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1.
术前血清白蛋白水平对胃癌预后的影响   总被引:3,自引:0,他引:3  
1989年~1993年本院外科施行胃癌切除术者468例,男328例,女140例,平均年龄57.7岁。早期、进展期和晚期患者分别占总数的16.4%、54.5%和29.1%。术前血清白蛋白水平平均达到38.32g/L,术后并发症发生率为3.9%,干均住院天数33.4天,五年生存率达45.5%。通过Logistic回归分析各水手段Alb与性别、年龄、肿瘤分期、并发症发生率、住院天数、生存率的关系。结果:(1)肿瘤越早期,术前Alb水平越趋向正常值上限;(2)年龄越轻,术前Alb水平越趋于正常;(3)Alb<35g/L的病人组中约1/3女性病人的白蛋白水平表现为<30g/L;(4)存在术前Alb水平越低,术后并发症发生率越高。住院无数越长、生存率越不理想的趋势,但无统计学意义。提示胃癌患者入院时的白蛋白水平在一定程度上反映了肿瘤对机体代谢所造成的侵害,对临床诊治过程及预后仍具有一定的参考价值。患者存在明显低白蛋白血症时,应注重防治手术并发症。  相似文献   

2.
血清瘦素对恶性肿瘤患者营养状况的影响   总被引:6,自引:0,他引:6  
为探讨瘦素在恶性肿瘤中的作用及作为营养评价指标的价值。检测了325例癌症病人和66例健康人血清瘦素含量以及癌症病人的体质指数(BMI),血液血红蛋白,红细胞计数,血清白蛋白浓度(ALB),血脂和血清脂蛋白水平等。结果显示:全组癌症病人中,23%BMI小于18.5,14%为低ALB血症者;42%发生贫血,17.2%,发生高胆固醇血症,21.4%,发生高甘油三酯血症,肺癌组BMI小于18.5的发生率明显低于胃癌组(P=0.022),而高血糖及甘油三酯血症发生率明显高于胃癌组(P分别为0.003,0.029),营养不良的癌症患者的血清瘦素含量明显低于营养正常或肥胖患者(P=0.000),BMI均为18.5-25的相同性别的肺癌,胃癌病人,健康人的血清瘦素水平无显著性差异,BMI,性别和血白蛋白浓度均为影响恶性肿瘤病人的血清瘦素浓度的最显著因素,血清瘦素水平与BMI,性别,血白蛋白显著相关(r=0.599-0.698,P=0.000),结果表明:癌症病人贫血发生率高;血清瘦素含量反映恶性肿瘤病人的BMI和营养状况的变化,且可作为其营养 状况的判断指标。  相似文献   

3.
目的:分析216例普外手术期病人的血清白蛋白、磷、镁改变。方法:采用自动生化分析仪检测,按血清白蛋白>35g/L和≤35g/L分为正常组和营养不良组,用t检验对正常组和营养不良组间的血清磷、镁进行比较,对总体病人间的血清磷、镁和血清白蛋白进行直线相关分析。结果:营养不良组的血清磷、镁均低于正常组(P<0.001)。总体病人的血清磷与血清白蛋白正相关(r=0.28,P<0.001);血清镁与血清白蛋白亦成正相关,但无统计学上差异(r=0.10,P>0.05)。结论:低磷、低镁与营养不良有关,血清磷较血清镁更能作为判断普外围手术期营养不良的一个辅助指标  相似文献   

