复方α酮酸合并苯拉普利对糖尿病合并蛋白尿患者的尿蛋白、肾功能及营养状况的影响

目的观察低蛋白饮食、苯拉普利及复方α酮酸对糖尿病合并蛋白尿患者的尿蛋白、肾功能及营养状况的影响。方法糖尿病合并蛋白尿患者给予低蛋白饮食加苯拉普利基础上控制血糖、血压、血脂平稳后随即分为2组,治疗组给予复方α酮酸。共治疗6月,检测患者的尿蛋白、GFR及各项营养指标。结果2组治疗后的糖化血红蛋白、血压、血脂均较治疗前明显改善,尿蛋白较治疗前明显减少,治疗组减少尤明显（P〈0．01）,且治疗组和对照组在治疗后差异有统计学意义（P〈0．05）;对照组GFR治疗后较治疗前有下降（P〈0．05）,治疗组下降不明显（P〉0．05）;治疗组在治疗前后各项营养指标（上臂肌围、前白蛋白、BMI、肱三头肌皮褶厚度、血白蛋白）均无明显改变（P〉0．05）,对照组的前白蛋白、上臂肌围、肱三头肌皮褶厚度治疗后较治疗前明显下降（P〈0．05）。结论复方仅酮酸能有效避免低蛋白饮食造成的营养不良,且能更有效减少尿蛋白,避免GFR进一步下降。     

低蛋白饮食配合酮酸作为治疗慢性肾衰竭基本原则的临床疗效观察

目的观察低蛋白饮食配合酮酸治疗慢性肾衰竭的临床疗效。方法应用低蛋白饮食配合酮酸作为基本治疗原则,治疗23例慢性肾衰竭病人,并对其疗效进行观察。结果治疗组总有效率明显优于对照组（P〈0．05）。结论低蛋白饮食配合酮酸治疗慢性肾衰竭是行之有效的。     

低蛋白饮食治疗慢性肾衰竭疗效观察

目的探讨低蛋白饮食治疗慢性肾衰竭的临床疗效。方法将80例慢性肾衰竭患者随机分为治疗组和对照组,对照组按正常饮食,治疗组给予低蛋白饮食,观察两组的血尿素氮、血肌酐、每月内生肌酐清除率（Ccr）的减少率。结果治疗组治疗前血尿素氮（28．38±9．19）mmol／L,治疗后血尿素氮（21．85±7．05）mmol／L,两者差异有统计学意义（P〈0．05）;治疗组血肌酐治疗后与治疗前比较差异无统计学意义（P〉0．05）;对照组血尿素氮及血肌酐与治疗前比较差异无统计学意义（DO．05）。治疗组Ccr的减少率为（0．21±0．18）mL（min·月）,对照组Ccr的减少率为（0．46=s0．38）mL（min·月）,差异有统计学意义（P〈0．05）。结论低蛋白饮食可延缓慢性肾衰竭的病情进展。     

中老年口腔颌面部肿瘤术后患者应激反应期的营养支持

目的探讨中、老年口腔颌面部肿瘤术后患者应激反应期营养支持的能量、营养素供给量及配比。方法将60例颌面部肿瘤根治术后患者随机分为营养治疗组（35例）和对照组（25例），营养治疗组患者接受肠内营养治疗，对照组自备膳食。两组的临床诊断及分期的差异无统计学意义（P〉0．05）。采用营养状况简捷评价法评价两组患者术前的营养状况。采用人体测量指标和实验室检查指标评价患者的营养状况。统计患者术后的并发症发生率和恢复时间（手术后至出院的时间）。结果术后营养治疗组的体重和上臂围均较术前显著下降（P〈0．05），而对照组除总淋巴细胞计数外，其他营养评价指标均显著低于术前（P〈0．05），特别是体重平均下降6kg。营养治疗组的并发症发生率显著低于对照组（5．7％vs．12．0％，P〈0．05）。对照组患者的恢复期显著长于营养治疗组[（28．62±2．38）135．（22．76±3．24）d，P〈0．01]。结论营养治疗组的膳食所提供的能量及营养素能够适应中、老年患者颌面外科肿瘤根治术后应激反应期高分解代谢的需求。     

