微生态调节剂联合谷氨酰胺预防老年肠内营养相关性腹泻

目的 探讨微生态调节剂联合谷氨酰胺对老年患者肠内营养相关性腹泻的预防作用.方法 选取行肠内营养治疗患者75例,完全随机分为观察组(42例)和对照组(33例).2组患者均予鼻饲肠内营养混悬液和微生态制剂,前者用量为100 ml/h开始重力滴注,500 ml/d,直至供给全量;2组未静脉滴注抗生素者均选用双歧四联活菌片1.5g/次,3次/d,静脉滴注抗生素者选用乳酸菌素片2.4g/次,3次/d,观察组同时给予谷氨酰胺1.0g/次,3次/d.疗程1周.观察2组患者腹泻发生率和肠内营养达到目标供给量的时间.结果 观察组和对照组患者腹泻发生率分别为9.5％ (4/42)和24.2％ (8/33),差异有统计学意义(x2=5.469,P=0.019).观察组患者肠内营养液达到目标供给量时间为(3.4±1.0)d,小于对照组(4.7±1.5)d,差异有统计学意义(t=4.386,P=0.002).结论 在肠内营养治疗的老年患者中,适量添加微生态调节剂及谷氨酰胺,可明显减少腹泻的发生,利于肠内营养治疗的顺利进行.     

颅脑疾病的单纯肠内营养安全性和有效性观察

目的 观察颅脑疾病完全肠内营养支持的临床安全性和效果。方法 对43例颅脑疾病患者在入院早期进行经鼻胃管完全肠内营养支持．直到患者能经口进食停止．观察患者的体重、血生化指标的变化以及临床副作用，以评估其安全性和效果。结果 6例患者的血浆蛋白指标下降．其余患者保持原有水平或不同程度的增高；体重较入院时没有明显下降；9例（20．93％）患者出现便秘或腹泻；4例（9．30％）在营养支持第1、2天出现食管返流，改用泵入后好转；2例（4．65％）患者出现上消化道应激性溃疡。结论肠内营养混悬液作为肠内营养制剂在颅脑疾病患者早期的应用是安全有效的。     

胃大部切除术后早期整蛋白型和短肽型肠内营养的疗效观察

探索胃癌患者胃大部切除术后应用不同肠内营养制剂的优化方案。将65例拟行胃大部切除术的胃癌患者随机分为整蛋白组（31例）和短肽组（34例）。在术前3天予康全甘（500 mL/日，口服）进行肠道预适应，术后24~48 h内两组分别开始予以早期肠内营养制剂康全甘和百普力，能量不足部分予以补充性肠外营养。比较两组患者入院时、术后第1天、术后第7天主要营养指标和免疫指标的差异，记录胃肠道耐受情况、肠道恢复通气时间、术后并发症和营养治疗费用等。结果显示，两组患者围术期营养治疗后营养指标、免疫指标组间差异无统计学意义（P＞0.05），整蛋白型和短肽型营养制剂疗效相当。短肽组肠道恢复通气时间较短，术后住院时间较长，组间差异有统计学意义（P＜0.05）；短肽组肠内营养治疗费用较高，组间差异有统计学意义（P＜0.05）。建议临床胃大部切除术后患者早期选用短肽型制剂，缩短肠道恢复通气时间，可促进肠道生理功能恢复；待肠道恢复通气后换用整蛋白型制剂，提高肠道耐受性，既安全且经济。     

更昔洛韦致腹泻与皮疹1例

患儿，男，2岁。因剧烈咳嗽，于2005年11月8日下午就诊于我院，该患儿既往无药物致变态反应史，给予更昔洛韦（广东阳江制药厂生产，批号：0504024）50mg加入0．9％氯化钠溶液250mL，bid，静脉滴注。下午4时左右滴注完毕回家，傍晚6时出现少量皮疹伴瘙痒，接着出现腹泻，连续3次，呈水样便。因未考虑到更昔洛韦可致腹泻和皮疹，第2天上午再次静脉滴注同样药物，完毕后，患儿再次出现皮疹瘙痒和腹泻，程度比第1次加剧。立即停药，对症治疗，给予氯雷他定片5mg，qd；泼尼松片1．5mg，tid口服补液盐10g，加水500mL溶解后分次服用后，皮疹消退，腹泻停止。     

