肠外营养添加精氨酸与谷氨酰胺对胃癌患者术后免疫功能的影响

目的:评价联合应用精氨酸(arginine,Arg)和谷氨酰胺(glutamine,Glu)的肠外营养(parenteral nutri- tion,PN)对胃癌患者根治术后免疫功能影响。方法:将60例胃癌患者随机平分为四组:Arg组、Glu组、Arg+Glu组及常规PN组(Rou组)。术后第1天起各组均连续给予PN支持7d,均为等氮等热量。另取15例同期行择期手术的普外科腹部手术患者(其中胆囊息肉6例、胆囊结石9例)作为空白对照组。术前、术后第8天分别检测各组的细胞免疫和体液免疫指标。结果:术前60例胃癌患者的CD3、CD4、CD4/CD8、IgA、IgM及IgG均低于空白对照组(P<0.05),CD8则高于空白对照组(P<0.05)。术后第8天,IgA、IgM、IgG在Arg组、Glu组和Arg+Glu组三组之间差异无显著性,三组均高于Rou组(P<0.05);CD3、CD4的百分比及CD34/CD8比值在Arg组和Glu组组间差异无显著性,两组均高于Rou组(P<0.05),均低于Arg+Glu组(P<0.05);而CD8的百分比和CRP、C3、C4的浓度与上述相反,CD3、CD4及CD4/CD8在Arg+Glu组和Rou组组间差异有极为显著性(P<0.01)。结论:联合Arg和Glu增强的PN比单用Arg或Glu增强的PN更能增强胃癌患者根治术后细胞免疫功能。     

营养不良的胃癌患者术后肠内营养与肠外营养效果比较

目的:观察肠内营养(EN)与肠外营养(PN)对营养不良的胃癌患者术后临床恢复的影响.方法:选取经主观综合性营养评估法(SGA)评价为中、重度营养不良的胃癌患者58例,随机分为EN组和PN组各29例,共治疗7 d.观察治疗期间感染发生情况,记录患者肛门排气时间和术后留院时间.手术前后均测量体质量指数(BMI),同时抽取静脉血检测前白蛋白(PA)、血红蛋白(HG)和白蛋白(AL).结果:2组感染率差异无统计学意义(P＞0.05),EN组肛门排气时间提前(P＜0.05),术后留院时间明显缩短(P＜0.05).EN组术后BMI和PA明显高于PN组(P＜0.05).结论:EN治疗营养不良的胃癌患者术后临床恢复多个方面均优于PN治疗.     

早期肠内营养支持对胃肠道肿瘤患者术后营养状况及免疫功能的作用

目的 探讨肠内营养支持在胃肠道肿瘤患者术后营养状况及恢复中的作用。方法 将65例胃肠道肿瘤且伴有营养不良的患者,行根治性手术后随机分为肠外营养（PN）组34例,肠内营养（EN）组31例,PN组给予静脉营养,EN予静脉营养的基础上,术后24 h内开始实施肠内营养,分别于术前及术后第9天抽取外周血,测定营养状况及免疫指标。结果 术后EN组患者的血清前白蛋白较PN组恢复更快,差异有统计学意义（P〈0.05）,术后EN组患者的IgA、IgM和淋巴细胞计数较PN组上升快,差异具有统计学意义（P〈0.05）。结论 术后肠内营养可改善胃肠道肿瘤患者的营养状况,增强机体的免疫功能。     

早期肠内营养对胃癌术后患者营养状况和肠功能的影响

目的：探讨胃癌病人术后早期肠内营养对机体营养状况和肠功能的影响。方法：选择胃癌根治性手术病人60例,随机分为两组：早期肠内营养组30例,于术后24 h应用瑞素进行早期肠内营养,共实施7 d;肠外营养组30例,术后给予全肠外营养治疗。两组病人分别于手术前1 d、术后第1、8天检测营养指标血清清蛋白（ALB）、转铁蛋白（TF）和前清蛋白（PA）,并观察肠功能恢复时间。结果：术后第1天两组患者血清清蛋白、转铁蛋白和前清蛋白浓度较术前有明显下降（P〈0.05或0.01）,经过一段时期的肠内营养和肠外营养支持后基本恢复到术前水平,肠内营养的营养恢复作用与肠外营养相比无明显差异。肛门排气/排便时间两组病人差异显著（P〈0.01）。两组病人在观察期间均未发生严重并发症。结论：术后早期肠内营养支持可以改善胃癌病人的营养状况,促进肠蠕动恢复的作用优于肠外营养。     