慢性湿疹治疗的临床疗效观察

【摘要】目的分析研究慢性湿疹采取临床治疗的治疗效果。方法抽取2011年3月-2013年9月在我院收治的患有慢性湿疹病人120例,采取随机抽取模式,随机分为实验组和对照组,每组各60例。对照组对病人使用皮炎平霜治疗,实验组对病人使用外用冰黄肤乐膏治疗。结果两组病人之前SSRI值差异不具有统计学意义（P〉0．05）,临床治疗以后,实验组SSRI明显优于对照组,差异具有统计学意义（P〈0．05）;实验组和对照组的总有效率分别为90％、61．6％,实验组临床治疗效果明显优于对照组（P〈0．05）：实验组病人满意率为91．6％;对照组病人满意率为76．6％,实验组护理满意度情况明显优于对照组（P〈0．05）。结论冰黄肤乐膏对慢性湿疹起到显著的临床治疗效果,使不良反应发生率明显减低,使病人健康生活质量得到保障。具有临床推广价值。     

41例腹透病人营养状况与疗效观察

目的：了解腹膜透析（PD）患营养状况和营养干预措施的效果。方法：间歇性腹膜透膜（IPD）或连续不卧床腹膜透析（CAPD）患41例（男16例,女25例）,于接受PD治疗前和出院时分别观察血清肌酐（Scr),尿素氮（BUN）,白蛋白（Alb),总蛋白（TP）,血红蛋白（Hb),淋巴细胞计数（LYM）等营养指示的变化以及营养医嘱变化情况,同时记录营养干预情况,并分组进行分析。结果：腹膜透析后Hb升高,差异显,TP,Alb均呈下降趋势,P＞0．05,Cr和BUN均有下降,有非常显性差异（P＜0．01）,患在腹透期间接受的主要营养干预措施为输液白蛋白,输血,服用维生素C,B6,B1,B2,叶酸,α-D3以及钙剂和铁剂,输注白蛋白对TP和ALb改善不明显,输血后Hb升高显。结论：CRF病人在开始PD治疗时主要的营养问题是低血红蛋白血症,免疫功能减低和低蛋白血症,PD治疗后,肾功能和贫血好转,低蛋白血症则加重,静脉补充白蛋白似乎效果不佳,而EPO,铁剂,维生素C和输血的配合应用对于纠正贫血疗效确切。营养医嘱则能够随PD治疗的开展进行相应的改变,但是,接受PD治疗后热量和蛋白质的实际摄入量难以达到营养医嘱要求。     

慢性肾脏病患者的饮食结构分析

目的探讨慢性肾脏病（CKD）非透析患者的饮食营养摄入情况,以制定饮食营养健康教育方案。方法采用饮食习惯调查问卷与3日饮食日记结合的方法进行调查。结果72例患者蛋白质摄入（0．92±0．29）g／（kg·d）,能量摄入（118．93±30．54）kJ／（kg·d）。不同性别的患者中能量摄入量[女性（122．92±28．95）kJ／（kg·d）,男性（115．50±31．86）kJ／（kg·d）]差异有统计学意义（P〈0．05）;女性脂肪摄入比例[（28．43±8．38）％]高于男性[（24．22±6．34）％];随着病情进展,患者营养素摄入量显著减少,CKD早期与中晚期比较,在能量、蛋白质以及优质蛋白的比例等方面差异有统计学意义（P〈0．05）;不同年龄患者三大营养素摄入量差异无统计学意义（P〉0．05）。结论教育者应重视门诊慢性肾脏病患者的饮食健康教育;建议结合蛋白质占总能量的百分比指导、评估低蛋白饮食更有效。     

