关于加强临床营养教育的若干建议

临床营养学作为一门重要的综合学科,已经成为临床治疗中重要的组成部分.临床营养教育是依靠临床营养学这门课程,为培养更加专业的临床营养学人才开展的一门新的教育课程.目前我国的临床营养学教育现状不容乐观,医学院校对临床营养学课程重视不够,在专业教学内容和课程建设方面均无法满足社会需求.通过借鉴国外营养教育制度,并结合国内临床营养人才需求现状,应注意不同专业的医学生在日后工作对临床营养的需求,逐渐开展临床营养学必修课教学,加强营养在临床应用的实践教学;并完善毕业后教育体系,对所有规范化培训的医师增加要求到临床营养科轮转培训且不少于1个月,对非临床医学的营养师要求到临床科室轮转至少2个月.提高进修临床医师继续教育及培训营养支持治疗的认识.临床营养专业的教学改革任重而道远,仍需我们不断完善理论体系,积极践行学科理论和知识,满足我国临床营养的人才需求,使社会认识到临床营养对促进健康、预防和治疗疾病的重要性.     

谷氨酰胺和ω—3多不饱和脂肪酸对大鼠肠道缺血再灌注损伤时肠道通透性和肺细胞凋亡的影响

目的研究大鼠肠道缺血再灌注损伤时,肠淋巴管结扎和不同肠内营养对肠道通透性、系统炎性反应和肺损伤的影响。方法SPF级雄性大鼠胃造瘘术后随机分为正常饮食组、普通肠内营养组、谷氨酰胺（Gin）肠内营养组、ω-3多不饱和脂肪酸（ω-3PUFA）肠内营养组和假手术组．前4组根据淋巴管是否结扎又各分为结扎和不结扎组．共9组．每组8只。所有肠内营养组均经胃造瘘给予等氮（1．8gN·kg-1·d-1）等热卡（1046kJ·kg-1·d-1）的营养支持,7d后除假手术组外其他8组实施肠道缺血60min,结扎组在缺血前同时进行淋巴管结扎：然后继续原营养再灌注3d。在胃造瘘术后第5、7和9天测定肠道通透性（尿中乳果糖／甘露醇浓度值．L／M）：术后第11天取血检测血清二胺氧化酶、内毒素、细胞因子及ALT、AST的水平：取小肠黏膜检测黏膜厚度和绒毛高度;取肺组织检测髓过氧化物酶（MPO）、NO和NO合酶（NOS）浓度及细胞凋亡指数。结果肠道缺血60min可引起肠道损伤;缺血后第1天,各组L／M均显著增加（P〈0．05）;缺血后第3天L／M明显下降（P〈0．05）,其中Gin肠内营养组和（ω-3PUFA肠内营养组已恢复至接近缺血前水平（P〉0．05）．且淋巴管结扎组L／M明显低于不结扎组（P〈0．05）。在肠道缺血再灌注损伤时．与普通肠内营养和正常饮食组比较,Gln肠内营养组和ω-3PUFA肠内营养组血清内毒素和细胞因子水平显著降低．小肠黏膜厚度和绒毛高度明显增高（P〈0．05）;且淋巴管结扎后效果更为明显（P〈0．05）。予以Gln或（ω-3PUFA肠内营养以及淋巴管结扎后,肺组织MPO、NO、NOS及细胞凋亡指数都有不同程度的下降（P〈0．05）。结论肠道缺血再灌注损伤引起的肺等远隔组织损伤及系统性炎性反应可能与肠淋巴液中的某些因子有关．阻断“肠-淋巴途径”和（或）补充Gln和ω-3PUFA的肠内营养可以降低缺血引起的肠道通透性增加．降低循环内毒素水平．增加肠黏膜的厚度．减轻系统炎性反应和肺组织损伤。     

The effects of n-3 PUFA and intestinal lymph drainage on high-mobility group box 1 and Toll-like receptor 4 mRNA in rats with intestinal ischaemia-reperfusion injury

