肠内营养支持的应用进展

营养不良是住院患者常见的症状之一,对患者造成巨大的不良影响,能降低患者免疫力,延缓伤口愈合,影响正常肌力,导致心理障碍,最终造成患者病情迁延,住院时间延长和费用增加。如果患者胃肠道功能不全则无法通过正常的饮食来维持自身的营养需求,必须借助营养支持。营养支持方式主要分为口服营养补充、肠内及肠外营养支持。肠内营养支持是为无法通过口服补充所必需的的营养物质或通过口服仍无法满足营养需求的患者提供的一种营养支持方式,对患者疾病的治疗以及生存具有重要意义,目前已广泛应用于临床。本文收集整理近几年肠内营养支持的相关文献,从肠内营养支持的适应证及禁忌证、常见制剂、输注途径、临床应用等方面进行归纳总结,从而为肠内营养支持的临床应用提供参考依据。     

肠外瘘病人肠内营养支持临床应用研究

目的：观察肠内营养在肠外瘘病人应用的时机、条件、途径及肠内营养制品的选择,研究肠内营养在肠外瘘病人中的作用。方法：收集１７０例肠外瘘病人诊断、住院总天数及全肠外营养（ＴＰＮ）、全肠内营养（ＴＥＮ）、肠内＋肠外营养（ＰＮ＋ＥＮ）、经口饮食的天数,计算不同营养支持方法期间,非蛋白质热量、蛋白质的供给量和并发症的发生率。收集ＴＰＮ、ＴＥＮ支持前和支持后满１５天病人的血清白蛋白浓度。另对４０例肠外瘘病人进行为期１５天的前瞻性观察,了解肠内营养对白蛋白、前白蛋白、转铁蛋白、纤维连结蛋白、总蛋白、球蛋白和肝酶谱的影响。结果：１７０例病人的总住院天数为１３５５３天,其中１６４人曾使用ＴＰＮ６０４０天（４４．６％）;１２９人使用ＴＥＮ３６７６天（２７．１％）;８３人使用肠内＋肠外营养４８９天（３．６％）;１２８人经口饮食２３３     

肠内＋肠外营养在胰腺炎治疗中的疗效评估

目的：探讨肠内营养在治疗急性重症胰腺炎中的作用。方法：收集急性重症胰腺炎患者46例,24例接受肠内营养＋肠外营养治疗,22例接受全肠外营养治疗,比较两组患者治疗效果、住院天数、住院费用的差异。结果：肠内＋肠外营养经济,可降低肠道功能紊乱的发生,对胰腺炎治疗效果明确。比全肠外营养症状体征改善明显,生化指标恢复及住院时间显著缩短,住院费用明显减少。结论：EN＋PN是重症急性胰腺炎治疗的重要手段,合适的肠内＋肠外营养能有效降低SAP患者感染性并发症的发生和病死率,治疗费用明显减少,缩短了住院天数,值得临床推广。     

谷氨酰胺对新生儿临床结局的影响

目的 评价肠内、肠外补充谷氨酰胺对新生儿临床结局的影响.方法 采用平行、随机、双盲、对照试验,将100例新牛儿随机分为5组,分别为对照组(常规肠外营养组)、肠外谷氨酰胺1组[肠外营养1组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d),其中谷氨酰胺取代了处方中相应氨基酸的量]、肠内谷氨酰胺Ⅰ组[肠内营养1组,口服添加谷氨酰胺0.3 g/(kg·d),谷氨酰胺取代了常规肠外营养中相应氨基酸的量]、肠外谷氨酰胺2组[肠外营养2组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d)]、肠内谷氨酰胺2组[肠内营养2组,口服添加谷氨酰胺0.3 g/(kg·d)],每组20例,对照组按照常规给予肠外营养支持,氨基酸的剂量按照中国新生儿营养支持临床应用指南给予[从1.0～2.0 g/(kg·d)开始,增至3.5 g/(kg·d)].首要终点指标为达到全肠内喂养日龄[标准配方摄入量≥120ml/(kg·d)]、胃潴留次数、完全脱离肠外营养时间和死亡率.次要终点指标为体重变化和头围变化、肝功能、肾功能、呼吸机应用天数、住院天数.结果 5组患儿达到全肠内喂养日龄、胃潴留次数及脱离肠外营养时间差异均无显著性.患儿肝肾功能水平及体重增长、头围增长、抗生素应用天数、住院天数差异均无显著性(P＞0.05).肠外谷氨酰胺1组和2组较对照组呼吸机应用天数显著减少(P＜0.05).死亡率通过意向性分析显示,与对照组比较,肠外谷氨酰胺1组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺1组RR为1.333,95%CI为1.035～1.717;肠外谷氨酰胺2组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺2组RR为1.25,95%CI为1.004～1.556.结论 补充谷氨酰胺未能缩短达到全肠内喂养天数、减少胃潴留次数、缩短全肠外营养应用时间;肠外补充谷氨酰胺可以减少新生儿呼吸机应用大数.新生儿肠外补充谷氨酰胺对患儿住院期间的死亡率无明显影响.     

