经鼻空肠管早期肠内营养在重症胸外伤老年病人中的应用

目的:探讨经鼻空肠管早期肠内营养(EEN)在伴呼吸功能衰竭的重症胸外伤老年病人中的应用.方法:将42例伴呼吸功能衰竭的重症胸外伤老年病人随机分为试验组和对照组.试验组经鼻空肠管行EEN;对照组病人早期给予全胃肠外营养(TPN)支持,比较两组营养、炎症、免疫和临床观察各项指标.结果:两组病人在机械通气开始时营养、炎症、免疫指标均无显著性差异.经营养支持后,试验组病人营养指标和免疫功能指标均优于对照组(P＜0.05,P＜0.01),炎症指标均低于对照组(P＜0.05,P＜0.01);病死率、肺部感染率和机械通气时间显著低于对照组(P＜0.01).结论:伴呼吸功能衰竭的重症胸外伤老年病人经鼻空肠管EEN安全可行,可提高免疫功能,改善营养状况,减轻炎症反应,减少伤后并发症的发生率,从而提高生存率.     

重症急性胰腺炎病人不同时机早期肠内营养治疗效果研究

目的:探讨重症急性胰腺炎(SAP)病人早期肠内营养(EN)治疗的效果。方法:选择180例SAP病人随机分为三组,早期肠内营养(EEN)组于患病后第3天通过鼻空肠管给予EN、肠内营养(EN)组于患病后第6天通过鼻空肠管给予EN和肠外营养(PN)组,每组60例。并分别测定各组病人在患病后相同时间点的相关生化和营养指标,评估其疗效。结果:EN组病人营养指标、反映病情严重度指标恢复正常均快于PN组。EEN组较EN效果更好。结论:SAP病人早期EN治疗效果肯定,宜尽早给予EN。     

重症急性胰腺炎早期肠内外营养支持的临床对比研究

目的 分析比较肠内与肠外营养支持对重症急性胰腺炎(SAP)患者的影响,从而探讨经胃镜放置鼻空肠营养管行肠内营养支持在SAP中的临床应用价值.方法 分析2003年3月至2008年3月因SAP住院的患者,其中经胃镜放置鼻空肠营养管行早期肠内营养支持的患者35例(NENE组),并选择同期行完全胃肠外营养支持的患者35例作为对照组(TPN组),比较两组患者治疗前、治疗后1、2、3、4周血红蛋白、血清白蛋白、血肌酐、血胆固醇、三酰甘油及空腹血糖水平的变化,以及治疗前、治疗后4周免疫功能水平,并比较两组患者的住院时间、住院费用、各种并发症的发生情况和病死率.结果 治疗后,两组患者营养状况均有改善,但NENE组的血红蛋白升高和空腹血糖的下降较TPN组更为明显(P<0.05).而免疫功能测定表明治疗后NENE组IgA、CD4/CD8明显高于TPN组(P<0.05).而并发症方面,NENE组发生率明显低于TPN组(P<0.05).此外,NENE组的平均住院时间和住院费用明显少于TPN组[分别为(38.46±20.08)d比(57.75±26.69)d与(60716.24±42 357.35)元比(93 852.70±76493.62)元](P<0.01);但两组病死率比较差异无统计学意义(P>0.05).结论 SAP患者应尽早给予肠内营养有利于改善全身营养状况,增强机体免疫功能,显著减少各种感染、多脏器功能衰竭等并发症的发生率,缩短患者的住院时间和住院费用,其价值更优于TPN.     

床旁空肠营养管徒手置入技术在危重症病人营养治疗中的应用研究

目的:探讨床旁空肠营养管徒手置入技术在危重症病人肠内营养(EN)治疗中的安全性、有效性和实用性. 方法:鼻空肠管组病人采用美国CORPAK公司CORFLO导管置入行鼻空肠营养29例.鼻胃管组采用普通胃管置入行EN支持30例.观察鼻空肠管组置管成功率,置管时间和不良反应.对比观察两组病人血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、APACHEⅡ评分、入住ICU时间、置管费用和ICU总费用等指标的变化,以及反流、腹胀、腹泻、应激性溃疡和吸入性肺炎等并发症的发生率. 结果:床旁经鼻空肠营养管徒手置入成功率为93.1％,置管时间为(19.3-6.8) min,无不良反应.鼻空肠管组病人营养指标和APACHEⅡ评分改善明显,且入住ICU时间、ICU总费用和并发症的发生率均低于对照组. 结论:床旁空肠营养管徒手置入技术在危重症病人EN支持治疗中,具有操作简单、安全、置管成功率高、并发症低、病人营养状况改善明显的优点.     