4.
微型营养评定法在恶性肿瘤病人中的应用   总被引:7,自引:1,他引:6  
为探讨微型营养评定法 (MNA)在恶性肿瘤病人的营养状况评价中的价值 ,测定 2 6 2例恶性肿瘤病人的MNA总分、身高、体重、年龄、体力状况、血液血红蛋白量 (Hb)、红细胞数 (RBC)、血清白蛋白浓度 (Alb)、血清前白蛋白浓度 (PA)。计算实际体重 健康时平时体重比 (UBW % )。根据MNA总分评价病人营养状况 :营养不良组 (MNA总分 <17) ;营养不良危险组 (MNA总分介于 17~ 2 3 5 ) ;营养良好组 (MNA总分≥ 2 4)。结果显示 :MNA总分与UBW %、Alb、PA、BMI值呈显著相关 (r=0 5 0 1~ 0 72 4,P =0 0 0 0 )。MNA与UBW %、BMI、PA、Alb方法评价病人的营养状况有良好的一致性 ,符合率分别为 82 %、76 %、71%、6 8%。根据MNA方法评价全组病人 ,营养不良者占 31 7% (83 2 6 2例 ) ,营养不良危险者占 2 5 9% (6 8 2 6 2例 ) ,营养良好者占 42 4%(111 2 6 2例 ) ;营养不良与营养不良危险的发生率无显著性差异 ;老年与非老年患者营养不良发生率无明显差异。胃癌、肝癌的营养不良发生率明显高于肺癌 (P =0 0 0 1)。体力状况越差 (ECOG分级越高 )、营养不良发生率越高。贫血患者营养不良发生率明显高于非贫血者。感染患者营养不良发生率明显高于非感染者。结果提示 ,MNA对于恶性肿瘤患者具有良好的营养评价作用。胃癌?  相似文献   

5.
目的 探讨消化道恶性肿瘤术后早期肠内营养(EN)和肠外营养(PN)联合应用对患者恢复的影响,并与完全胃肠外营养(TPN)进行比较。方法 将2002年1月-2004年3月择期行消化道恶性肿瘤手术的患者65例随机分为二组:EN-PN组(35例)和TPN组(30例),于术后24小时开始营养治疗。分别于术前和术后第7天测定血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)及白细胞介素6(IL-6)、肿瘤坏死因子α(TNFα)水平,同时测定血清内毒素水平和尿乳果糖/甘露醇(L/M)评价肠黏膜通透性,测定血清IgA、IgG、IgM、CD4、CD8及CD4/CD8评价免疫功能,比较二组患者感染等并发症的发生率和平均住院时间。结果 术后第7天,EN-PN组的尿L/M、血清内毒素、IL-6及TNFα水平均明显低于TPN组(P〈0.05),而EN-PN组的IgG及CD4/CD8水平均明显高于TPN组(P〈0.05),EN-PN组TFN及PA明显高于TPN组(P〈0.05),EN-PN组患者感染并发症和住院时间亦明显降低(P〈0.01)。结论 消化道恶性肿瘤患者术后早期应用肠内和肠外营养相结合的营养方式是安全有效的,可提高患者的免疫功能,促进患者恢复。  相似文献   

6.
胃癌切除术后三种不同营养方式的前瞻性研究   总被引:1,自引:0,他引:1  
目的比较肠外营养(PN)、肠内营养(EN)和肠内外相结合的互补营养(CN),对胃癌切除手术后病人恢复的不同影响。方法将连续收治适合切除手术的90例胃癌病人随机分成三组,进行前瞻性研究。1)PN(n=30)组。2)EN(n=30)组:经空肠道倭管在24小时内以大约80ml/hr速度匀速注入全量日需营养。3)CN(n=30)组:术后第1天经静脉给予3/4量的日需营养,经空肠造瘘管以20ml/hr匀速注入1/4量的日需营养。此后依病人肠功能恢复情况逐渐减少PN而逐渐增加EN,至术后第5天经空肠造瘘管注入全量日需营养。各种方式营养均在术后第1天开始给予至第5天营养输完而结束。三组病人均技术前公斤体重给以等值热卡和氮量。测定病人手术前及术后第6天时的体重、血白细胞计数以及血清白蛋白水平,同时记录术后肠功能恢复时间及并发症发生情况。结果1)CN组和EN组肠功能恢复距手术结束时间(小时)显著短于PN组(PN组7Z.5±0.3,EN组34.8±0.6,CN组36.7±0.5,P<0.05)。2)CN组术后9天内主要并发症发生率(20.0%)显著低于PN组(56.7%)和EN组(100%,P<0.05)。对手术前第5天,三组间血白细胞计数正常者所占比率(PN96.7%,EN100%,CN96.7%)、血清白蛋白水平(PN4.1±0.5g/dl,EN4.0±O.3g  相似文献   