胃癌术后患者肠内营养的护理

肠内营养不仅具有营养支持作用，而且还能促进肠蠕动功能的恢复，加速门静脉系统的血液循环，促使胃肠道激素的分泌，改善肠黏膜的屏障功能。2005年1月至2006年12月，我们对本科49例胃癌术后患者行肠内营养支持，取得良好效果，现报告如下。     

Culture and purification of human fetal olfactory ensheathing cells using different attachment rates combined with intermittent NT3 nutrition

Objective：To explore a simple and pragmatic method to obtain sufficient olfactory ensheathing cells from human fetus by selective attachment of harvested cells combined with intermittent NT3 nutrition. Methods：DMEM/F12 culture solution including 10% fetal bovine serum or NT3 was used to culture olfactory ensheathing cells intermittently every 48 h. The cell state and growth rates of OECs were observed, and P75 staining was used to estimate the purity of the cells. Results：Human fetal OECs were positive with P75 immunocytochemical staining. OECs in dipolar or tripolar shape formed networks by their processes in vitro. The purity of OECs in ＂good state＂ was about 95% at 9 d and 83% on 12 d, respectively. Conclusion：The method of using different attachment rates combined with intermittent NT3 addition is a simple and effective way to culture and purify OECs.     

影响极低出生体重儿早期生长赶超的原因

目的 分析极低出生体重儿（very low birth weight infant，VLBWI）在纠正胎龄40周时的生长赶超情况及影响因素。方法 以50例VLBWI作为研究对象。以40周胎龄健康足月儿和15个城市不同胎龄婴儿出生体重为正常值，比较50例VLBWI在出生、出院时及纠正胎龄40周时的小于胎龄儿（small for gestational age，SGA）发生率；分析喂养方式、并发症、辅助治疗等对VLBWI生长赶超的影响。结果 50例VLBWI在纠正胎龄40周时的体重为（3290±640）g，与同胎龄足月儿比较差异无统计学意义（P〉0．05）。50例VLBWI出院时SGA所占比例为64．0％（32／50），明显高于出生时的24．0％（12／50）和纠正胎龄40周时的32．0％（15／50），P均〈0．05。出生时SGA（OR=0．035，95％CI0．003-0．487）、低T3综合征（OR=0．101，95％CI0．013～0．774）及长期使用静脉营养（OR=0．307，95％CI0．097-0．972）是导致VLBWI生长赶超失败的危险因素，而早期开展肠道喂养（OR=8．241，95％CI1．373～49．470）则有利于VLBWI的生长赶超。并发低T3综合征的VLBWI住院4周期间及出院后平均体重增长速度均低于未并发低T3综合征的VLBWI（P均〈0．05）。结论 合理的营养方案、降低并发症的发生率是VLBWI实现早期生长赶超的关键。     

Sociodemographic and clinical characteristics associated with vitamin D status in newly diagnosed pediatric cancer patients

