Clinical Analysis of One Case Patient of Multiple Organs Failure Developing after Small Intestinal Transplantation

Small intestinal transplantation has become the standard treatment for small intestinal failure and some complications associated with total parenteral nutrition （TPN）. Because the small intestine is the largest source of lymph and bacteria, it is inevitable to induce strong immune response after small intestinal transplantation. Moreover, immunosuppressive therapy used following small intestinal transplantation often causes severe side effects. For these reasons, the application of small intestinal transplantation is seriously hampered. Therefore, small intestinal transplantation is the most challenging abdominal organ transplantationILl. On July 14, 2004, the first case of allogeneic small intestinal transplantation in Zhejiang Province （China） was successfully conducted in a patient with short bowel syndrome at our hospital. However, the patient died from multi-organ failure on day 34 after the transplantation. Here, a clinical analysis of the transplantation in this patient is conducted.     

Application Status of Chinese Medicine on Cancer Rehabilitation: A Preliminary Questionnaire Survey

Objective: To investigate the application status of Chinese medicine (CM) in cancer rehabilitation, so as to provide references for improving the level of CM cancer rehabilitation. Methods: A survey questionnaire regarding "application status of CM rehabilitation in cancer patients" for oncologists (doctor version) and cancer patients (patient version) were developed, respectively. From September 2014 to November 2016, a total of 1,000 doctors from oncology department in 48 hospitals and 2,000 cancer patients from CM oncology department from 8 hospitals in China were recruited in this survey. The psychological, nutrition and exercise rehabilitation guidance for cancer patients provided by doctors, their mastery conditions regarding cancer staging treatment and CM syndrome differentiation, and recommendation from doctors on CM rehabilitation were investigated. Cancer patients'' awareness on the importance of psychological, nutrition and exercise rehabilitation, as well as their knowledge and needs for rehabilitation were also analyzed. The impact of gender, age, professional title, hospitals grades of physicians on their knowledge of cancer staging treatment and CM syndrome differentiation, and the relationship between gender, age, education level and economic conditions and patient''s knowledge along with the needs of CM rehabilitation were further analyzed. Results: Totally 1,000 questionnaires were issued to doctors and 963 questionnaires returned, among which 948 were valid representing a response rate of 94.80%. A total of 2,000 questionnaires were issued to patients and 1,705 valid data finally returned with a response rate of 85.25%. The survey showed that cancer patients generally paid much attention to psychological, nutritional and sports rehabilitation, and had a strong demand for CM rehabilitation. Knowledge of CM rehabilitation was not well provided by oncologists, and the rehabilitation guidance as well as CM rehabilitation measures were obviously insufficient in cancer patients. Educational and economic levels were positively correlated with cognition level of CM rehabilitation knowledge among cancer patients (Kendall-taub correlation coefficients=0.130, 0.057, respectively; P<0.05). Gender and education level were positively correlated with the patients'' willingness for taking CM measures (Kendall-tau_b correlation coefficient=0.057, 0.105, respectively; P<0.05). Age was negatively correlated with intention of applying CM measures (kendall-taub correlation coefficient=–0.105, P<0.05). Conclusions: Health education and professional training for both cancer patients and oncologists should be strengthened and CM rehabilitation knowledge among cancer patients and oncologists should be improved, so as to give full play to CM in cancer rehabilitation.     

