Creatine and beta-hydroxy-beta-methylbutyrate (HMB) additively increase lean body mass and muscle strength during a weight-training program.

We investigated whether creatine (CR) and beta-hydroxy-beta-methylbutyrate (HMB) act by similar or different mechanisms to increase lean body mass (LBM) and strength in humans undergoing progressive resistance-exercise training. In this double-blind, 3-wk study, subjects (n = 40) were randomized to placebo (PL; n = 10), CR (20.0 g of CR/d for 7 d followed by 10.0 g of CR/d for 14 d; n = 11), HMB (3.0 g of HMB/d; n = 9), or CR-and-HMB (CR/HMB; n = 10) treatment groups. Over 3 wk, all subjects gained LBM, which was assessed by bioelectrical impedance analysis. The CR, HMB and CR/HMB groups gained 0.92, 0.39, and 1.54 kg of LBM, respectively, over the placebo group, with a significant effect with CR supplementation (main effect P = 0.05) and a trend with HMB supplementation (main effect P = 0.08). These effects were additive because there was no interaction between CR and HMB (CR x HMB main effect P = 0.73). Across all exercises, HMB, CR, and CR/HMB supplementation caused accumulative strength increases of 37.5, 39.1, and 51.9 kg, respectively, above the placebo group. The exercise-induced rise in serum creatine phosphokinase was markedly suppressed with HMB supplementation (main effect P = 0.01). However, CR supplementation antagonized the HMB effects on serum creatine phosphokinase (CR x HMB interactive effect P = 0.04). Urine urea nitrogen and plasma urea were not affected by CR supplementation, but both decreased with HMB supplementation (HMB effect P < 0.05), suggesting a nitrogen-sparing effect. In summary, CR and HMB can increase LBM and strength, and the effects are additive. Although not definitive, these results suggest that CR and HMB act by different mechanisms.     

Response of whole-body protein and urea turnover to exercise differs between patients with chronic obstructive pulmonary disease with and without emphysema

BACKGROUND: Exercise is known to improve physical capacity and muscle mass in patients with chronic obstructive pulmonary disease (COPD). However, recent evidence suggests that exercise may also negatively influence metabolism in COPD. OBJECTIVE: The objective was to investigate whether exercise influences whole-body protein metabolism differently in COPD patients and control subjects and to elucidate the effect of the specific underlying lung disease. DESIGN: Whole-body protein synthesis and breakdown and urea synthesis were measured by using stable-isotope methods in 14 male patients with severe COPD (forced expiratory volume in 1 s: 37 +/- 12% of predicted) and in 8 male control subjects during and after 20 min of exercise. Subjects were normal weight [body mass index (in kg/m2) of COPD patients and control subjects: 25.8 +/- 3.9 and 25.7 +/- 4.4, respectively]. The COPD group was selected to include patients with (Emph+, n = 7) and without (Emph-, n = 7) emphysema. Absolute workload was 35 +/- 5 W, corresponding to 17 +/- 2%, 33 +/- 9%, and 52 +/- 14% of the maximal obtained workload in the control, Emph-, and Emph+ groups. RESULTS: Exercise induced a 9% increase in protein synthesis and breakdown in the Emph- and control groups, which normalized postexercise. In the Emph+ group, protein turnover did not change significantly during exercise but decreased postexercise (+/- 10%). Exercise did not change net protein breakdown (protein breakdown - synthesis) or urea synthesis, except in the Emph+ group, which showed a 14% reduction in urea synthesis postexercise (P < 0.05). CONCLUSION: Low-intensity exercise suppresses whole-body protein and urea turnover in COPD patients with emphysema and needs to be considered when maximal anabolism is targeted through a combination of exercise and nutrition.     