老年卧床患者使用能全力与瑞素行肠内营养的疗效

目的观察老年患者分别或联合使用能全力与瑞素能否降低肠内营养副作用的发生率。方法按照入院顺序,将老年卧床需鼻饲患者随机分为能全力组、瑞素组、能全力和瑞素混合组,每组68例。三组营养液的输注量及速度一致,能全力组采用能全力1 000 mL进行肠内营养;瑞素组采用瑞素1 000 mL进行肠内营养;能全力联合瑞素组则交替使用能全力和瑞素各500 mL进行肠内营养,中间输注温水50～100 mL,防止鼻饲管堵塞,该组始终将两种营养液总量平均,由能全力和瑞素共同构成肠内营养的营养液。在肠内营养治疗后7 d,观察并比较各组患者的腹泻发生率。结果三组患者进行肠内营养治疗后7 d,腹泻发生率比较,差异有统计学意义(P<0.05),能全力和瑞素交替组腹泻发生率低于瑞素组和能全力组。结论交替使用能全力与瑞素进行肠内营养,两者在营养构成上存在互补性,联合使用既能加强营养供给的均衡性,又能明显降低老年卧床患者肠内营养腹泻等副作用的发生率。     

新生儿金葡菌性烫伤样皮肤综合征1例

患儿，男，日龄12天，因发热，皮肤水泡样皮疹两天，伴拒乳1天入院。入院前体温38.2～40℃，在当地卫生院治疗，给静滴青霉素，抗过敏治疗，热不退，皮疹由面部逐渐遍及全身，两天后患儿拒乳，热不退住入我院。检查：体温39.8℃，脉搏140次／分，呼吸41次／分，体重4kg，发育正常，营养尚好，精神差，发热貌、面部、颈部、躯干、四肢猩红样红皮疹，在红斑基础上有     

慢性阻塞性肺疾病急性加重期患者早期肠内营养护理干预

目的探讨早期肠内营养在慢性阻塞性肺疾病（chronicobstructive pulmonarydisease）急性加重期患者治疗中的护理干预。方法将慢性阻塞性肺疾病（COPD）急性加重期患者60例随机分为试验组和对照组,于入院后24h内分别给予鼻饲肠内营养支持和普通鼻饲饮食,两组患者分别于入院第1天及21天测定血清总蛋白质、血清白蛋白、血红蛋白含量。并观察营养指标的变化和呼吸功能变化。结果21天后,肺功能和血气检查,试验组的FVC、FEV／FVC及PaO2有明显改善（P〈0．05）,试验组的营养指标亦显著优于对照组。结论早期肠内营养是COPD患者的一项重要治疗措施,良好细致的护理是保证其成功实施的关键。     

糖尿病专用型肠内营养混悬液对重症脑卒中 合并应激性高血糖患者的影响*

目的：探讨糖尿病专用型肠内营养混悬液（TPF-DM）对重症脑卒中合并应激性高血糖患者血糖及降钙素原（PCT）水平的影响。方法：将48例并发应激性高血糖的重症脑卒中患者随机均分两组,经整理后每组各20例,分别给予肠内营养混悬液TPF（对照组）和TPF-DM（研究组）作为肠内营养支持。于入院第1、7、14天分别抽取患者静脉血测定空腹血糖（FBG）、餐后2小时血糖（2hPBG）及 PCT水平,对组间指标进行统计学分析。结果：研究组第7天和第14天血糖水平均低于同期对照组（P<0.05）;两组患者在第1天监测PCT水平均高于正常,营养支持后第7天研究组与对照组PCT水平均较第一天下降,但相比之下研究组PCT改善较对照组显著,差异有统计学意义（P<0.05）;第14天两组患者PCT水平均恢复至正常水平且组间差异不再有统计学意义（P>0.05）。结论：TPF-DM对重症脑卒中合并应激性高血糖患者血糖影响显著优于TPF,可能对早期感染的控制产生积极影响。     

20 %甘露醇注射液致过敏性皮疹1例

患者，男，8岁。因头痛2个月余，抽搐1次收住院。入院后头颅CT后给予20 %甘露醇注射液(四川科伦药业股份有限公司，批号：Au5114h)120 mL，iv，qid，另给予青霉素及胞二磷胆碱等药对症处理。治疗5 d后，20 %甘露醇注射液减为每天3次，第9天开始减为每天2次。入院第8天患儿出现颜面部，躯干部红色斑丘疹，压之不褪色，疹间肤色正常，体温37.0～38.5 ℃。考虑为青霉素所致的迟缓变态反应，故停用，并给予抗变态反应治疗，但皮疹未完全消退，反而增多，尤其是静脉推注20 %甘露醇注射液后皮肤瘙痒明显。入院第11天体温在39.0～40.5℃，全身皮疹弥漫分布，双侧睑结膜充血，全身瘙痒。立即停用20 %甘露醇注射液，静脉滴注西咪替丁0.2 g，10 %葡萄糖酸钙注射液20 mL，地塞米松10 mg。约4 h后体温逐渐降至正常，双侧睑结膜充血消失，全身皮疹明显消退。24 h后全身皮疹完全消退。考虑为20 %甘露醇注射液引起的变态反应，继续运用其他药物未出现上述反应。     

