Daily nutrient intake represents a modifiable determinant of nutritional status in chronic haemodialysis patients.

BACKGROUND: In maintenance haemodialysis patients, daily food intake is changeable; however, its relationship with nutritional status is unexplored. This study aimed to evaluate the isolated, long-term effect of daily nutrient intake on nutritional status in haemodialysis patients. METHODS: We performed a prospective 1-year controlled study in 27 chronic haemodialysis patients, without recognized risk factors for malnutrition. Each day for 1 week, four times in the year, we measured protein nitrogen appearance, and assessed dietary protein (DPI) and energy (DEI) intake from dietary diaries. We compared the nutritional outcome of patients spontaneously reducing nutrient intake below the threshold of 0.8 g/kg body weight/day for DPI and 25 kcal/kg body weight/day for DEI during the week (LOW, n = 8), with controls at adequate nutrient intake (CON, n = 19). An interventional 6-month study was then carried out in LOW to verify the cause-effect relationship. RESULTS: All patients showed a day-by-day reduction of whole nutrient intake during interdialytic period, which was mostly relevant in the third interdialytic day (L3). During the 1-year study, even in the presence of adequate dialysis dose and normal inflammatory indexes, body weight (68.0 +/- 5.5 to 65.8 +/- 5.9 kg), serum albumin (3.96 +/- 0.07 to 3.66 +/- 0.06 g/dl) and creatinine (9.2 +/- 1.1 to 8.1 +/- 0.7 mg/dl) significantly decreased in LOW but not in CON. Diaries evidenced in LOW a reduced number of meals at L3 that was explained by the fear of excessive interdialytic weight gain. During the interventional study, daily DPI and DEI increased at L3; this was associated with a significant increment of body weight, and serum albumin and creatinine levels. CONCLUSIONS: In maintenance haemodialysis patients the persistent, marked reduction of daily nutrient intake, even if limited to a single day of the week, is an independent determinant of reversible impairment of nutritional status.     

小儿全合一肠外营养液的配制和临床应用

目的 介绍一种新生儿、婴儿和儿童兼用的全合一肠外营养液。 方法 将葡萄糖、电解质、7%凡命 (17-氨基酸 )、20%脂肪乳剂和维生素等配制成可兼用于新生儿、婴儿和儿童的全合一肠外营养液 ,脂肪供热占非蛋白热量的45% ,总热量247kJ(60kcal)/100ml,用量按小儿液体生理日需量公式计算。研究其理化性状和稳定性 ,并对新生儿、婴儿和儿童各10例临床应用1周 ,观察副作用和血浆蛋白变化。结果 该全合一液在22℃室温下放置24h无理化性状变化。临床应用并发轻度静脉炎2例 (2/30) ,血甘油三酯一过性增高1例 (1/30) ,无其他代谢并发症。血浆前白蛋白明显增高 (P<0.05)。结论 本配方全合一肠外营养液计算简便 ,使用安全 ,可用于各年龄组小儿短期全肠外或部分肠外营养支持     

全营养素混合液(TNA)在肠外营养的应用

脂肪乳剂、葡萄糖、氨基酸、电解质、维生素及微量元素按一定程序混合配成10种全营养素混合液。在4℃14天贮存期内,10种混合液的pH和渗透压变化不大,不同混合液在不同时期的脂粒平均直径变化为0.3135±0.1012μm～0.4813±0.1893μm,94.93％脂粒的直径<0.6μm,无直径>6μm的脂粒,细菌培养阴性。74例共输全营养素混合液1,796次,无不良临床反应和异常实验室检查结果;用1周以上者大都显示氮平衡改善,用2周以上者血清转铁蛋白和白蛋白浓度可有不同程度升高。     

Enteral versus parenteral nutritional support in acute pancreatitis: A clinical review

Abstract   A critical analysis of the trials comparing enteral with parenteral nutritional support in acute pancreatitis is presented with particular scrutiny of the clinical endpoints in each trial. The heterogeneity of the trials and the discrepancies in caloric intake between enterally and parenterally fed patients are discussed. The hazards of each route of nutritional support are highlighted and the concept of 'nutritional bioavailability' in the context of acute pancreatitis is introduced. It is concluded that although there is evidence to support enteral feeding as the preferred option, both routes have a role.     

烧伤后早期应用中/长链甘油三酯对患者免疫功能的影响

目的　探讨烧伤后早期肠内喂养中链甘油三酯 (MCT) /长链甘油三酯 (LCT)对机体免疫功能的影响及其可能机制。　方法　选取 30例烧伤面积 >30 %TBSA的患者 ,随机分为两组 (每组 15例 )。F组 ,饲以含MCT/LCT的肠内营养制剂Fresubin 75 0MCT ;N组 ,饲以只含LCT的肠内营养制剂Nutrison。于伤后 2 4h内进行完全肠内营养支持 ,共持续 10d。于伤后 1、4、7、10d检测两组患者血浆白细胞介素 (IL) 2、IL 4、前列腺素 (PG)E2 及外周血T淋巴细胞转化率的改变。　结果　伤后各时相点F组患者血浆IL 2水平与N组相比 ,无明显差异 (P >0 .0 5 ) ;伤后 4dF组PGE2 水平较N组明显降低 (P <0 .0 1) ;伤后 4、7、10dF组IL 4水平及外周血T淋巴细胞转化率均明显高于N组 (P <0 .0 5～ 0 .0 1)。　结论　在改善烧伤后机体的免疫功能方面 ,含MCT/LCT的肠内营养制剂较单纯LCT制剂更具优势。     