The effects of beta-hydroxy-beta-methylbutyrate (HMB) and HMB/creatine supplementation on indices of health in highly trained athletes

This study aimed to investigate the effects of 6 wk oral supplementation of beta-hydroxy-beta-methylbutyrate (HMB) and HMB combined with creatine monohydrate (HMBCr) on indices of health in highly trained athletes. Elite, male rugby league players (n=28) were allocated to 1 of 3 groups: a control group (n=6), a HMB group (3 g/d; n=11), or a HMBCr group (3 g/day HMB, 3 g/d Cr; n=11). Testing prior to, and immediately following, supplementation included a full blood count, plasma testosterone and cortisol, blood electrolytes, lipids, urea and glucose, sperm count and motility, and assessment of psychological state. A 3 x 2 factorial ANOVA revealed no effect of HMB or HMBCr on any of the measured parameters except minor changes in blood bicarbonate and blood monocyte and lymphocyte counts. Blood bicarbonate was significantly decreased in the HMB post-supplementation sample compared to the control and HMBCr groups. Blood monocyte and lymphocyte counts showed no within-group changes for HMB or HMBCr supplementation but were significantly different from the control. However, the majority of these readings remained within normal range. HMB and HMBCr were concluded to have no adverse effects on the parameters evaluated in this study when taken orally by highly trained male athletes over a 6-wk period.     

Biochemical assessment of nutritional status in patients with chronic obstructive pulmonary disease and acute respiratory failure on admission to an intensive care unit

Although chronic obstructive pulmonary disease (COPD) is associated with weight loss and malnutrition, there is a paucity of relevant data on COPD patients with acute respiratory failure (ARF). We studied 30 consecutive patients on the day of admission to our intensive care unit for ARF. In addition to a clinical work-up, the following biochemical parameters were determined: markers of nutritional status (albumin - ALB, transferrin - TRF, transthyretin - TTR, retinol binding protein - RBP, fibronectin), inflammation (C-reactive protein - CRP, alpha(1) glycoprotein acid - alpha(1)GPA) and catabolism (plasma phenylalanine - PHE, urinary 3-methylhistidine - 3-MH). Values were expressed as mean +/- SD and compared to those of 10 healthy subjects matched for age. COPD-ARF patients had a poor protein status (ALB = 30 +/- 5 vs 42 +/- 3 g.l(-1); TTR = 118 +/- 75 vs 251 +/- 43 mg.l(-1); RBP = 23 +/- 12 vs 46 +/- 8 mg.l(-1); p < 0.001), were hypercatabolic (3-MH Cr = 31 +/- 12 vs 22 +/- 7 mumol.mmol Cr (-1); PHE = 62 +/- 27 vs 46 +/- 10 mumol.l(-1); p < 0.001) and inflamed (CRP = 68 +/- 50 vs 12 +/- 5 mg.l(-1); alpha(1)GPA = 1.2 +/- 0.4 vs 0.5 +/- 0.1 g.l(-1); p < 0.001). Severity of the disease correlated with short half-life proteins and protein catabolism markers but not with inflammation markers. Considering ALB, TTR, RBP, the 3- MH Cr ratio and PHE values, the 30 COPD patients fell into 3 groups: chronic malnutrition (n = 7), acute malnutrition (n = 2), and acute + chronic malnutrition (n = 18). 3 patients had normal nutritional status. We conclude that an assessment of nutritional status at admission to intensive care units could contribute towards a rapid formulation of specific nutritional therapy.     

慢性阻塞性肺疾病急性加重期患者血清C-反应蛋白指标与肺功能的相关性研究

目的研究慢性阻塞性肺疾病急性加重期(AECOPD)患者血清C-反应蛋白(CRP)指标与肺功能相关性。方法选择2017年3月-2018年3月在本院接受诊治的102例AECOPD患者(AECOPD组),另选择同期101例缓解期患者为COPD缓解期组,选择103例健康体检者为对照组;对比3组人员的血清CRP表达水平、肺功能情况,分析血清CRP与AECOPD组患者肺功能的相关性。结果AECOPD组患者的血清CRP表达水平显著高于COPD缓解期组、对照组(P<0.05),且COPD缓解期组高于对照组(P<0.05);AECOPD组患者的肺功能指标FEV1、FEV1/FVC水平均显著低于对照组(P<0.05);AECOPD组患者的血清CRP与肺功能指标FEV1、FEV1/FVC均呈负性相关(r值分别为-0.387、-0.398,P<0.05)。结论AECOPD患者血清CRP指标与肺功能(PEF、FEV1、FEV1/FVC)存在相关性,能反映COPD患者病情严重程度,故血清CRP指标检测能为诊断AECOPD患者的肺功能、评估预后效果提供信息。     

Early Fish Oil Supplementation and Organ Failure in Patients With Septic Shock From Abdominal Infections