糖尿病专用型肠内营养混悬液对重症脑卒中 合并应激性高血糖患者的影响*

目的：探讨糖尿病专用型肠内营养混悬液（TPF-DM）对重症脑卒中合并应激性高血糖患者血糖及降钙素原（PCT）水平的影响。方法：将48例并发应激性高血糖的重症脑卒中患者随机均分两组,经整理后每组各20例,分别给予肠内营养混悬液TPF（对照组）和TPF-DM（研究组）作为肠内营养支持。于入院第1、7、14天分别抽取患者静脉血测定空腹血糖（FBG）、餐后2小时血糖（2hPBG）及 PCT水平,对组间指标进行统计学分析。结果：研究组第7天和第14天血糖水平均低于同期对照组（P<0.05）;两组患者在第1天监测PCT水平均高于正常,营养支持后第7天研究组与对照组PCT水平均较第一天下降,但相比之下研究组PCT改善较对照组显著,差异有统计学意义（P<0.05）;第14天两组患者PCT水平均恢复至正常水平且组间差异不再有统计学意义（P>0.05）。结论：TPF-DM对重症脑卒中合并应激性高血糖患者血糖影响显著优于TPF,可能对早期感染的控制产生积极影响。     

1例卡培他滨所致腹泻的治疗

1例78岁男性结肠癌晚期患者接受贝伐珠单抗联合XELOX化疗方案：贝伐珠单抗200mg静脉滴注,第1、15天;卡培他滨1500mgbid口服,第1～14天;奥沙利铂150mg静脉滴注,第2天;21d为1个周期。化疗第8天,患者开始出现腹泻糊状便,每天5次,每次约90～100mL,立即给予洛哌丁胺,2d后（化疗第10天）,患者腹泻未缓解,出现水样便,每天8～9次,每次约40～50mL,伴轻度脱水,停用洛哌丁胺,给予皮下注射醋酸奥曲肽注射液,48h后,患者大便次数明显减少（每天5次）,继续给予醋酸奥曲肽及补液治疗,2d后患者的腹泻症状消失。     

神阙灸防治ICU肠内营养并发腹泻的临床疗效观察

目的：观察艾灸神阙穴防治ICU肠内营养并发腹泻的临床疗效。方法将120例患者随机分为试验组和对照组,每组60例,所有患者在积极治疗原发疾病同时,给予百普力采用持续输注的鼻饲方式进行肠内营养,试验组在肠内营养第1天开始给予神阙穴温和灸。结果在肠内营养治疗第7天时观察患者的腹泻发生率,发现试验组、对照组腹泻发生率分别为16.7%、36.7%,试验组明显低于对照组,经x2检验,P＜0.05,差异有统计学意义。结论神阙穴艾灸用于防治ICU危重患者肠内营养并发的腹泻疗效显著,且操作简便,成本低廉,值得推广应用。     

能全力联合瑞素在危重症患者肠内营养支持中的应用评价

目的观察危重症患者使用能全力联合瑞素对肠内营养不良反应发生率的影响。方法选取2015年2月至2016年6月我科通过鼻饲行肠内营养患者56例,随机分为2组。观察组28例,采用能全力500 m L联合瑞素500 m L进行肠内营养;对照组28例,采用能全力1 000 m L进行肠内营养。治疗2周后,观察并比较两组患者营养状况及肠内营养不良反应发生率。结果两组患者营养状况改善情况比较差异无统计学意义(P>0.05)。观察组腹泻、便秘、肺炎发生率与对照组比较,差异有统计学意义(6.88%vs.22.34%,3.34%vs.21%,3.34%vs.14.28%,P<0.05);观察组肝功能异常发生率(6.88%)略低于对照组(10.71%),但差异无统计学意义(P>0.05)。结论能全力联合瑞素进行肠内营养支持在营养构成上具有互补性,联合使用既能加强均衡的营养供给,又能降低肠内营养不良反应的发生率,值得临床推广。     