大黄联合早期肠内营养在重症急性胰腺炎治疗中的意义

目的:观察大黄联合EEN治疗重症急性胰腺炎(SAP)的疗效.方法:将73例SAP病人随机分为TPN组、EEN组和大黄联合EEN(REN)组.观察三组病人住院费用、住院时间、死亡人数、肠道功能恢复时间、APACHEⅡ评分,检测血浆降钙素原(PCT)、C-反应蛋白(CRP)、PA等,并进行比较.结果:REN组无一例死亡,EEN组死亡1例,TPN组2例;REN组病人的肠道功能恢复时间、平均住院天数和费用均低于其他两组(与TPN组比,P<0.01;与EEN组比,P<0.05).治疗1周后,REN组APACHEⅡ评分和CRP明显下降(P<0.01);PCT阳性例数由21例下降为2例(P <0.01);TPN组PA显著上升(P<0.01).结论:大黄联合EEN治疗SAP,能促进病人消化道功能恢复,改善病人的营养状况,降低炎性反应,缩短住院时间,减少医疗费用.     

鼻饲营养泵经鼻空肠管肠内营养在重症急性胰腺炎中的应用

目的 探讨鼻饲营养泵经鼻空肠管肠内营养在重症急性胰腺炎(SAP)中的应用。方法 选取2018年1月至2022年9月于浙江省台州医院消化内科住院治疗的SAP患者70例，随机分为两组，各35例。对照组给予肠外营养支持治疗，试验组给予鼻饲营养泵经鼻空肠管肠内营养治疗，两组均治疗7 d。比较两组症状缓解时间、治疗前后急性生理与慢性健康量表(APACHEⅡ)评分和营养状况[人血白蛋白(ALB)和血红蛋白(Hb)水平]、并发症发生情况。结果 试验组腹痛缓解时间、肠鸣音恢复时间、血淀粉酶(AMS)恢复正常时间和尿淀粉酶(UAMY)恢复正常时间较对照组短(P<0.05)；治疗后，两组APACHEⅡ评分较治疗前明显下降，血清ALB和Hb水平较治疗前明显上升(P<0.05)，且试验组变化幅度较对照组明显(P<0.05)。试验组总并发症发生率较对照组低(χ²=6.34,P <0.05)。结论 鼻饲营养泵经鼻空肠管肠内营养用于SAP患者中的疗效优于肠外营养支持治疗，不仅可改善临床症状，减轻病情严重程度，而且可改善营养状况，减少并发症的发生。     

老年病人肝胆术后早期肠内营养的临床评价

探讨老年病人肝胆手术后早期肠内营养的合理性 ,并与肠外营养的效果比较。将 30例肝胆手术后老年病人随机分为 :早期肠内营养组 (EEN组 )和完全肠外营养组 (TPN组 ) ,两组各 15例。EEN组术后 2 4h内经鼻肠管输注肠内营养制剂百普素 (PEPTI- 2 0 0 0 ) ,TPN组经右锁骨下腔静脉进行 ,共7天。结果 :EEN组均完成肠内营养计划 ,两组术后体重、三头肌皮褶厚度、上臂周径均较术前略低 (P<0 .0 1) ,组间比较无差异。两组总淋巴细胞计数、白蛋白、总蛋白营养支持前后差异不显著。对肝功能的影响 ,总胆红素 TPN组术后高于EEN组 (P<0 .0 5 …     

肠内与肠外营养对胃癌患者术后应激状态的影响

目的评价早期肠内营养(EEN)与完全胃肠外营养(TPN)对胃癌患者根治术后应激状态的影响。方法将30例胃癌病人随机平分两组:EEN组术后第1d以静脉支持为主,第2d开始经空肠营养管滴入肠内营养制剂能全力(肠内营养混悬液),逐步加大支持强度并减少静脉支持。TPN组术后每日行完全肠外营养支持直到经口进食。另取15例同期行择期手术的普外科腹部手术病人(胆囊结石病人)作为对照组。术前、术后第8d分别检测各组C3、C4、CRP及TNF-α指标;观察各组患者术后肛门排气的时间。结果术前30例胃癌病人的C3、C4、CRP及TNF-α高于对照组(p<0.05)。术后第8d,EEN组的C3、C4、CRP及TNF-α均低于TPN组,差异有统计学意义(p<0.05)。术后EEN组患者胃肠道功能恢复时间短,排气时间与TPN组比较差别有统计学意义(p<0.05)。结论胃癌术后EEN比TPN更能降低胃癌患者根治术后应激反应,促进胃肠功能恢复。     