The aim of the present study was to investigate the impacts of n-3 PUFA and lymph drainage (D) on intestinal ischaemia-reperfusion (I/R) injury in rats. A total of forty-eight Sprague-Dawley male rats were randomly divided into three groups (n 16): normal diet (N), enteral nutrition (EN) and EN plus n-3 PUFA. Each group was further divided into lymph drainage (I/R+D) and non-drainage (I/R) sub-groups (n 8). After 5?d with different nutrition regimens, the rats were subjected to 60?min ischaemia by clamping the superior mesenteric artery, followed by 120?min reperfusion. At the same time, the rats in the I/R+D sub-groups were treated with intestinal lymph drainage for 180?min. Organs were harvested and we detected the cytokine, endotoxin, and expression of Toll-like receptor (TLR) 4 mRNA and its endogenous ligand high-mobility group box 1 (HMGB1). We found that the serum levels of HMGB1, inflammatory cytokine and endotoxin in the three I/R+D sub-groups were significantly lower than those in the N (I/R) and EN (I/R) sub-groups (P?相似文献   

Evidence of zinc deficiency in competitive swimmers

ObjectiveThe aim of this study was to assess the nutritional zinc (Zn) status of elite swimmers during different training periods.MethodsA longitudinal paired study was performed at the University of Sao Paulo in eight male swimmers 18 to 25 y old who had been swimming competitively at the state and national levels for at least 5 y. The swimmers were evaluated over a total period of 14 wk: before the basic and specific preparatory period (BSPP-baseline), at the end of the basic and specific preparatory period (post-BSPP), and at the end of the polishing period (PP). Levels of Zn were determined in the plasma, erythrocyte, urine, and saliva by atomic absorption spectrophotometry. Anthropometric measurements and a 3-d food record were also evaluated.ResultsThe median plasma Zn concentration was below the reference value in all training periods (BSPP-baseline 59 μg/dL, post-BSPP 55.9 μg/dL, after PP 58.8 μg/dL, P > 0.05), as were threshold values for erythrocytes (BSPP-baseline 36.5 μg of Zn/g of hemoglobin, post-BSPP 42 μg of Zn/g of hemoglobin, after PP 40.7 μg of Zn/g of hemoglobin, P > 0.05), urinary Zn (BSPP-baseline 280 μg/24 h, post-BSPP 337 μg/24 h, after PP 284 μg/24 h, P > 0.05), and salivary Zn (BSPP-baseline 66.1 μg/L, post-BSPP 54.1 μg/L, after PP 79.7 μg/L, P > 0.05). Salivary Zn did not correlate with plasma and erythrocyte Zn levels.ConclusionThe results suggest that the elite swimmers studied presented a possible Zn deficiency and that salivary Zn was not adequate to evaluate the Zn nutritional status.     

Similar Liver Function Abnormalities Occur in Patients Receiving Glucose-Based and Lipid-Based Parenteral Nutrition

Biochemical and histopathological evidence of hepatic dysfunction has been associated with the use of glucose-based total parenteral nutrition (TPN). In the present study liver indices, SGOT, SGPT, alkaline phosphatase, and bilirubin, were analyzed retrospectively during the course of total parenteral nutrition in 40 patients; 15 patients received a glucose-based system and 25 received a lipid-based system. Transient elevations in at least one of the measured parameters were found in a majority of patients receiving either system. These data confirm previous reports of liver function test abnormalities in patients receiving glucose-based total parentual nutrition. However, in contrast to results from prior studies, these derangements also were observed during the administration of a nutritional support system using lipids as the primary source of calories.     

Malnutrition Diagnoses in Hospitalized Patients

Malnutrition is common among hospitalized patients in the United States, and its coded prevalence is increasing. Malnutrition is known to be associated with increased morbidity, mortality and healthcare costs. Although national data indicate that the number of malnutrition diagnoses among hospital discharges has been steadily rising, an in‐depth examination of the demographic and clinical characteristics of these patients has not been conducted. We examined data from the 2010 Healthcare Cost and Utilization Project (HCUP), the most recent nationally‐representative data describing U.S. hospital discharges. Using ICD‐9 codes, we constructed a composite variable indicating a diagnosis of malnutrition. Based on our definition, 3.2% of all U.S. hospital discharges in 2010 had this diagnosis. Relative to patients without a malnutrition diagnosis, those with the diagnosis were older, had longer lengths of stay and incurred higher costs. These patients were more likely to have 27 of 29 comorbidities assessed in HCUP. Finally, discharge to home care was twice as common among malnourished patients, and a discharge of death was more than 5 times as common among patients with a malnutrition diagnosis. Taken together, these nationally representative, cross‐sectional data indicate that hospitalized patients discharged with a diagnosis of malnutrition are older and sicker and their inpatient care is more expensive than their counterparts without this diagnosis.     