Background: Fish oil (FO) has immunomodulating effects and may improve organ function and outcome in critically ill patients. This retrospective, propensity‐matched cohort study investigates the effects of early intravenous FO supplementation on organ failure in patients with septic shock from abdominal infection. Methods: A medical database was retrospectively searched for critically ill patients admitted because of septic shock from abdominal infection (n = 194). Demographic, clinical, and laboratory data; FO supplementation (10 g/d) (n = 42); rate, degree, and number of organ failures assessed by the Sequential Organ Failure Assessment (SOFA) score; and secondary outcome variables were recorded. A propensity score‐based model was used to establish 2 comparable groups (FO, n = 29; control, n = 29). Mann‐Whitney rank sum test, Fisher exact test, and logistic regression analyses were used to compare variables between groups. Results: There were no differences in the rate of single organ failures, the maximum SOFA score (median [interquartile range (IQR)], 12 [8‐15] vs 11 [9‐14]; P = .99), or the number of organ failures (median [IQR], 2 [1‐3] vs 2 [1‐3]; P = .54] between patients receiving FO supplementation and those not receiving supplementation. There were no group differences in the maximum C‐reactive protein levels (P = .1), duration of mechanical ventilation (P = .65) or hemofiltration (P = .21), intensive care unit–acquired infections, intensive care unit length of stay (P = .59), and intensive care unit (P = 1) or hospital mortality (P = 1). Conclusions: Early intravenous FO may not decrease the number and degree of organ failures in patients with septic shock from abdominal infection. Future trials are needed before FO supplementation in septic shock from abdominal infection can be recommended.     

肠内营养支持对慢性阻塞性肺疾病机械通气患者免疫功能的影响

目的探讨慢性阻塞性肺疾病并发呼吸衰竭患者机械通气时早期肠内营养支持治疗对患者免疫功能的影响。方法采取随机、对照试验方法,27例患者随机分为肠内营养治疗组(EN组)和对照组,治疗7天。观察治疗前后血清白蛋白,免疫球蛋白IgA、IgG、IgM,血液淋巴细胞总数(TLC)及T细胞亚群等的变化。结果EN组血淋巴细胞总数、血清白蛋白、IgA、IgG浓度、CD3(%)、CD4(%)及CD4/CD8较治疗前显著升高(P<0.05,P<0.01)。治疗后两组比较,EN组血淋巴细胞总数、血清白蛋白、IgA、IgG浓度、CD3(%)、CD4(%)及CD4/CD8显著高于对照组(P<0.05,P<0.001)。结论对于慢性阻塞性肺疾病机械通气患者,及时合理的肠内营养支持治疗有助于改善机体的免疫功能,提高综合治疗的疗效。     

Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients

Chronic Obstructive Pulmonary Disease (COPD) is a public health problem worldwide. Increased energy and protein needs, decreased energy and protein intake are common in COPD patients. Adequate intake is essential to improve pulmonary function and immune system, prevention of weight loss and maintaining muscle mass and strength. Assessment of energy and protein intake and its relationship with pulmonary function in COPD patients was performed in this study. The study group included 63 COPD patients. For all subjects, evaluation of energy and protein intake by Food Frequency Questionnaire (FFQ) and 24-hour recall, spirometry for measuring pulmonary function and determining disease severity were performed. The subjects were divided into three groups based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. Relationship between energy and protein intake with pulmonary function was assessed. Energy and protein intake were lower than the calculated energy and protein demand for all groups. Significant relationship was found between the amount of protein intake extrapolated from food frequency questionnaire with Forced Vital Capacity (FVC) (r=0.2, P=0.02) and Vital Capacity (VC) (r=0.3, P=0.008). The results of the study suggest that accurate evaluation of protein and energy intake and requirements should be included in the goals of medical treatment of COPD patients.     

Vitamin E and vitamin C supplementation in patients with chronic obstructive pulmonary disease

The purpose of this study was to determine whether vitamin E or vitamin C supplementation alters the DNA damage of whole blood white blood cells (WBC) in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were recruited in this randomized and placebo-controlled study. Patients were randomly assigned to placebo (n = 8), 400 mg/day vitamin E (E400, n = 9), 200 mg/day vitamin E (E200, n = 9), or 250 mg/day vitamin C (C250, n = 9) for 12 weeks. The results showed that vitamin E or C supplementation did not significantly change the mean level of endogenous DNA breakages. Whereas, after 12 weeks of vitamin supplementation, the H2O2-induced DNA breakages were significantly suppressed by 45%, 59%, and 52%, respectively, in E400, E250 and C250 groups (p < 0.05). In addition, neither the level of thiobarbituric acid-reactive substances (TBARS) nor spirometric parameters were significantly changed after 12 weeks of supplementation. In conclusion, vitamin E or C supplementation for 12 weeks may improve the resistance of DNA in whole blood WBC against oxidative challenge, although more research is needed to demonstrate the beneficial effect on slowing the decline of lung function in patients with COPD.     