早期护理干预对ICU患者营养状况及免疫功能影响临床观察

目的：探讨早期护理干预对ICU患者营养状况及免疫功能影响。方法：通过收集分析2010年10月-2013年4月期间绍兴县中心医院ICU住院治疗的218例患者的临床资料,分为行肠内营养（EN）的72例患者采取营养支持护理干预措施,行肠外营养（TPN）的74例采取营养支持护理干预措施,对照组72例患者采取常规ICU护理。比较护理前后患者各项营养及免疫功能指标。结果EN干预组患者体质量上升率明显高于对照组,体质量下降率明显低于对照组（P〈0．05）。TPN干预组体质量下降率明显低于对照组（P〈0．05）。EN干预组治疗后总蛋白及血红蛋白含量明显高于治疗前,且均明显高于TPN及对照组治疗后总蛋白及血红蛋白（P〈0．05）。TPN治疗前后各项指标差异无统计学意义（P〉0．05）;TPN干预组治疗后各项指标与对照组比较差异无统计学意义（P〉0．05）。EN干预组治疗后TLC、IgA、IgG和IgM均较治疗前显著性升高（P〈0．05）;EN干预组治疗后TLC、IgM明显高于TPN治疗后TLC、IgM;EN干预组治疗后TLC、IgA、IgG和IgM均明显高于对照组（P〈0．05）。TPN干预组治疗后TLC、IRA、IgG和IgM与治疗前及对照组治疗后比较差异无统计学意义（P〉0．05）。结论：相对TPN来讲EN更能有效改善患者营养状况及免疫功能,配合护理工作的规范、安全、人性化的实施均可以在一定程度上提高患者的营养状况及免疫功能。     

大黄联合黄芪治疗慢性肾衰竭的临床研究

目的对中药黄芪联合大黄在慢性肾功能衰竭中的作用进行临床观察和研究。方法将非透析治疗的慢性肾衰竭病人共60例随机分成两组,每组30例。在纠正其他可逆因素的基础上治疗组加用黄芪和大黄30d,观察病人BUN Scr及24h尿蛋白定量变化。结果（1）治疗组和对照组治疗后显BUN Scr有明显下降,但对两组治疗后BUN Scr下降差值观察,治疗组明显优于对照组（P〈0．01）。（2）治疗组24h尿蛋白下降以及血浆白蛋白提高均较对照组显著改变（P〈0．05）,（P〈0．01）血脂降低两组变化不大,差异无统计学意义（P〉0．05）。结论（1）大黄联和黄芪治疗慢性肾衰竭在一定程度上可促进毒素排泄,延缓肾衰,减少尿蛋白,改善低蛋白血症。（2）大黄配伍黄芪对血脂的作用有待进一步观察。     

肠内营养在克罗恩病治疗中的应用

目的探讨肠内营养在克罗恩病（CD）治疗中的作用。方法随机选取39例综合确诊的CD患者，依据是否行肠内营养治疗分为肠内营养组（n=31）和对照组（n=8），记录其临床表现、实验室检查结果和CD活动指数（CDAI）。结果（1）临床表现：肠内营养治疗2周和4周后，肠内营养组在发热、腹部包块、腹泻和肠外表现等临床症状方面，以及活动性病变人数和需肠外营养支持的人数方面，均较治疗前和对照组有明显好转（P〈0．05）；在肠梗阻、腹痛和便血等临床症状上也较治疗前明显好转（P〈0．05）；患者体重亦较治疗前明显增加（P〈0．05），而对照组却较治疗前显著下降（P〈0．05）。（2）实验室检查：肠内营养治疗2周和4周后，肠内营养组在γ球蛋白、α2球蛋白、CRP和ESR等方面均较治疗前显著下降（P〈0．05）；在H曲和血白蛋白方面较治疗前明显增加（P〈0．05），而对照组却较治疗前明显下降（P〈0．05）。（3）CDAI：肠内营养治疗2周和4周后，肠内营养组和对照组的CDAI均较治疗前明显下降（P〈0．05），但肠内营养组CDAI下降的幅度较对照组大。（4）皮质激素使用方面：肠内营养组和对照组无统计学上的显著差异（P均〉0．05），肠内营养组15例在观察期内均开始激素减量。结论肠内营养是CD患者充分有效的营养支持方式，有助于CD活动期病情的改善，可以作为激素的替代治疗选择。对于疾病的治疗具有重大意义。     

男性慢性肾功能衰竭膳食现状调查

目的:了解男性慢性肾功能衰竭(CRF)病人的膳食质量.方法:采用膳食史法和24 h回顾法,调查140例男性CRF病人膳食热量、容易缺乏的营养素摄入量,将结果与我国城乡男性每标准人每天营养素摄入量比较.结果:男性CRF的病人,随着病程的延长热量和多种营养素摄入量呈逐渐下降趋势.结论:当前CRF存在热量和多种营养素的摄入不足,需引起临床医护人员的重视.     