胃癌术后肠内营养支持的临床研究

目的 探讨胃癌术后早期肠内营养支持的临床意义,并观察肠内营养对胃肠功能恢复、营养状况以及免疫功能的影响.方法 将40例行远端胃大部切除胃癌患者随机分为两组,20例术后行肠外营养治疗(PN组),20例术后早期行肠内营养治疗(EN组).PN组术后每日行完全肠外营养支持直到经口进食;EN组术后第1天以静脉支持为主,第2天开始经鼻营养管滴入肠内营养制剂,逐步加大用量并减少静脉支持.观察两组术后排气、排便时间,并发症发生率,平均住院费用、住院时间.结果 EN组术后排气、排便时间,并发症发生率和平均住院时间、费用均少于PN组.结论 胃癌术后早期EN支持可促进小肠功能恢复,提高免疫力,减少住院时间.肠内营养是胃癌术后营养支持的首选途径. Abstract： Objective To investigate the clinical significance of early enteral nutrition support after operation of gastric cancer.The recovery of gastrointestinal function,nutritional status and immune function were observed. Methods Forty patients with distal subtotal gastrectomy were randomly divided into two groups, 20 patients received parenteral nutrition(PN group), 20 patients were supplied with early enteral nutrition(EN group).Patients of parenteral nutrition(PN) were given total parenteral nutritional supports as routinely from the first postoperative day until oral feeding.Patients with enteral nutrition(EN) were given parenteral nutritional supports routinely on the 1st postoperative day,and then with nutrition through naso-duodenal infusion, gradually increasing the dosage and reducing the venous support.The observation indexes including flatus and defecation time,complication rate,the average hospital costs and duration.Results The time of flatus and of bowel movement, complication rate,hospital duration and costs after operation in the EN group was lower than that of the PN group.Conclusions Early postoperative enteral nutrition support can promote the recovery of intestinal motor function,improve immunity and reduce the hospitalization duration. Enteral nutrition is the first choice for postoperative gastric cancer nutritional support.     

腹部手术后早期炎性肠梗阻的诊断与治疗

To investigate the clinical features and principles of diagnosis and treatment of early postoperative inflammatory ileus (EPII). The clinical data of 69 patients with EPII treated in this hospital were retrospectively reviewed. EPII mostly occurred in 3-11d after abdominal surgery, and the average time was 5d. Sixty two cases were cured in a mean period of (22±13)d through combination therapy including gastroenteral decompression, somatostatin, dexamethasone and total parenteral nutrition (TPN). Seven cases were cured by operation. EPII is a special type of early intestinal obstruction which often occurs in two weeks after abdominal operation. Its typical symptoms are abdominal distension; conservative therapy is effective for most cases and reoperation is usually contradicted.     

Treatment strategies for mass burn casualties

Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.     

Therapeutic effect of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients:a clinical two-center randomized controlled trial

OBJECTIVE:To evaluate the therapeutic effects of acupuncture and massage for shoulder-hand syndrome in hemiplegia patients.METHODS:One hundred and twenty hemiplegia patients with stage I shoulder-hand syndrome were randomly divided into a group treated with standardized electric acupuncture and massage,and a group treated with rehabilitation therapy for 6 weeks.The primary indices evaluated were pain on passive movement of the shoulder using the numeric pain rating scale(NPRS),and the number of patients with shoulder-hand syndrome at Steinbrocker stage II or III after treatment.The secondary indices were Fugl-Meyer evaluation of functional movement of the upper limb and hand using the modified rankin scale(MRS).RESULTS:At post-treatment evaluation and a 12-week follow-up visit,NPRS score,number of patients with stage II or III shoulder-hand syndrome,and MRS score were all improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).On Fugl-Meyer evaluation,functional movement of the upper limb was also improved in the acupuncture-massage group compared with the rehabilitation group(P<0.05).CONCLUSION:Standardized acupuncture-massage therapy may have curative effects on shoulder-hand syndrome in hemiplegia patients.     

Clinical features and management of Crohn’s disease in Chinese patients

Background An increasing incidence of Crohn‘s disease has been found in China in recent years.Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn‘ s disease in order to improve early diagnostic accuracy and therapeutic efficacy.Methods Thirty patients with active Crohn‘s disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease.Results Most patients were young adults with a higher proportion of females to males ( ratio: 1.14:1 ). The disease affects any segment or a combination of segments along with the alimentary tract(from the mouth to the anus). In this study, the colon and small bowel were the major sites involved.Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30. 8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host‘ s nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported.Conclusion Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP (or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.     