7.
目的:观察生长激素加强危重病人应用全肠外营养支持的效果。方法:对严重应激(7例)和重度营养不良(9例)共16例病人采用低热量肠外营养加重组生长激素联合治疗,并与仅用TPN治疗的同类病人作对照研究,治疗后分别测定体重、血清白蛋白,前白蛋白和转铁蛋白及免疫球蛋白,计算氮平衡,观察精神状态。结果:治疗组比对照组在氮平衡、前白蛋白和转铁蛋白有明显改善(P<0.01),血清白蛋白,免疫球蛋白亦有明显增高(P<0.05),精神状态普遍较好,获得了较好的临床疗效。结论:低热量肠外营养加重组生长激素联合治疗是机体病理状态下一种较为理想的营养支持方法  相似文献   

8.
目的:了解生长素加术后早期肠内营养(GH+EPEN)对蛋白质代谢及免疫功能的影响。方法:36例全胃或次全胃切除术后病人随机分成传统肠内营养(TEN),EPEN及GH+EPEN 3组。EPEN组于术后第一天开始连用7天。生长激素剂量为每天8单位。于术前1天、术后4、8天,分别测定所有病人血清白蛋白(Alb)、血清转铁蛋白(Tf)、血液淋巴细胞计数(TLC)及CD4/CD8。结果:术后4天GH+EPEN组的Alb、Tf、TLC及CD4/CD8均显著高于TEN组(P<0.05)。术后8天,EPEN组的Alb、Tf、TCL及CD4/CD8均显著高于TEN组,而GH+EPEN组的相应指标则显著地高于EPEN组(均P<0.05),而且非常显著地高于TEN组(均P<0.01)。结论:GH+EPEN对全胃或次全胃切除术后病人蛋白质的合成代谢及免疫功能的恢复具更佳的疗效。  相似文献   

9.
目的 探讨早期肠内营养在重症急性胰腺炎(SAP)治疗中的安全性和有效性。方法回顾性分析71例SAP患者临床资料,经综合治疗观察患者血清白蛋白、前白蛋白、TNF-α、CD4/CD8、IgG水平。随机分为肠内营养组(EN组,36例)和全肠外营养组(TPN组,35例)。结果 EN组治疗后14d患者血清CD4/CD8及IgG水平比TPN组明显升高(P〈0.05);EN组治疗后7、14d时TNF-α水平与治疗前比较明显下降(P〈0.05),且与TPN组比较明显减少(P〈0.05);EN组治疗后血清前白蛋白水平较治疗前明显增高(P〈0.05),且与TPN组比较亦有显著性增高(P〈0.05)。结论早期肠内营养对SAP治疗是安全、有效的,可提高血清前白蛋白水平,改善其营养状况,增强肠道黏膜屏障,抑制炎性因子释放,增强患者的免疫功能,改善SAP的预后。  相似文献   

10.
采用自动生化分析仪检测了216例普外围手术期病员的血清白蛋白、磷、镁,按血清白蛋白>35g/L和≤35g/L分成正常组和营养不良组,用t检验对正常纽和营养不良组间的血清磷、镁进行比较,对总体病员间的血清磷、镁和血清白蛋白进行了直线相关分析。结果表明营养不良组的血清磷、镁均低于正常组,且与正常组相比有极其显著性差异(P<0.001)。总体病员的血清磷与血清白蛋白成正相关,且有极其显著性差异(r=0.28,P<0.001);血清镁与血清白蛋白亦成正相关,但无统计学上差异(r=0.10,P>0.05)。提示低磷、低镁与营养不良有关,血清磷较血清镁更能作为判断普外围手术期营养不良的一个辅助指标。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L?1 to a maximum of 79?mg·L?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.  相似文献   

16.
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.  相似文献   

17.
The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.  相似文献   

18.
19.
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).  相似文献   

20.

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.  相似文献   

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