丹参酮ⅡA磺酸钠注射液致严重过敏反应2例

2名男性患者给予丹参酮ⅡA磺酸钠注射液治疗时出现头晕、头痛、胸闷、全身发麻、高热、斑丘疹等不良反应。病例1,1例60a男性患者,因车祸致伤入院。术后给予丹参酮ⅡA磺酸钠注射液8mL＋0.9%氯化钠注射液500mL静脉滴注,输液约3h时患者出现头晕、头痛、胸闷、全身发麻,立刻停止滴注,并给予地塞米松磷酸钠进行抗过敏治疗,20min后症状逐渐好转。遂改用血栓通注射液,未再发生上述不良反应。病例2,1例43a男性患者,因车祸致伤入院。术后给予丹参酮ⅡA磺酸钠注射液8mL＋5%葡萄糖注射液500mL静脉续滴,每日1次。次日继续静滴,10min后出现丘疹,6h后出现高热,体温39.6℃,伴斑丘疹。立刻停止滴注,并给予物理降温及肌内注射复方氨林巴比妥,5min后体温39.7℃。给予口服氯雷他定片,并静脉滴注地塞米松磷酸钠,10min后体温38.2℃,但斑丘疹未见明显消退。用药3d后基本恢复。     

健脾中药方剂辅助胃肠内营养的治疗

目的:探讨采用健脾中药方剂辅助胃肠内营养治疗的疗效。方法:选择2009年1月-2011年10月于我院住院营养不良的患者115例,按随机数字表随机分为2组,一组为中药辅助组共53例,给予中药方剂,每天1剂,连续服用10 d,并同时按热量25～30 kcal.kg-1.d-1给予肠内营养乳剂喂养,另一组为对照组按热量25～30 kcal.kg-1.d-1给予肠内营养乳剂喂养,对于卧床患者采用作者研究方法测量体质量,采用文献报道方法测量身高,然后计算BMI,采用电子握力计测量患者最大握力3次,取平均值,其余治疗相同。比较2组治疗5 d前后患者握力、治疗7 d前后血清前白蛋白量、达到正常膳食所需时间、改为插管喂养的患者数。结果:治疗后2组握力和前白蛋白皆有明显提高,但中药辅助组握力和前白蛋白改善优于对照组,中药辅助组改为插管喂养和达到正常膳食的人数均优于对照组,而且达到正常膳食时间快于对照组。结论:采用健脾益气消食的中药辅以胃肠内营养治疗可明显改善长期食欲不振患者的营养状况,较快恢复正常膳食。     

Comparison of Specialized and Standard Enteral Formulas in Trauma Patients

Study Objective . To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral formula with those receiving standard enteral therapy. Design . Prospective, randomized clinical trial. Setting . Level 1 trauma center at a county government hospital. Patients . Forty-one consecutive patients with major trauma who required enteral nutrition support. Thirty-seven patients completed the study. Four patients (two in each group) were excluded, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury. Interventions . Nineteen patients fed the specialized enteral formula received supplemental arginine, linolenic acid, β-carotene, and hydrolyzed protein for up to 10 days. Eighteen control patients received standard enteral nutrition. Measurements and Main Results . After study entry, patients who received the specialized enteral formula had fewer infections than those receiving standard enteral nutrition (3/19 vs 10/18; p<0.05). The change in nitrogen balance was significantly better (p<0.05) from day 1 (−11.8 ± 1.8 g/day) to day 5 (−5.9 ± 2.0 g/day) for the group who received the specialized formula compared with the group who received standard enteral nutrition (-7.3 ± 1.7 g/day to −7.4 ± 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly better (p<0.05) from day 1 (18.0 ± 2.1 mg/dl) to day 5 (11.8 ± 1.5 mg/dl) in the group who received the specialized formula compared with the group who received standard enteral nutrition (17.6 ± 1.2 mg/dl to 14.4 ± 1.7 mg/dl). The CD4:CD8 ratio increased more in the group who received the specialized formula, although this difference did not reach statistical significance. Conclusion . Trauma patients who received the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive patient outcomes are necessary before these specialized enteral formulas are used as the standard of practice in critically ill patients.     