Abstract

Vitamin D deficiency and insufficiency are associated with serious sequelae in childhood cancer survivors. However, data on vitamin D deficiency in children with newly diagnosed cancer are scarce and the role of sociodemographic factors and vitamin D supplementation is largely unknown. We assessed vitamin D status and its socio-demographic and clinical correlates in 163 children with newly diagnosed cancer, using 25-hydroxy vitamin D (25(OH)D) concentrations and assessed longitudinal changes following vitamin D supplementation. Sixty-five percent of the patients with newly diagnosed cancer had low 25(OH)D concentrations. Fifty-two patients (32%) were vitamin D deficient (≤20?ng/mL 25(OH)D concentration), and 53(33%) were insufficient (21-29?ng/mL 25(OH)D concentration). Age over 10 (P?=?0.019), Hispanic ethnicity (P?=?0.002), and female sex (P?=?0.008) were significantly associated with lower 25(OH)D concentration at diagnosis. Vitamin D supplementation resulted in significant increase in 25(OH)D concentrations (P?<?0.001). However, following supplementation in the longitudinal analysis, this increase was less pronounced in Hispanic patients vs. non-Hispanic (P?=?0.007), and in children with solid tumors vs. hematological malignancies (P?=?0.003). Vitamin D deficiency and insufficiency are common in children with newly diagnosed cancer. Hispanic patients, females and older children were at higher risk for vitamin D deficiency and insufficiency. Although supplementation appeared to increase 25(OH)D concentrations over time, this increase was not as pronounced in certain subsets of patients. Prospective trials of the effects of vitamin D supplementation on bone health in children with newly diagnosed cancer are warranted, particularly in Hispanics and patients with solid tumors.     

Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury

Objective: To determine how immediate enteral nutrition (EN) affects gut permeability and the development of multiple organ failure (MOF) in multiply injured patients. Design: Prospective, randomised clinical trial. Setting: 20-bed surgical intensive care unit (ICU), university hospital. Patients: 28 consecutive multiply injured patients, admitted in shock and stabilised in 6 h. Interventions: Patients were randomly assigned to EN started not later than 6 h after admission to the ICU (group A), and to EN started later than 24 h after admission (group B). Measurements and main results: The lactulose/mannitol (L/M) test was performed in patients on days 2 and 4 after trauma, and in 5 healthy volunteers. MOF scores were calculated daily. The mean MOF score from day 4 onwards was 1.84 in group A versus 2.81 in group B (p < 0.002), and was correlated with the time of initiation of EN after injury and the L/M ratio on day 2. The median L/M ratio on day 2 was 0.029 for group A and 0.045 for group B, while on day 4 it was 0.020 and 0.060, respectively. On day 2 after trauma, the L/M ratio was significantly higher in group B (p < 0.05) than in normal volunteers (median 0.014) and was positively correlated with the time of starting EN. Conclusions: In contrast with normal volunteers, the patients started on EN later than 24 h after admission to the ICU demonstrated increased intestinal permeability on the second day after sustaining multiple injury. Also, they had a more severe form of MOF than the group placed on EN immediately upon admission. However, early EN had no influence on the length of ICU stay or the time of mechanical ventilation. Received: 16 March 1998 Final revision received: 15 September 1998 Accepted: 18 September 1998     

Protracted diarrhoea: Secondary monosaccharide malabsorption and zinc deficiency with cutaneous manifestations during total parenteral nutrition

Protracted diarrhoea in early infancy gives rise to many diagnostic and therapeutic problems. Jejunal biopsy often reveals villous atrophy of varying degrees. Severe reduction of small intestinal absorptive area causes secondary monosaccharide malabsorption, as well as secondary disaccharide deficiency, consequences which are relevant in any attempts at oral feeding. Morphologic, metabolic, endocrinological and microbiological studies have to be undertaken in order to establish a definitive diagnosis in protracted diarrhoea, but these studies often fail to reveal the aetiology of the disease. Immunologic abnormalities like phagocyte dysfunction, thymic atrophy and hypoplasia of B-cell regions in lymph nodes might be secondary events, but some types of immunodeficiency are of primary importance in the development of protracted diarrhoea. Total parenteral nutrition in many cases has to be instituted, with all its implications and hazards: septicaemia is the most dangerous of these. Zinc deficiency and acrodermatitis enteropathica may occur during total parenteral nutrition, and zinc deficiency secondarily contributes to the symptoms of diarrhoea. Parenteral administration of zinc is able to overcome these effects.