益生菌(元)联合肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的:探讨益生菌(元)联合肠内营养(EN)对重症急性胰腺炎(SAP)大鼠肠道屏障及吸收功能的影响.方法:将24只大鼠诱发重症胰腺炎模型后,随机分为四组,分别给予肠内要素营养(A组)、双歧三联活菌 肠内要素营养(B组)、β-葡聚糖 肠内要素营养(C组)以及双歧三联活菌 β-葡聚糖 肠内要素营养,即合生元 肠内要素营养(D组),共持续7天.四组大鼠营养供给为等热量和等氮量.第7天处死大鼠前,先作木糖吸收实验,取血检测血浆二胺氧化酶(DAO)、内毒素、肿瘤坏死因子(TNF)和白细胞介素-6(IL-6)的变化;再处死大鼠,取空肠观察小肠的病理改变,测量黏膜绒毛高度.结果:B组与A组相比,血浆内毒素、DAO、TNF和IL-6明显降低(P＜0.05),C组和D组虽有下降趋势,但无显著性差异(P＞0.05);B组和C组木糖吸收试验较A组明显改善(P＜0.05);病理检查显示,B组小肠结构较完整,黏膜厚度、绒毛高度均比A组明显增加(P＜0.05).结论:益生菌(元)联合EN可保护SAP大鼠肠道屏障及吸收功能;β-葡聚糖对SAP大鼠肠道功能改善不明显.     

甘肃省临夏回族自治州碘缺乏病流行状况调查

临夏回族自治州是甘肃省碘缺乏病重病区之一.为全面评估该地区碘缺乏病现状,为实施因地制宜的补碘措施提供依据,2006年5月在自治州内的7县1市开展了调查.     

Critical review of nutrition assessment tools to measure malnutrition in chronic kidney disease

The use of the Subjective Global Assessment (SGA) and similar clinical tools for nutrition assessment is integral in the nutritional management of chronic kidney disease (CKD) patients. The present paper is a critical review of the quality of studies introducing and validating SGA‐based tools in CKD. In the CKD literature, clinical, predictive and criterion validity were investigated by a number of studies. Common limitations identified include the use of questionable statistical methods, difference in prevalence of malnutrition based on tool or administrator (i.e. dietitan, nephrologist or nurse) and use of inadequate reference tests to establish true nutrition status. The SGA appears to have the best diagnostic evidence to adequately detect the presence of abnormal nutrition status and prognostic evidence to predict poor outcome. Modified scored versions may improve clinician’s ability to detect degree of malnutrition; however, the present review indicates more work is required. Tools based on the original SGA claiming validity in CKD and potentially other clinical areas should be approached with caution. Critical evaluation of study design, reference tests and statistical methods is recommended before implementing new tools in practice.     

Follow-up phone calls increase nutrient intake estimated by three-day food diaries in 13-year-old participants of the Raine study

Aim: Our primary objective was to determine the effect of follow‐up phone calls on estimated nutrient intakes obtained by three‐day food diaries from 13‐year‐old adolescents. Methods: Food diaries were recorded using household measures and entered into a dietary analysis software program, before and after follow up by telephone. A sample of 340 participants aged 13 years born into the Western Australian Pregnancy Cohort (Raine) Study, a population‐based longitudinal cohort followed from 16 to 20 weeks' gestation to 13 years of age (current follow up). After face‐to‐face instruction, participants completed three‐day food diaries at home and returned them by post. Follow‐up telephone calls were made to each participant to improve data collection response and to verify missing details in the food diaries. Nutrient intakes before and after telephone follow up were compared using Student's t‐tests in spss . Results were also compared with those of the Child and Adolescent Physical Activity and Nutrition survey. Results: Follow‐up phone calls significantly increased the estimated intake of total kilojoules, water, total carbohydrates, sugars and magnesium (P < 0.05). Conclusion: These results indicate the importance of follow‐up phone calls to obtain missing details in three‐day food diaries completed by adolescents.     

低热量肠内营养联合生长激素在胃肠道肿瘤患者术后的应用

目的探讨低热量肠内营养联合重组人生长激素(rhGH)对胃肠道肿瘤患者术后蛋白质代谢的影响及其治疗效果。方法将2003年1月～2005年7月在我科行胃肠道肿瘤根治术的40例患者随机分成两组:低热量肠内营养支持 安慰剂为对照组(n=20);低热量肠内营养支持 rhGH为研究组(n=20)。rhGh在术后第3天开始应用,连续应用7天。观察患者术后蛋白质代谢和血清胰岛素样生长因子-1(IGF-1)的变化情况。结果研究组术后第5天恢复正氮平衡。两组血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白、IGF-1在术后第3天均显著下降,治疗后有不同程度的恢复。研究组术后第10天前白蛋白、转铁蛋白、纤维连接蛋白和IGF-1显著高于对照组(P<0.05)。结论低热量肠内营养支持联合rhGH能促进胃肠道肿瘤患者术后的蛋白质合成,改善患者营养状况。     