Epidemiology of methicillin-resistant Staphylococcus aureus infection and empirical antibiotic therapy for MRSA infection: multicenter investigation

Background The epidemiology of methicillin-resistant Staphylococcus aureus （MRSA） maybe changed by strict infection control measures,and the impact of empirical antibiotic therapy on the outcomes of MRSA infection was not clear.We aimed to investigate the present epidemiological status of MRSA infection and empirical antibiotic therapy for MRSA infection in university teaching hospitals in mainland China.Methods The present study was a multicenter prospective observational study conducted in five university teaching hospitals.Patients who were consecutively admitted to the intensive care unit and signed a consent form from March 3,2011 to May 31,2011 were included.Patients with age 〈18 years or with a length of hospital stay 〈48 hours were excluded from this study.The following variables were collected or recorded：demographic data,general status,APACHE Ⅱ score of the patient at the time of admission,infections,and the use of antibiotics during a stay.Primary outcomes and prognostic indicators included length of hospital stay and 28-day and 90-day mortality.The differences between the patients with appropriate empirical therapy and patients with inappropriate therapy were analyzed to detect the influences of antibiotic therapy on the prognosis of MRSA infection.Results A total of 682 cases were enrolled.Thirty （66.2%） of 88 MRSA cases were treated with effective antibiotics for MRSA infection; only 20% received appropriate empirical antibiotic treatment.The empirical therapy group compared with the target therapy group had a shorter length of stay,but there were no significant differences in mortality rates.There were no significant differences in the length of hospital stay,length of stay,and 28-day and 90-day mortality between MRSA-infected patients who received or not received effective antibiotics.Two hundred and eighteen cases received sensitive antibiotics for MRSA.Conclusions The MRSA infection rates are at relatively low levels in university teaching hospitals in China.The empirical use of sensitive antibiotics for MRSA infection was at relatively high rate,and there is a tendency of overusing in patients without MRSA infection.On the other hand,the rate of appropriate empirical antibiotic therapy for patients with MRSA infection is relatively low.     

Structured lipid emulsion as nutritional therapy for the elderly patients with severe sepsis

Background The nutritional support is one of the important therapeutic strategies for the elderly patients with severe sepsis, but there is controversial in choosing a parenteral nutrition formulation. This study was designed to compare the therapeutic effects of structured lipid emulsion, physically mixed medium, and long-chain fat emulsion in the treatment of severe sepsis in elderly patients.

Methods A total number of 64 elder patients with severe sepsis were enrolled in the study. After a week of enteral nutritional support, the patients were randomly divided into research (structured lipid emulsion as parenteral alimentation) and control groups (physically mixed medium and long-chain fat emulsion as parenteral alimentation). The alterations of plasma albumin, lipid metabolism, and blood glucose level were recorded after parenteral alimentation and were compared between the two groups.

Results The plasma levels of albumin, prealbumin, cholesterol, and triglyceride were decreased in all the patients after one week of enteral nutritional support treatment (t=7.78, P=0.000; t=10.21, P=0.000; t=7.99, P=0.000; and t=10.99, P=0.000). Further parenteral alimentation with different lipid emulsions had significant effects on the serum prealbumin and albumin (t=3.316, P=0.002; t=3.200, P=0.002), whilst had no effects on the blood glucose and triglyceride level (t=7.78, P=0.000; t=4.228, P=0.000). In addition, the two groups had a significantly different Apache II score, ventilator time, and hospital stay time (t= ?2.213, P=0.031; t=2.317, P=0.024; t=2.514, P=0.015).

Conclusions The structured lipid emulsion was safe as parenteral nutrition for elderly patients with severe sepsis. It was demonstrated to be superior to the physically mixed medium and long-chain fat emulsion with respect to the protein synthesis and prognosis.

