改变,有的地方多,有的少
Øchangesingrowingseasons生长期改变
Øchangesinarableland耕地
ØChangesinrisingsealevelsandoceancurrentflow海平面与洋流
ØChangesinecosystem,economy,agriculture,industry,settlementsandrelatedtoallthese–thehealthandliving生态系统、经济、农业、工业、居住等一系列与健康生存有关的
【greenhousegas】
Øagasinanatmospherethatabsorbsandemitsradiationwithinthethermalinfraredrange.
大气中可吸收和释放红外线范围内辐射的气体
ØThisprocessisthefundamentalcauseofthegreenhouseeffect
造成温室效应的基础原因
ØthemostabundantgreenhousegasesinEarth'satmosphereare:
■watervapor
■carbondioxide
■Methane
■nitrousoxide
■Ozone
■Chlorofluorocarbons
温室气体有:
水蒸气,CO2,甲烷,氮氧化合物,臭氧,氯氟烃
【greenhouseeffect】
ØtheriseintemperaturethattheEarthexperiencesbecausecertaingasesintheatmosphere(watervapor,carbondioxide,nitrousoxide,andmethane,forexamp
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