术后早期肠内营养

肠内营养的应用,越来越引起广大临床医师的重视。直接向肠道提供营养物,不仅是满足机体营养的需求,更重要的是维持了肠道的完整性,这对严重创伤,大手术后病人的恢复,减少术后感染性并发症的发生具有重要的意义。何时开始肠内营养,如何选择理想的肠内营养制剂,关系到肠内营养的效果。本文就术后早期肠内营养的可行性,开始的时间,制剂的选择及给予途径,对代谢的影响等作一综述。     

2008至2010年住院药房肠内、肠外营养制剂使用情况分析

目的 分析2008至2010年我院住院患者使用肠内、肠外营养制剂的情况,为临床更合理使用该类药物提供参考.方法 统计2008至2010年我院住院药房肠内、肠外营养制剂的销售品种、数量及销售金额,对各类肠内、肠外营养制剂按用药频度进行对比排序.结果 肠内营养制剂的品种数从2008年的7种增加到2010年的9种,用药金额从2008年的42.64万元增加到2010年的67.37万元,增加了57.99％;肠外营养制剂的品种数从2008年的43种增加到2010年的50种,用药金额从2008年的891.31万元增加到2010年的1363.73万元,增加了53.00％.结论 在肠外营养和肠内营养的应用上,我院营养支持仍以肠外营养为主,肠内营养制剂的使用比例较低.     

极低出生体重儿住院期间体重增长速度与营养摄入的关系

目的 分析极低出生体重儿住院期间营养摄入与其体重增长速度的关系。方法 回顾性调查2011-2012年在深圳市妇幼保健院住院的极低出生体重儿的临床和营养资料。按体重增长速率将患儿分为低体重增长组、适宜体重增长组和高体重增长组,比较三组的临床营养摄入情况。结果 147例极低出生体重儿的体重增长速度中位数为12.77 g/(kg·d),住院时间中位数为48 d;高体重和适宜体重增长组的住院天数、静脉氨基酸开始使用时间和达到全肠内营养时间均小于低体重增长组;极低出生体重儿生后第7天、14天、21天和28天肠外营养中的碳水化合物、脂肪和蛋白质的用量呈递减趋势。结论 极低出生体重儿住院期间的体重增长速度与营养摄入状况和住院时间密切相关,加强肠内外营养,缩短住院时间有利于促进极低出生体重儿的体重增长。     

婴儿体位评估工具在低体重早产儿中的应用及效果分析

目的 探讨婴儿体位评估工具(IPAT)在低出生体重早产儿中的应用及效果。方法 以2021年1—12月在我院NICU住院的低出生体重早产儿为对照组,以2022年1—12月住院早产儿为试验组。对照组实施鸟巢式护理,试验组在对照组基础上使用IPAT指导体位摆放。比较两组患儿生长发育、新生儿行为神经测定(NBNA)、非骨缝闭合性头颅畸形和合并症的发生率。结果 试验组患儿全肠内营养时间和住院时间明显低于对照组(p<0.05);出院时NABA得分、纠正胎龄40周时的体重和头围明显高于对照组(p<0.05)。试验组患儿头颅畸形发生率明显低于对照组(p<0.05)。结论 在鸟巢式护理基础上对早产儿行IPAT体位干预,可缩短其全肠内营养时间,促进生长发育和行为神经发育,减少住院时间和头颅畸形的发生率。     

营养不良患者的肠内肠外营养支持的疗效观察

目的:探究肠内场外营养支持对营养不良患者的疗效。方法:以我院在2012年3月-2013年3月收治的60例0营养不良患者为研究对象,随机均分为观察组和对照组,其中对观察组患者实施全肠内营养治疗,对照组患者实施半肠内营养+半肠外营养治疗,观察两组患者治疗费用、精神状态和蛋白代谢等方面的临床结果。结果:两组患者在治疗后的精神状态、言语对答和反应均有明显好转,其视黄醇结合蛋白、转铁蛋白、血清前蛋白和白蛋白的水平均有明显升高,P>0.05,其差异无统计学意义;观察组患者所用医疗费用明显低于给对照组患者,P<0.05。结论:全肠内营养支持和半肠内营养+半肠外营养支持都可以改善营养不良患者的临床症状,提升其营养指标,而全肠内营养治疗所需费用更少,是营养不良患者选用治疗的最佳方案。     

全肠内营养支持在胃大部切除术后胃瘫治疗中的应用

介绍了全肠内营养治疗胃大部切除术后胃瘫的经验。胃瘫一般情况下可以非手术疗法治愈 ,营养因素在胃瘫的成因和治疗中具有重要作用 ;全肠内营养采用鼻肠管灌饲 ,营养液为混合奶和匀浆食物 ;肠内营养较肠外营养有防止肠道细菌移位入血及胆汁淤积 ,改善腹腔内脏功能 ,防止 MODS发生 ,避免 TPN并发症 ,简便价廉等突出优点。全肠内营养支持在胃大部切除术后胃瘫治疗中的应用@李卫东$河北省沧县医院外科 @刘思芝$河北省沧县医院外科     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.