早期肠内营养及其输注方式对大鼠重症急性胰腺炎病理和肠道功能的影响

目的:观察早期肠内营养及其不同输注方式对重症急性胰腺炎的影响。方法:采用胰管逆行注射建立大鼠重症急性胰腺炎(SAP)模型,假手术组用生理盐水,SAP组随机分为持续、间隙和未行肠内营养3个亚组(每组12只),假手术组同样分为3个亚组(每组8只)。各组于48 h后启动肠内营养,72 h后再次麻醉大鼠,收集组织及血液标本;检测指标包括肠道转运系数、血淀粉酶、器官细菌移位率、血清细胞因子TNF-α、胰腺病理评分及血浆D-乳酸等。结果:①、SAP后48h进行肠内营养并未加重胰腺炎;肠内营养组与未行肠内营养组在血淀粉酶、胰腺病理评分方面,差异无统计学意义(P>0.05);然而早期肠内营养可以促进肠蠕动,减少肠道细菌移位率,两组间在肠道转运系数、脏器细菌移位率及血清TNF-α水平方面,差异有统计学意义(P<0.05)。②、SAP行肠内营养的两种方式间,各项指标比较无显著差异。结论:SAP大鼠在早期行肠内营养是可行的,其可保持肠道生理的完整性、减少了脏器细菌移位率,但未改善预后;持续和间隙二种肠内营养输注方式间无显著差异。     

STUDIES ON NUTRITION AND PRECANCEROUS LESIONS OF THE ESOPHAGUS IN THE ADOLESCENTS

This paper reports the prevalence of chronic esophagitis and nutritional status among 538 young persons aged 15 to 26 years from the high risk area for esophageal cancer. Of these subjects, 166 were from households with history of esophageal cancer and 372 were from households without history of esophageal cancer. The Incidences of chronic esophagltis among male and female adolescents were 37. 6% and 36% respectively, which was significantly higher than those in the low risk area (17%). The frequency of chronic esophagltis in the adolescents in the households with history of esophageal cancer was aiso higher than in those In the households without history of esophageal cancer. The deficiencies of vitamins, especially of riboflavin and ascorbate, are prevalent and severe among these adolescents. Ascorbate deficiency Is correlated with the severity of the chronic esophagltis. These results indicate that chronic esophagltis may be involved in the natural history of esophageal carclnogenesis. Nutrient defic     

脂肪乳剂在重症急性胰腺炎营养治疗中的安全性及有效性分析

目的 :探讨脂肪乳剂应用于重症急性胰腺炎的安全性和有效性。　方法 :回顾分析重症急性胰腺炎病人肠外营养治疗期间 ,应用脂肪乳剂的影响。 74例重症急性胰腺炎病人行肠外营养治疗 ,按静脉营养液是否含脂肪乳剂分为脂乳组和非脂乳组。　结果 :脂乳组肠外营养治疗后清蛋白、前白蛋白改善显著 (P <0 .0 1 ) ,非脂乳组则无显著变化 (P >0 .0 5 ) ,脂乳组较非脂乳组改善明显 (P <0 .0 1 ) ;血清肌酐、尿素氮等在脂乳组治疗后下降明显 (P <0 .0 5 ) ,较非脂乳组改善显著 (P <0 .0 5 ) ;营养治疗结束后 ,脂乳组高血糖症状明显得到控制 (P <0 .0 1 ) ,而非脂乳组效果不佳 (P >0 .0 5 ) ,脂乳组优于非脂乳组 (P <0 .0 5 ) ;血淀粉酶均有下降 ,脂乳组未见异常增高。　结论 :重症急性胰腺炎病人输注脂肪乳剂安全有效 ,有助于恢复正氮平衡     

Microbial aspects of home enteral nutrition–a discussion

Factors that might contribute to the microbial contamination of enteral feeds prepared and administered in the home are reviewed and the significance of this contamination discussed. Numbers, types and sources of micro-organisms, and possible routes for contamination of home enteral feeds, are outlined and the role of cleaning and disinfection in reducing the microbial load is discussed. Some preliminary guidelines are suggested for the handling of enteral feeds in the home.     

腹部术后早期肠内营养支持的临床研究

为了研究手术后早期胃肠内营养支持的有效性及安全性，我们将腹部手术病人随机分为肠内与肠外营养两组。自术后第一天起给予等氮等热量的营养支持，持续8天。结果发现营养支持前后研究组病人前白蛋白、转铁蛋白水平较对照组明显升高且手术后第二日即达到正氮平衡，无明显的肝肾功能影响，消化道反应轻。认为术后早期营养支持是安全有效的。