建立大鼠持续性肠内营养的输注模型和淋巴液引流方法

目的建立大鼠持续性肠内营养的输注模型和淋巴液引流的方法。方法大鼠行胃造口后游离硅胶管至背部,通过swivel管连接到微量输液泵。5 d持续匀速的输入肠内营养后开腹并游离肠淋巴干,大鼠在肠道缺血60 min再灌注120 min同时潜行插入硅胶管收集淋巴液。结果第一次胃造口术后大鼠持续肠内营养输注通畅,未出现死亡或并发症状。第二次手术时通过较简单的方法可以获取淋巴液,成功率较高,可达90%以上。结论大鼠持续肠内营养输注模型的建立,为研究营养物质的作用搭建了一个平台;通过较简单的方法获取淋巴液可以为研究淋巴液的成分提供便利。     

实时定量PCR检测人全血标本中烟曲霉基因组载量的方法及临床应用

目的建立实时定量PCR（RQ-PCR）快速检测人全血标本中烟曲霉基因组载量的方法及进行初步临床应用。方法基于烟曲霉多拷贝基因ITSl-5．8S基因设计引物和TaqMan探针,用QIAamp^DNA Blood Mini Kit提取烟曲霉基因组DNA,建立20μlRQ-PCR反应体系,对含有不同载量烟曲霉基因组的模拟人全血标本和66份外科发热患者全血标本进行烟曲霉基因组的定量检测。结果检测限为10^-1基因组／μl上机待测液（即约78CFU／ml全血）;检测特异度和灵敏度分别为94．25％和99．04％,阳性预告值和阴性预告值分别为97．63％和97．62％;测定结果的平均相对误差为（3．67±13．19）％;批内及批间平均重复性变异系数分别为（12．38±1．53）％和（16．27±2．72）％;人血标本中烟曲霉基因组平均回收率为（107．81±25．92）％,回收率平均变异系数为（26．24±5．62）％。66份外科发热患者血标本中未检测出烟曲霉基因组。结论RQ-PCR可以快速、特异、灵敏地定量检测人血标本中烟曲霉基因组的载量,且有着较好的准确度与精密度。本研究外科发热患者血中未检测到烟曲霉基因组。     

心可舒片对社区2型糖尿病患者血液流变学影响的研究

目的:探讨心可舒片对社区2型糖尿病患者血液流变学的影响。方法:北京西城区疾病防治中心(centers fordisease control,CDC)及西城区各社区服务站120例符合研究条件的II型糖尿病患者纳入本研究。分为治疗组(心可舒片)及对照组,入组后继续给予降糖药物或胰岛素降糖、口服降压药物降压治疗,治疗组在此基础上加用心可舒片治疗8周,治疗组给予安慰剂治疗。分别观测入组前和治疗后两组的血液流变学指标(全血黏度1,全血黏度5,全血黏度30,全血黏度200,全血还原黏度中切,全血还原黏度高切,红细胞变形指数,红细胞电泳指数,血沉,血沉方程K值)、血糖、血脂以及糖化血红蛋白。结果:①治疗组在心可舒片治疗前较心可舒片治疗后的血液流变学指标(全血黏度1,全血黏度5,全血黏度30,全血黏度200,全血还原黏度中切,全血还原黏度高切,红细胞变形指数,红细胞电泳指数,血沉,血沉方程K值)有好转趋势(P<0.05)。②心可舒片治疗8周后,治疗组较对照组的两项血液流变学指标(全血还原黏度中切,血沉)有所好转(P<0.05)。结论:心可舒片能改善II型糖尿病患者血液流变学,进而可以有效地防止和减少糖尿病并发症的发生以及提高...