     

Sixteen years'''' home parenteral nutrition for a patient with total small bowel resection

Objective To study the metabolic changes and complications of a patient on long term home parenteral nutrition ( HPN ). Methods Clinical data were summarized on a female patient with total small bowel plus right colon resection receiving home parenteral nutrition support for 16 years. Results The patient became pregnant on the 5 th year of HPN,and gave birth to a healthy baby. Her liver function remains almost normal during the 16 years. Each central vein catheter averagely lasted for 240 days, with the longest one more than 26 months. Catheter related sepsis rate was very low. Several complications occurred during the 16 years, including anaemia, zinc deficiency and increased serum iron level. Lipid peroxidation increased significantly. Conclusion Long-term HPN support patient could suffer many metabolic abnormalities complications. Catheter related sepsis and occlusion should be prevented. The HPN formula should be adjusted according to the patient's condition.5 refs, 1 tab.     

短肠综合征的康复治疗

目的总结27例短肠综合征病人康复治疗的经验,介绍短肠康复治疗的具体方法,探讨改善短肠病人营养状况、促进肠功能代偿的措施。方法短肠康复治疗包括营养支持、应用谷氨酰胺和生长激素促进肠粘膜生长、富含膳食纤维的短肠康复饮食、减轻短肠临床症状以及预防和治疗短肠并发症等措施。1997年1月至2000年7月间共27例短肠患者接受了29次康复治疗,患者平均年龄38.5岁±19.3岁。剩余小肠长度范围15～80cm,平均46.8cm±23.4cm,15例有回盲瓣。从肠切除至接受康复治疗的平均时间为86d±105d。结果治疗后病人的营养状况明显改善,肠道吸收功能有所增强。随访超过2年者8例,4例完全脱离肠外营养,随访时间超过1年者13例,有10例完全脱离肠外营养。结论短肠康复治疗能够有效地改善短肠病人的营养状况、并能促进肠功能代偿,治疗效果与残留小肠长度、治疗开始的时间和病人年龄有关,及早进行康复治疗能够促进肠功能代偿,减少病人对肠外营养的依赖。     

短肠综合征患者营养康复治疗的观察和护理

目的：研究和探索短肠综合征患者营养康复治疗的观察和护理重点，以及并发症的预防和处理措施。方法：选择短肠综合征患者119例，在其疾病的不同阶段实旌肠外营养（PN）、肠内营养（EN）及肠康复治疗。结果：108例完成预定治疗方案患者的营养状况明显改善、肠道吸收功能显著增强；实旌PN共3507次，有9例发生1～2次中心静脉导管感染；EN过程中有27例患者发生腹泻（3～7次／d）；12例患者因饮食不当引起腹泻（5～9次／d）；13例患者共发生15次喂养管堵塞；3例患者发生高血糖，均被及时发现和处理。结论：短肠综合征患者病情重，病程长，营养康复治疗中的仔细观察与良好护理是预防和及时处理并发症的关键。     

Intestinal adaptation after massive intestinal resection

Patients with short bowel syndrome require long term parenteral nutrition support. However, after massive intestinal resection the intestine undergoes adaptation and nutritional autonomy may be obtained. Given that the complications of parenteral nutrition may be life threatening or result in treatment failure and the need for intestinal transplantation, a more attractive option is to wean patients off nutrition support by optimising the adaptive process. The article examines the evidence that after extensive small bowel resection adaptation occurs in humans and focuses on the factors that influence adaptation and the strategies that have been used to optimise this process. The review is based on an English language Medline search with secondary references obtained from key articles. There is evidence that adaptation occurs in humans. Adaptation is a complex process that results in response to nutrient and non-nutrient stimuli. Successful and reproducible strategies to improve adaptation remain elusive despite an abundance of experimental data. Nevertheless given the low patient survival and quality of life associated with other treatments for irreversible intestinal failure it is imperative that clinical research continues into the optimisation of the adaptation.     