重症急性胰腺炎的早期肠内营养支持

目的:通过对15例重症急性胰腺炎(SAP)病人进行早期肠内营养支持,探讨SAP时早期肠内营养的可行性、安全性及有效性.方法:对我院普通外科2002年4月至2003年6月间15例SAP病人在入院3～5天时放置空肠螺旋管,在到达空肠后,进行肠内营养支持.观察病人的一般情况、营养状况、免疫功能及并发症的发生率等.结果:11例病人在置管2～3天后到达空肠,3例置管第4天时在X线透视辅助下置入空肠,1例在置管第4天时在内镜辅助下进入空肠.所有病人对早期肠内营养耐受良好,无胰腺炎复发,而且肠内营养开始后1～2周营养状况及免疫功能与营养支持前比较明显好转,无胰腺坏死组织继发感染的发生.结论:对SAP进行早期肠内营养支持是可行、安全和有效的,能改善SAP病人的营养状况及免疫功能.     

早期肠内营养支持对脑卒中病人疗效影响的研究

目的:观察早期肠内营养(EEN)对脑卒中病人疗效的影响. 方法:将122例脑卒中病人分为EEN和完全肠外营养(TPN)组,每组61例.两组病人于入院后24h开始实施营养支持.由营养师计算热量,即按照Harris-Benedict公式确定基础能量消耗(BEE),再根据BEE×活动系数×应激系数×体温系数来确定总热量,按照每个病人理论所需的热量选择合适的营养制剂,连续支持治疗7d.观察两组病人的营养监测指标、胃肠道等主要并发症情况和两组日均营养支持费用,并对结果进行统计. 结果:营养支持7d后,除清蛋白(ALB)指标和胃肠道等主要并发症外,EEN组病人前清蛋白(PA)、淋巴细胞总数(TLC)均显著高于TPN组,两组营养支持后ALB、PA、ILC显著高于营养支持前,EEN组营养支持日均费用显著低于TPN组,经统计学分析有显著性差异(P＜0.05). 结论:对于脑卒中病人早期给予EN,能促进病人营养状况的恢复,达到良好的治疗效果.     

重症急性胰腺炎病人在X线及内镜辅助下放置鼻空肠管的比较

目的:比较重症急性胰腺炎(SAP)病人在X线及内镜辅助下放置鼻空肠管的方法. 方法: 选取52例SAP病人分别采用X线辅助超滑导丝法和内镜辅助下放置鼻空肠管,记录置管成功率,置管时间,置管相关并发症的发生率,置管前、置管中、置管后舒适度(VAS评分)以及留置时间. 结果: X线辅助下超滑导丝法较内镜辅助法的置管时间短,VAS评分低,置管相关并发症(腹痛、腹胀)的发生率低(P＜0.05);两种方法在置管成功率,其他置管相关并发症(鼻咽部出血、上消化道出血、穿孔、误吸、呼吸困难)以及远期并发症(导管移位、咽炎、鼻窦炎、肺部感染)的发生率、留置时间等差异无显著性意义(P＞0.05). 结论: X线辅助下超滑导丝法和内镜辅助法均是SAP病人早期非手术放置鼻空肠管有效、安全、易行的方法.X线辅助下超滑导丝法可作为一般病人的首选方法;对需要机械通气、持续血液滤过治疗以及并发胰性脑病、十二指肠狭窄的SAP病人,内镜辅助法则更合适.     