Low protein diet and ketosteril in predialysis patients with renal failure

After a short review of the contemporary understanding of amino acid supplementation to low protein diets in patients with uremia we present the results of administration of ketosteril in 20 low-protein-diet patients on such a diet. MATERIAL AND METHODS: Twenty patients (10 men and 10 women) with stable II and III stage chronic renal failure were assigned to a low protein diet (protein up to 40 g/day). Ketosteril (6 tablets a day) were added to the diet. Some of the basic markers of protein metabolism and nitrogen balance were followed. RESULTS: No evidence of deteriorated protein synthesis was found in the therapy thus administered. Serum urea and creatinine values did not change and even tended to decrease. Glomerular filtration was found to increase insignificantly more markedly in the patients with renal failure in the early stages. CONCLUSIONS: A low protein diet with increased content of essential amino acids and their keto-analogues does not deteriorate the nitrogen balance of patients with chronic renal failure. By adding essential amino acids and keto-analogues a normal protein metabolism is maintained in spite of the reduce intake of protein substances with the diet. Supplementation of the diet of chronic renal failure patients with essential amino acids and keto-analogues allows a considerable reduction of the protein intake to be achieved which brings about reduction of glomerular hyperfiltration which actually retards the progression of renal failure and improves its short-term prognosis.     

Metabolic consequences of feeding a high-carbohydrate, high-fiber diet to diabetic patients with chronic kidney failure

The aim of this study was to compare the metabolic effects of a high-carbohydrate (CHO), high-fiber diet with only moderate protein restriction with those of a low-CHO, low-fiber diet with a low protein content in six diabetic patients with moderate chronic renal failure. The high-CHO, high-fiber diet induced a significant improvement in blood glucose control, a significant decrease in serum cholesterol, and a significant increase in fecal nitrogen losses. Other variables evaluated were not significantly different between the two diets, except for a significant increase in serum phosphorus during the high-CHO, high-fiber diet. N balance was not significantly different from 0 at the end of either dietary period and was very similar for both diets. The high-CHO, high-fiber diet presents many beneficial metabolic effects in diabetic patients with chronic renal failure.     

Total Parenteral Nutrition in Experimental Uremia: Studies of Acute and Chronic Renal Failure in the Growing Rat

The effects of total parenteral nutrition (TPN) on experimental acute and chronic renal failure were studied with special reference to age in the rat. TPN prolonged survival in acute renal failure. The young experimental animals benefitted more from the TPN. The accumulation of urea in the body was inhibited during TPN. In chronic renal failure, the low nitrogen TPN with essential amino acids as the source of nitrogen had no advantages over a regular diet fed ad libitum. Instead the TPN-rats had a markedly less positive nitrogen balance than the uremic and healthy controls. This difference was accentuated in the rapidly growing young animals. The results of this study suggest that TPN has a crucial role in the treatment of acute renal failure at an early age and are against the use of low protein diets in chronic renal failure if rapid growth is expected. (Journal of Parenteral and Enteral Nutrition 8 :427–432, 1984)     

Effects of catabolic stress in acute and chronic renal failure

The degree of catabolism was studied in a group of seven patients with postsurgical acute renal failure, and net protein catabolism of 43.1 to 927 g/day. In 70% of a group of 30 patients with stable chronic renal failure receiving and 18 g high biological value protein diet, urea synthesis was equivalent to what could be accounted for by the protein content of the food. This equivalence was not found in studies in both adults and children who were treated for catabolic chronic renal failure. Data obtained show the superiority of feeding essential amino acids with an adequated caloric supply. The need for studies aimed at adapting the uremic patient to protein depletive mechanisms is strongly stressed.     