Greater whole-body myofibrillar protein breakdown in cachectic patients with chronic obstructive pulmonary disease

BACKGROUND: Experimental studies indicate that greater skeletal muscle protein breakdown is a trigger for the cachexia that often is prevalent in chronic obstructive pulmonary disease (COPD). OBJECTIVE: We compared myofibrillar protein breakdown (MPB) with whole-body (WB) protein breakdown (PB) in 9 cachectic COPD patients [x +/- SEM forced expiratory volume in 1 s (FEV(1)): 48 +/- 4% of predicted], 7 noncachectic COPD patients (FEV(1): 53 +/- 5% of predicted), and 7 age-matched healthy control subjects, who were matched by body mass index with the noncachectic patients. DESIGN: After the subjects fasted overnight (10 h) and discontinued the maintenance medication, a primed constant and continuous infusion protocol was used to infuse L-[ring-(2)H(5)]-phenylalanine and L-[ring-(2)H(2)]-tyrosine to measure WB protein turnover and L-[(2)H(3)]-3-methylhistidine to measure WB MPB. Three arterialized venous blood samples were taken between 80 and 90 min of infusion to measure amino acid concentrations and tracer enrichments. RESULTS: Body composition, WB protein turnover, and WB MPB did not differ significantly between the noncachectic COPD and control subjects. Cachectic COPD patients had lower fat mass and fat-free mass values (both: P < 0.01) than did the noncachectic COPD patients. WB MPB was significantly (P < 0.05) higher in the cachectic COPD group (18 +/- 3 nmol . kg(-1) . min(-1)) than in the combined control and noncachectic COPD groups (10 +/- 1 nmol . kg(-1) . min(-1)), but WB protein turnover did not differ significantly between the groups. Correlations with fat-free mass were significant (P < 0.05) for plasma glutamate and branched-chain amino acids, and that for WB MPB trended toward significance (P = 0.07). CONCLUSION: Cachexia in clinically stable patients with moderate COPD is characterized by increased WB MPB, which indicates that myofibrillar protein wasting is an important target for nutritional and pharmacologic modulation.     

强化呼吸道护理联合延续性护理对重度COPD患者肺功能和生活质量的影响

目的探讨强化呼吸道护理联合延续性护理对重度慢性阻塞性肺疾病(COPD)患者肺功能和生活质量的影响。方法82例重度COPD患者随机分为观察组(强化呼吸道护理+延续性护理)与对照组(常规护理),比较两组的肺功能、临床症状、生活质量以及CHE、Scr水平。结果干预后,观察组的FEV₁、MMEF、FVC均高于对照组(P<0.05)。干预后,观察组的SGRQ评分、Scr水平均低于对照组,SF-36评分、CHE水平均高于对照组(P<0.05)。结论强化呼吸道护理联合延续性护理可改善重度COPD患者的肺功能,提升生活质量,可能与调节CHE、Scr水平有关。     

主动有效循环康复疗法对改善慢性阻塞性肺气肿心肺功能的影响

目的调查呼吸控制训练配合肢体运动训练对慢性阻塞性肺病患者心肺功能的影响。方法入选68例患者随机分为两组,治疗组38例,给与药物治疗联合主动循环及四肢训练,每大干预二次每次10min;对照组30例,未接受上述康复治疗。所有患者治疗20天,前后均进行六分钟步行测试、血气分析及肺功能测定。结果经过治疗后,治疗组各项指标较对照组,有非常显著的增加。结论主动循环技术配合上下肢的运动训练对改善患者的肺功能有明显的效果。     