Feasibility of self-propelling nasojejunal feeding tube in patients with acute pancreatitis

BACKGROUND & AIMS: To assess the success rate of a self-propelling nasojejunal feeding tube in patients with acute pancreatitis. METHODS: All patients admitted for acute pancreatitis were included. A self-propelling nasojejunal feeding tube was introduced into the stomach, and gastrointestinal motility was stimulated using metoclopramide. If the tube failed to advance to the ligament of Treitz, a nasojejunal tube was placed endoscopically. RESULTS: A total of 108 patients, 94 with necrotizing pancreatitis (Balthazar D/E) and 14 with nonnecrotizing pancreatitis (Balthazar B/C), were referred for artificial nutrition. In 11 cases, ileus persisted and parenteral nutrition was initiated. Among the remaining 97 patients, 5 refused tube placement. The self-propelling feeding tube was inserted in 92 patients with successful migration to the ligament of Treitz in 61% (n = 56) and failure in 39% (n = 36). Of the 36 patients with an initial failed placement, endoscopic placement of a nasojejunal tube was successful 80% of the time (29 patients). The success rate of a nasojejunal self-propelling feeding tube placement correlated directly with the severity of the acute pancreatitis (92% in B/C vs 61% in D vs 48% in E; P < .05). CONCLUSIONS: Use of a self-propelling nasojejunal tube is a simple technique that can be successfully performed in the majority of patients with acute pancreatitis. The utility of this procedure in the most severe cases of acute pancreatitis continues to pose a challenge.     

营养支持在胰源性腹水治疗中的应用(附1例报告及文献总结)

目的:观察营养支持在胰源性腹水治疗中的作用.方法:对1例慢性胰腺炎合并Oddi括约肌炎性狭窄引起的胰源性腹水病人,在一般治疗的基础上,采取肠外营养2周,腹水消退后,行胆道下端扩张和胆道引流手术.术后行肠内营养2周.在肠外营养前后,观察腹水引流量和血清清蛋白水平的变化.结果:经过肠外营养支持,腹水引流量迅速减少,1周时消退,血清清蛋白水平明显升高.术后肠内营养改善了营养状态.结论:在胰源性腹水治疗中,肠外营养能让胰腺休息,促进腹水消退,减少蛋白质丢失,提高血清清蛋白水平;肠内营养更能有效地改善营养状态.     

早期肠内营养对重症急性胰腺炎病人营养状况和预后影响

目的:观察早期肠内营养(EEN)对重症急性胰腺炎(SAP)病人营养状况和预后的影响。方法:回顾分析本院近4年收治的38例SAP病人EEN和综合治疗情况,监测其并发症和临床生化指标变化,判断临床应用效果。结果:EEN组病人的并发症和生化指标等均低于对照组,同时在缩短病程、降低费用、改善机体营养状况方面有较好的临床效果。结论:EEN可改善SAP病人的营养状况,促进肠蠕动恢复,降低感染等并发症的发生率。     

Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness

Background:  Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust.
Methods:  A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak® system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed.
Results:  Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was £111.
Conclusions:  This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.     

Feasibility and safety of needle catheter jejunostomy for enteral nutrition in surgically treated severe acute pancreatitis

BACKGROUND: The role of the gut in the development of septic complications and promising clinical results have led to a shift from the parenteral to the enteral route for nutrition support of patients with acute pancreatitis. In patients undergoing surgery for severe necrotizing pancreatitis, the application of a needle catheter jejunostomy might be useful. However, there is a shortage of clinical data on its feasibility and possible harmful effect. METHODS: Between January 1999 and December 2002, 13 patients were operated for severe acute necrotizing pancreatitis. At the time of surgery, needle catheter jejunostomy was performed using a standard technique. Enteral nutrition was initiated without a strict protocol by feeding small amounts of a standard diet and carefully monitoring patient tolerance. As long as necessary, patients were also fed parenterally in order to achieve target caloric goals. RESULTS: No major tube- or feeding-related complications were observed. A single case of tube dislodgement caused by manipulation during relaparotomy for lavage occurred and was rectified during the same operation. CONCLUSIONS: In patients undergoing surgery for severe acute pancreatitis, needle catheter jejunostomy for long-term enteral nutrition can be applied with no additional risk.     