恶性肿瘤患者的营养不良风险和干预

恶性肿瘤患者存在营养不良的风险,其程度取决于肿瘤的类型、部位、大小、分期等。相对于非消化道和早期肿瘤,消化道和中晚期肿瘤对人体营养状况的影响更大。营养不良又与患者对肿瘤治疗的应答性、不良反应和生活质量相关;营养不良者的预后明显差于营养良好者。导致营养不良的因素除恶性肿瘤的局部作用、肿瘤产生的各类细胞因子导致的代谢异常和伴随抗肿瘤治疗的负性作用外,还包括患者对肿瘤的恐惧、焦虑、无望、疼痛和睡眠障碍等。不同恶性肿瘤对人体营养状况影响的共性主要表现为厌食、体质量下降和恶病质。目前,已将抗肿瘤治疗对患者生活质量和营养状况产生的正性影响视为与生存率同等重要;对伴有营养不良的肿瘤患者,在循证基础上提供营养干预已成为不可缺少的综合治疗措施之一,目的是改善功能和生活质量。营养干预主要包括处理厌食和供给营养素,尚无足够证据证实癌症患者需要特殊营养配方。     

肠外营养添加精氨酸、谷氨酰胺对胃癌术后C3、C4、CRP的影响

目的 评价联合应用精氨酸(Arg)和谷氨酰胺(Glu)的肠外营养(PN)对胃癌患者根治术后C3、C4、C-反应蛋白(CRP)的影响. 方法 将60例胃癌病人随机均分4组:Arg组、Glu组、Arg Glu组及常规组(Rou组).术后第1 d起各组均连续给予PN支持7 d,均为等氮等热量.15例同期行择期腹部手术病人(胆囊息肉6例,胆囊结石9例)作为对照组.术前、术后第8 d分别检测各组C3、C4及CRP;观察术后肛门排气时间. 结果 术前胃癌病人的C3、C4及CRP高于对照组(P＜0.05).术后第8 d,Arg组与Glu组的C3、C4和CRP比较差别无统计学意义,但2组均高于Rou组(P＜0.05),均低于Arg Glu组(P＜0.05);Arg Glu组与Rou组的CRP比较差别有统计学意义(P＜0.01).术后Arg Glu组胃肠道功能恢复时间短,排气时间与其他3组比较差别有统计学意义(P＜0.05). 结论 Arg Glu比单用Arg或Glu增强的PN可降低胃癌患者根治术后应激反应.     

肠内营养支持老年脑血管意外病人的护理观察

目的观察老年脑血管意外患者施行肠内营养支持的效果及护理。方法将48例老年脑血管意外需要行肠内营养支持的患者随机分为实验组和对照组各24例。实验组给予较为完善的营养设计和护理(包括营养液的选择和配制、无菌技术的操作、输注的温度、速度及供给方式等),对照组则常规方式治疗。比较两组的营养状况指标、胃肠道情况和并发症的发生情况。结果实验组的清蛋白、氮平衡与对照组比有显著性差异(P<0.05),实验组的胃肠道反应较对照组减少,对照组的并发症与实验组比较有显著性差异(P<0.05)。结论肠内营养是一种方便、安全、有效的临床营养支持方法;对肠道粘膜屏障具有明显的保护作用。较为系统的、合理的营养设计和护理,可以使患者得到合理的营养支持,减少胃肠道的反应和并发症的发生。     

2001～2005年龙岩市肺结核病人发现与治疗情况分析

[目的]评价龙岩市结核病防治规划实施进展情况,总结经验,发现和解决存在的问题,保证规划更好地顺利实施。[方法]对2001-2005年龙岩市肺结核病人发现与治疗情况进行分析。[结果]2001-2005年全市合计,新登记活动性肺结核病人7 866例,新登记涂阳病人5 146例,其中新涂阳病人3 974例,活动性肺结核病人新登率为54.3/10万,涂阳病人新登率为35.5/10万,新涂阳病人登记率为27.4/10万;合计治疗涂阳肺结核病人4 457例,治愈3 931例,治愈率为88.2%,其中初治涂阳病人治愈率为90.2%,复治涂阳病人治愈率为81.6%。[结论]龙岩市基本完成了结核病防治规划中确定的中期目标。     

孕期妇女营养与健康状况调查

目的:了解和评价我国妇女孕期营养与健康状况。方法:以2002年中国居民营养与健康状况调查数据为研究背景,用横断面询问调查的数据,比较城乡孕妇膳食和营养素摄入以及健康状况。结果:农村孕妇米面和浅色蔬菜摄入量高于城市,城市孕妇水果、禽肉类、奶类、鱼和蛋类摄入量显著高于农村;农村孕妇的碳水化合物、能量、维生素B1、维生素C、维生素E摄入量高于城市,城市孕妇每日维生素A、维生素B2和钙的摄入量高于农村。城市孕妇孕晚期体检次数显著多于农村,孕妇合格率显著高于农村。城乡间孕妇腓肠肌痉挛的比例有显著差异。孕期有3.1%孕妇发生妊高征,城乡间没有显著差异。孕期有0.6%孕妇发生糖尿病,城乡间差异显著。结论:城乡间孕妇营养和健康状况存在差距,应加强城乡间孕妇的营养与健康监测。