Ⅲ-b型先天性肠闭锁患儿的治疗

目的: 总结Ⅲ-b型先天性肠闭锁患儿的临床特点和治疗经验。方法: 回顾性分析浙江大学医学院附属儿童医院新生儿外科2015年1月至2017年12月收治的12例Ⅲ-b型先天性肠闭锁患儿的临床资料,总结其临床特点和治疗经验。结果: 术中明确诊断为Ⅲ-b型先天性肠闭锁患儿12例,其中2例患儿的家属术中放弃治疗。1例患儿初次手术时仅对闭锁近端小部分肠管进行了裁剪成形,术后出现肠梗阻,再次剖腹探查确诊为十二指肠扩张伴有肠动力异常,行全十二指肠裁剪成形术;1例患儿因远端正常肠管较长,予部分苹果皮样肠管切除,未行肠系膜成形术,剩余8例患儿均行全十二指肠裁剪成形术和肠系膜成形术。1例患儿家属术后早期放弃治疗,1例患儿术后因复杂性先天性心脏病死亡,5例患儿术后合并短肠综合征。8例存活的患儿术后均接受肠外营养支持治疗,其中5例患儿肠外营养支持时间超过42 d,出院后继续随访1~3年,近期治疗效果满意。结论: Ⅲ-b型先天性肠闭锁患儿术中应尽量保留远端苹果皮样肠管并行肠系膜成形;对近端扩张肠管进行裁剪成形,术后予营养支持,可促进残留肠管的代偿和肠适应。     

SHORT BOWEL SYNDROME IN CHILDREN

Short bowel syndrome, a devastating outcome after major intestinal resection, manifests as malabsorption and diarrhoea. Improved outcome in recent years has come about with better understanding of the disease and its sequelae. Medical therapy using H₂ receptor antagonists, loperamide and growth hormone analogues has been found useful. Total parenteral nutrition has revolutionized the outcome of this crippling disorder. Diverse spectrums of surgical procedures aimed at deceleration of intestinal transit and intestinal lengthening have not found favour in clinical practice. Intestinal transplantation remains the only viable option when intestinal adaptation is inadequate and complications of total parenteral nutrition ensue.KEY WORDS: Adaptation, Intestinal transplantation, Small bowel syndrome, Small gut syndrome, Total parenteral nutrition     

2种营养支持疗法对腹泻型肠易激综合征患者的营养状况及生活质量的影响

目的 对比分析2种营养支持疗法对腹泻型肠易激综合征患者的营养状况及生活质量的应用效果。 方法 选取2015年3月—2018年1月哈尔滨医科大学附属第四医院收治的腹泻型肠易激综合征患者160例,采用随机数字表法将患者分为对照组和观察组,每组80例,对照组患者实施常规的肠外营养支持,观察组采取肠内营养支持,观察并比较2组患者的临床疗效、治疗前后营养指标的变化以及生活质量的情况。 结果 观察组的总有效率为91.2%,对照组的总有效率为80.0%,观察组高于对照组,差异具有统计学意义(P<0.05);治疗前,2组患者的清蛋白、血清前蛋白以及血红蛋白差异无统计学意义(均P>0.05);治疗后,观察组患者的清蛋白、血清前蛋白以及血红蛋白指标均高于对照组,差异具有统计学意义(均P<0.05);治疗前,2组患者的精神状态、日常社交、情绪状况和精力改变比较差异无统计学意义(均P>0.05);治疗后,观察组患者的精神状态、日常社交、情绪状况和精力改变均高于对照组,差异具有统计学意义(均P<0.05);观察组并发症发生率低于对照组,差异具有统计学意义(P<0.05)。 结论 营养支持疗法对腹泻型肠易激综合征患者的营养状况及生活质量的应用效果显著,且肠内营养效果更明显,能提高患者营养各指标,提高患者的生活质量,降低并发症的发生率。      

早期肠外营养与肠内营养在全胃切除术中的疗效观察

目的探讨全胃切除术早期肠外营养与肠内营养的疗效。方法将86例因胃癌行全胃切除术的患者随机分为早期肠外营养组与肠内营养组,每组43例。观察两组患者免疫功能状况指标、并发症发生率及术后肠道功能恢复时间和平均住院时间。结果肠内营养组TLC、TRF、CD4、CD8营养后均较肠外营养组明显升高,两组比较有显著性差异（P均〈0．05）;两组Alb、IgG、IgM、C3营养后均较营养前有所提高,但营养前后比较无显著性差异（P〉0．05）。肠内营养组腹泻、腹涨、恶心等不良反应的发生率为23.3％,较肠外营养组的37．2％低（P〈0．05）。肠内营养组术后肠道功能恢复时间、平均住院时间均低于肠外营养组（P均〈0．05）。结论全胃切除术后早期肠内营养是安全、有效的营养支持途径,可迅速恢复患者的免疫状态,缩短肠道功能恢复时间和住院时间。     