团体认知行为疗法对老年慢性阻塞性肺疾病患者的干预效果研究

目的探讨团体认知行为疗法对老年慢性阻塞性肺疾病(COPD)患者焦虑、抑郁、自我效能及生活质量的干预效果.方法采用方便抽样的方法,选取2017年9月至2018年9月山西省某三级甲等医院呼吸与危重症医学科收治的276例老年COPD患者为研究对象,按入院时间将患者分为实验组(n=132)和对照组(n=144),对照组接受常规护理和健康教育,实验组在常规护理基础上增加团体认知行为干预,在干预前、干预后、干预后1个月使用抑郁自评量表、焦虑自评量表、一般自我效能量表、生活质量量表评价干预效果.结果干预前两组患者焦虑自评量表、抑郁自评量表、一般自我效能量表及生活质量量表评分差异均无统计学意义(P>0.05);干预后、干预后1个月两组患者焦虑自评量表、抑郁自评量表、生活质量量表、一般自我效能量表评分均优于干预前,且差异均具有统计学意义(P<0.05).结论团体认知行为疗法可缓解老年COPD患者的焦虑、抑郁症状,提升自我效能感,改善其生活质量.本研究为老年COPD患者心理护理方法的改进提供了科学依据,同时为其他慢病人群的护理管理和健康教育提供参考.     

Effect of selenium supplementation on biochemical markers and outcome in critically ill patients

BACKGROUND & AIMS: This study aimed to assess the effect of high dose selenium (Se) supplementation on Se status in blood, oxidative stress, thyroid function and possible effects on requirement for renal replacement therapy (RRT) in severely septic patients admitted to the intensive care unit (ICU). METHODS: This prospective single-centre study was carried out in 40 septic ICU patients who were randomized to high dose Se (Se+ group, N=18 (474, 316, 158 microg/day), each for 3 consecutive days followed by a standard dose of 31.6 microg/day of Se given as sodium selenite whereas the control group (Se-, N=22) received only the standard dose of Se. Plasma Se, glutathione peroxidase (GSH-Px), F2 isoprostanes, thyroid function tests (total T4 and total T3), C-reactive protein (CRP) and red blood cell (RBC) GSH-Px were estimated on day 0, 3, 7, 14. RESULTS: In the Se+ group, plasma Se increased by day 3 and 7 (P<0.0001) and day 14 (P=0.02), plasma GSH-Px increased by day 3 and 7 (P=0.01) as compared to Se- group. There was a significant negative correlation between plasma Se and SOFA (sepsis related organ failure assessment) (r=-0.36, P=0.03) along with low plasma Se and high CRP at the time of admission. Requirement for renal replacement therapy was not significantly different between the groups. CONCLUSION: Although high dose Se supplementation increased plasma Se and GSH-Px activity, it did not reduce oxidative damage or the requirement for RRT. Se levels in blood are influenced by redistribution and severity of illness and therefore should be interpreted with caution.     

Metabolic effects of glutamine and glutamate ingestion in healthy subjects and in persons with chronic obstructive pulmonary disease

BACKGROUND: Because low plasma glutamate and glutamine concentrations are often seen in chronic obstructive pulmonary disease (COPD), glutamine or glutamate supplementation may be a good option for preventing further metabolic disturbances in COPD patients. However, the metabolic effects of glutamate supplementation have never been compared with those of glutamine supplementation. OBJECTIVE: We compared the metabolic effects of repeated ingestion of glutamine and glutamate in COPD patients and in age-matched healthy control subjects. DESIGN: On 3 d separated by intervals of > or = 2 d, a protocol of primed constant and continuous infusion of [2H5]phenylalanine and [2H2]tyrosine was performed for 3 h in 8 stable male COPD patients and 8 healthy control subjects. After a 90-min tracer infusion, all subjects ingested a glutamine or glutamate drink or the same amount of water every 20 min for 80 min. Blood samples were taken at the end of the postabsorptive and ingestion periods to test for effects on plasma amino acid and substrate concentrations and whole-body protein turnover. RESULTS: Glutamate but not glutamine ingestion resulted in higher plasma ornithine concentrations than did water ingestion (P < 0.01). The change in plasma arginine, citrulline, and urea concentrations was significantly (P < 0.01) higher after glutamine ingestion than after water or glutamate ingestion. Whole-body protein turnover decreased overall, independent of the drink consumed. CONCLUSIONS: Repeated ingestion of glutamine and glutamate resulted in different effects on the plasma amino acid concentration. In both groups, ingestion of glutamine but not of glutamate increased the plasma concentrations of citrulline and arginine, substrates produced in the intestine and the liver.     