早期高蛋白饮食对肾移植切口愈合的影响

收集慢性肾功能衰竭终末期肾移植后食欲改善，肾功恢复正常患者66例，随机分为两组，治疗组35例，对照组31例。于术后第5天分别进行人体测量，各种参数及化验指标经统计学处理无显著差异。两组均经术后4天禁食，流汁，半流汁饮食过渡。此后，治疗组选用优质蛋白占65％，且含铁、硒、锌及维生素C丰富的高蛋白饮食，而对照组采用优质蛋白为主的普食，经8天治疗，比较两组切口愈合情况。结果治疗组切口愈合明显优于对照组（P＜0．05），而对血肌酐无明显影响。     

肾病病人营养状况与肾功能的关系分析

目的 :探讨肾病病人营养状况与肾功能的关系。　方法 :对 110例住院肾病病人的身高、体重、血生化和血常规结果进行分析。　结果 :肾功能不全组病人体重分布与肾功能正常组比较有显著差异 ,低于理想体重者明显增加 ;红细胞、血红蛋白、总淋巴细胞计数水平显著降低 (P <0 .0 1) ,血肌酐、尿素氮、尿酸 (P <0 .0 1)、血磷 (P <0 .0 5 )水平显著升高 ;血肌酐、尿素氮与红细胞、血红蛋白水平间呈负直线相关关系 (P <0 .0 1)。　结论 :肾功能减退与热能 蛋白质营养不良、贫血、高血磷、高尿酸等营养障碍表现有关 ,采取合理饮食有可能延迟肾功能减退的进展     

Integrating renal nutrition guidelines into daily family life: a qualitative exploration

Background

Renal dietary compliance is challenging for individuals with chronic renal disease. Advice may change depending on renal function and medical treatment. Although patients seek support from family members with these changes, no literature exists with respect to how family members experience the offering of this support. The present study aimed to describe and interpret this lived experience of family members.

Methodology

Phenomenological qualitative semi‐structured interviews were conducted with 12 adult family members via telephone (transcribed verbatim). Framework analysis and the qualitative software nvivo , version 10 (QSR International Pty Ltd, Melbourne, VIC, Australia) were used. Participants commented on the themes for accuracy of experience representation.

Results

Four major themes emerged: (i) intrusion of the renal diet; (ii) dealing with the recommendations of a renal diet; (iii) seeking a new identity; and (iv) transition of family dynamics. Perceived conflicting advice intruded into family life. Children in the family resulted in more complex nutritional decisions. Continuing a diet to avoid perceived family and wider social judgement was not an option. Balance between nurturing the family as a whole and the necessity of attending to the specific needs of one individual with renal disease was challenging. Transition to a new identity included family members being drawn to scientifically guided understandings of nutrition and a medicalisation of daily food requirements, which included low prioritisation of children's nutritional needs.

Conclusion

Family members who cooked found the integration of renal nutrition guidelines challenging, with children presenting further challenges. The present study highlights the need to offer practical and psychological support to families who are coping with end‐stage renal failure and renal nutritional guidelines.     

医院与社区联合健康教育对慢性心力衰竭患者的作用

目的医院与社区结合对慢性心力衰竭患者进行健康教育,探索进行健康教育后慢性心力衰竭患者生活质量、服药依从性、心力衰竭再住院率等方面的作用。方法选择出院的慢性心力衰竭患者1263例,随机分为二组：医院与社区联合组630例,社区组633例,所有病例平均随访12±1．6个月。结果医院与社区联合组患者的低盐饮食、适当运动、戒烟、服药依从性、LVEF、生活质量均明显高于管理前和社区组,差异均有统计学意义（均P〈0．05）;再住院率、平均住院日较社区组分别减少19．48％、4．98天,均有显著性差异（P〈0．05）。结论通过医院与社区联合对院外慢性心力衰竭患者进行健康教育管理,可改变生活方式,显著提高患者的生活质量、服药依从性,降低再住院率和平均住院日。