危重新生儿营养支持基础研究与临床应用

危重新生儿常见疾病包括早产儿、低出生体质量儿以及需要早期手术干预的先天畸形等.目前,我国每年有100多万名患儿生后早期即需住院治疗,其中绝大多数无法正常喂养,需要接受营养支持.因此,建立危重新生儿营养支持规范一直是临床亟待解决的问题.课题组自1985年起,围绕新生儿临床营养支持,进行了一系列基础和临床研究,主要包括:①分析我国新生儿血清氨基酸代谢特点,成功研制国内首个小儿专用型静脉氨基酸制剂并广泛应用于临床;②通过静息能量代谢测定发现正常新生儿能量消耗值低于公式预计值,据此在国内外首次提出60～80 kcal/(kg·d)这一新生儿肠外营养能量推荐量(较传统值降低30％),并在临床应用中得到有效验证;③临床推广并培训经外周中心静脉置管,并率先开展经空肠穿刺造口术和经皮内镜胃造口术,完善肠内与肠外营养输注的新途径;④发现氧化应激线粒体凋亡途径是肠外营养相关肝损害的重要作用机制,并从动物实验和临床研究两个层面证实谷氨酰胺对肠外营养相关肝损伤具有一定的防治作用.此外,课题组还成功实施了新生儿短肠综合征的肠康复治疗,目前已成功救治来自全国各地共46例患儿,其中1例患儿剩余小肠仅25cm.2005年和2010年,课题组依据循证医学原理,分别制定了《中国新生儿营养支持临床应用指南》和《中国儿科肠外肠内营养支持临床应用指南》,为国内儿科患者的合理营养支持提供依据,提高了临床营养的实践水平.课题组相关研究成果获国家科技进步二等奖.     

不同剩余小肠长度的短肠综合征患儿远期营养状况分析

目的探讨不同剩余小肠长度的短肠综合征患儿远期营养状况。方法通过查阅短肠综合征患儿医疗文书及长期随访,获取17例新生儿期短肠综合征患儿的一般资料和营养状况资料,按小肠剩余长度分为小肠≤40 cm组和小肠长度>40 cm组,对其营养状况进行对比分析。结果小肠≤40 cm组患儿年龄别身高、体质量百分位偏低比率显著高于小肠>40 cm组患儿(P<0.05);小肠≤40 cm组患儿平均红细胞体积异常比率高于小肠>40 cm组(P<0.05)。结论小肠剩余长度较长患儿的营养状况较好,提示小肠剩余长度是短肠综合征患儿预后的关键影响因素。     

表皮生长因子对全胃肠外营养大部小肠切除大鼠肠适应的实验研究

目的：观察应用表皮生长因子(EGF)对全胃肠外营养(TPN)大部小肠切除大鼠残存小肠黏膜的代偿作用。方法：30只大鼠切除80％小肠后分为对照组、常规TPN组、TPN EGF组，观测体重、小肠黏膜形态学改变，流式细胞仪分析肠黏膜细胞增殖活性。结果：术后3组大鼠体重逐渐降低，1周后渐增加。3组间差异无显著性。TPN组小肠肠壁各层均变薄，黏膜萎缩。TPN EGF组肠黏膜厚度、绒毛高度、隐窝深度较TPN组均增加，S期细胞比率系数、增殖指数TPN EGF组较TPN组高，而TPN捐与对照绸差异无昂著件。结论：TPN联合EGF可晟著地增讲肠黏膜的适应性代偿。