重症急性胰腺炎不同营养支持方式的护理和效果

目的 :比较肠外营养和经鼻-空肠管途径肠内营养在治疗重症急性胰腺炎病人中的应用效果,总结护理方法。方法 :将收治的85例重症急性胰腺炎病人按入院先后分为试验组和对照组。对照组病人给予常规肠外营养支持治疗及相应理,试验组病人则采用鼻-空肠管行肠内营养支持治疗,并在治疗期间给予相应的临床护理干预,就两组病人的各项临床指标进行比较分析。结果 :两组病人护理干预前的血清CRP、ALB、TP水平比较无统计学差异(P0.05);营养治疗及护理干预后,两组病人的CRP、ALB、TP水平均有改善,但试验组改善幅度明显大于对照组,组间差异有统计学意义(P0.05)。试验组病人治疗后BMI指数于对照组未见明显差异(P0.05)。同时其首次下床时间、机械通气时间、腹胀缓解时间、血淀粉酶以及尿淀粉酶恢复时间均较对照组有明显降低(P0.05)。两组病人腹胀、腹泻、恶心呕吐、上消化道出血等并发症比较,试验组均明显低于对照组(P0.05)。结论 :经鼻-空肠肠内营养支持治疗在有效纠正重症急性胰腺炎营养不良的同时,还能够对胃肠道起到保护作用,降低并发症的发生率。良好的临床护理干预能够保证肠内营养的顺利实施。     

Severe acute pancreatitis: nutritional management in the ICU.

Patients with acute pancreatitis have elevated nutritional needs due to increased energy expenditure and catabolism. It is a clinical challenge to provide adequate nutrition to these patients while maintaining gut function, preventing pancreatic stimulation, and minimizing the risk of septic and metabolic complications associated with nutritional support. We present the case of a patient who had severe acute pancreatitis and was initially given total parenteral nutrition. After a period of initial improvement, he developed hyperglycemia, bacteremia, and sepsis. Parenteral nutrition was discontinued and infection was treated with antibiotics. Subsequent nutritional support consisted of enteral feeding with an elemental diet infused via a nasojejunal feeding tube. His condition improved gradually and he made a full recovery. This case illustrates the difficulties encountered while managing a case of severe acute pancreatitis and provides an evidence based approach to the nutritional management of severe acute pancreatitis in the intensive care unit setting.     

早期肠内营养对急性重症胰腺炎炎症介质及营养指标的影响简

目的：探讨早期肠内营养对急性重症胰腺炎患者炎症介质、营养指标及临床恢复的影响。方法2006年1月至2010年3月收治的急性重症胰腺炎患者患者59例,随机分成早期肠内营养组31例,肠外营养组28例,观察上述两组治疗后1、3、7天血清中TNF-α、IL-1β、前白蛋白、清蛋白的水平;外周血淋巴细胞数;并观察两组血清淀粉酶恢复时间,全身炎性反应综合征（ Systemic infammactery response syndrome ,SIRS）、腹腔脓肿及肝功能异常例数,治疗费用等指标的差异。结果早期肠内营养组治疗后3、7天血清TN F-α、IL-1β浓度明显低于肠外营养组（ P＜0．05）,前白蛋白、清蛋白的水平、外周血淋巴细胞数明显高于肠外营养组（P＜0．05）,治疗费用低于肠外营养组（P＜0．05）,两组血清淀粉酶恢复时间,SIRS、腹腔脓肿及肝功能异常例数无明显差异（P＞0．05）。结论早期肠内营养在改善急性重症胰腺炎患者营养状态方面明显优于肠外营养,有利于提高机体的抗感染能力和各系统机能的恢复,是可靠、安全、经济的营养支持手段。     

Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better?

BACKGROUND/AIMS: Severe acute pancreatitis is associated with microcirculatory impairment, increased gut permeability and metabolic changes. The aim of the present study was to evaluate initial fluid resuscitation and nutritional support versus outcome in patients with severe acute pancreatitis. METHODS: All cases of acute pancreatitis admitted 1994-2003 were analyzed retrospectively. The inclusion criteria of severe acute pancreatitis were organ failure and/or local complications according to the Atlanta classification system. Mortality was used as outcome measure. RESULTS: Ninty-nine patients were included in the study. The hospital mortality was 17%. Hypovolemia at arrival was found in 13% (13/99) and correlated with increased hospital mortality (P=0.009). During the first three days in average 11000+/-4100 ml of fluids and 1470+/-820 calories were administered. Total parental nutrition was given to 73% (69/95) and enteral nutrition served as a complement in 29% (28/95) of the patients. Hyperglycemia was seen in 61% (55/90) of the patients and insulin was administered to 53% (29/55) at an average glucose level of 19+/-3 mmol/l. The intake of oral food was reintroduced in average 15+/-9 days after admission and was interrupted in 17% (13/75) because of pain relapse. CONCLUSION: A nutritional treatment regime in severe acute pancreatitis including a moderate and hypocaloric initial fluid resuscitation, parental nutrition as the preferred route for nutritional support and a non-strict glucose control, with an associated mortality of 17%, indicates several modes of improving outcome.