Clostridium difficile colitis associated with valaciclovir

OBJECTIVE: To report a case of Clostridium difficile colitis associated with valaciclovir treatment. CASE SUMMARY: A 73-year-old man with lumbar herpes-zoster started valaciclovir 1 g tid. After three days he began vomiting and developed diarrhea, three to four stools per day. Symptoms worsened over the following days and he was admitted. Valaciclovir was stopped and fluid and electrolyte replacement was started. He continued 6 days later with diarrhea of 7 to 13 stools per day and a stool test for diagnosis of C. difficile infection was performed with a positive result. The patient received oral metronidazole (500 mg/t.i.d. for 10 days) and rapid improvement and eventual resolution of his diarrhea was observed after 3 days of therapy. DISCUSSION: Although no conclusive reports of this reaction exist, we think this is a case of C difficile colitis that appeared three days after valaciclovir was initiated. Colitis improved with metronidazole. Other causes of diarrhea were excluded, such as diabetes mellitus, renal failure, intestinal surgery and intestinal obstruction. Infection was confirmed by a positive test for C. difficile. The application of Naranjo's algorithm asserts the reaction as 'probable'. CONCLUSIONS: Valaciclovir-associated C. difficile colitis, although rare, can have severe consequences for the patient's health. It should be included as a possible adverse effect of valaciclovir treatment by health professionals.     

A clinical experience of fosfomycin tablet on cystitis

Twenty-five adult female patients with acute cystitis were treated with 500 mg fosfomycin tablets, at a dose of 6 tablets per day for 7 days. The clinical effects were evaluated on the 3rd day, and the treatment was found effective in all the 18 patients evaluated. The cystitis recurred in 1 patient, one week after the treatment. As for the side effects, three patients complained gastric discomfort and/or diarrhea.     

Cycled enteral antibiotics reduce sepsis rates in paediatric patients on long-term parenteral nutrition for intestinal failure

Aliment Pharmacol Ther 2011; 34: 1005–1011

Summary

Background Long‐term parenteral nutrition has transformed the prognosis for children suffering from intestinal failure. However, parenteral nutrition itself is associated with considerable morbidity and mortality including that caused by sepsis. Aim To examine a strategy of cycled enteral antibiotics in reducing the incidence of sepsis in paediatric intestinal failure patients. Methods Retrospective analysis of the incidence of sepsis rates of patients on long‐term parenteral nutrition, at a tertiary paediatric hospital. Patients were separated into those who received cycled enteral antibiotics and a control group. Sepsis rates before and during cycled enteral antibiotics were compared with comparable timeframes between the cycled enteral antibiotics and control groups. Central venous catheter removal rates were also compared. Results Fifteen patients (eight cycled enteral antibiotics, & seven controls) received 9512 parenteral nutrition days, with a total of 132 sepsis episodes. All eight patients of the treatment group demonstrated a decrease in the frequency of episodes of sepsis following the introduction of cycled enteral antibiotics. The cycled enteral antibiotics group had a significant reduction in infection rate during the treatment period (from 2.14 to 1.06 per 100 parenteral nutrition days, P = 0.014: median effect size ?1.04 CI 95%–1.93, ?0.22), whereas the controls had no significant change (1.91 – 2.36 per 100 parenteral nutrition days P = 0.402: median effect size 0.92 CI 95%–1.96, 4.17). The central venous catheter survival rates increased in the cycled enteral antibiotics group from 0.44 central venous catheter removals per 100 parenteral nutrition days to 0.27 central venous catheter removals per 100 parenteral nutrition days, although this was not statistically significant. Conclusions Cycled enteral antibiotics significantly reduced the rate of sepsis in a small group of paediatric intestinal failure patients. Larger well‐designed prospective studies are warranted to further explore this finding.

     

胃癌根治术后免疫型肠内营养支持的应用

目的：为了探讨免疫营养制剂在胃癌术后营养支持上的作用,通过使用含特殊营养物质的免疫增强型肠内营养制剂与术后早期标准肠内营养的比较,研究术后早期免疫肠内营养对胃癌患者营养状态、免疫功能、应激状况的影响,评价免疫肠内营养应用的优势。方法：将48例胃癌病人随机分为两组,每组24例。第l组术后早期给予常规肠内营养制剂（EN）（对照组）,第2组术后早期接受免疫增强型肠内营养制剂（IEN）（实验组）,均在肠内营养输注系统通过空肠造口管持续泵入肠内营养剂,连续7天。于术前、术后第1天、术后第9天分别检测两组病人的营养指标和免疫指标。结果：两组病人术后第9天营养指标、免疫指标均较术后第1天有升高（P〈0.05）;实验组营养指标及免疫指标较对照组显著升高（P〈0.05）;48例病人均能较好地耐受肠内营养支持。结论：免疫增强型肠内营养制剂较常规肠内营养制剂更有利于增强胃癌术后病人的营养及免疫功能。