戒烟对慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的探讨戒烟对慢性阻塞性肺疾病(COPD)患者肺功能和生活质量的影响。方法对2008年12月-2009年12月在承德医学院附属医院呼吸科接受诊治的吸烟的COPD患者实施医生"劝导戒烟干预",干预时间为2个月。根据戒烟成功与否,将其分为戒烟组(36人)、吸烟组(28人),同期接受诊治的有吸烟史但已戒烟2年以上的COPD患者为曾吸烟组(26人),每隔3个月检测其第一秒呼气容积(FEV1)、用力肺活量(FVC)、呼气峰值流速(PEF),12个月后采用CAT评定量表对其生活质量进行测定。结果随访3个月后,戒烟组一氧化碳血红蛋白结合百分比(COHb%)较入组(0个月)时显著降低(P<0.05)。FEV1、FVC在各时间点戒烟组和吸烟组均高于曾吸烟组,差异有统计学意义(P<0.05)。随访12个月时,戒烟组FEV1、FVC均高于吸烟组,但差异无统计学意义;PEF较0个月时增高37ml,差异有统计学意义(P<0.05)。CAT显示,吸烟组痰量高于戒烟组和曾吸烟组(P<0.05)。结论戒烟可以提高COPD患者FEV1、FVC、PEF及其生活质量。     

Vitamin B6 supplementation increases immune responses in critically ill patients

OBJECTIVE: To investigate whether vitamin B6 supplementation has a beneficial effect on immune responses in critically ill patients. DESIGN: A single-blind intervention study. SETTING: The study was performed at the Taichung Veterans General Hospital, the central part of Taiwan. SUBJECTS: Fifty-one subjects who stayed over 14 days in the intensive care unit completed the study. Subjects were not treated with any vitamin supplement before the intervention. INTERVENTIONS: Patients were randomly assigned to one of three groups, control (n = 20), a daily injection of 50 mg vitamin B-6 (B6 -50, n=15), or 100 mg vitamin B-6 (B6 -100, n = 16) for 14 days. MAIN OUTCOME MEASURES: Plasma pyridoxal 5'-phosphate (PLP), pyridoxal (PL), 4-pyridoxic acid (4-PA), erythrocyte alanine (EALT-AC) and aspartate (EAST-AC) aminotransaminase activity coefficient, and urinary 4-PA were measured. The levels of serum albumin, hemoglobin, hematocrit, high-sensitivity C-reactive protein (hs-CRP) and immune responses (white blood cell, neutrophils, total lymphocytes count (TLC), T- (CD3) and B-(CD19) lymphocytes, T-helper (CD4) and suppressor (CD8) cells) were determined. RESULTS: Plasma PLP, PL, 4-PA and urinary 4-PA concentrations significantly increased in two treated groups. T-lymphocyte and T-helper cell numbers and the percentage of T-suppressor cell significantly increased on day 14 in the B6 -50 group. Total lymphocyte count, T-helper and T-suppressor cell numbers, the percentage of T-lymphocyte cells and T-suppressors significantly increased in the B6 -100 group at the 14th day. There were no significant changes with respect to immune responses in the control group over 14 days. CONCLUSIONS: A large dose of vitamin B6 supplementation (50 or 100 mg/day) could compensate for the lack of responsiveness of plasma PLP to vitamin B6 intake, and further increase immune response of critically ill patients. SPONSORSHIP: This study was supported by the National Science Council, Taiwan, Republic of China (NSC-92-2320-B-040-026).     

中药排痰液防治呼吸机相关性肺炎的临床研究

目的探讨中药排痰液在防治呼吸机相关性肺炎（VAP）中的作用。方法采用随机双盲安慰剂对照研究方法,依据纳入和排除标准选取2011—2014年入住某院重症监护病房（ICU）且行机械通气的呼吸衰竭患者,分为治疗组和对照组。治疗组在常规治疗的基础上同时加用排痰液,对照组在常规治疗基础上加用排痰液模拟剂,比较两组患者VAP的发病率、治疗有效率、发生时间及预后情况。结果共监测139例患者,其中治疗组70例,对照组69例。治疗组发生VAP 26例,发病率为37.14%,对照组发生VAP 40例,发病率为57.97%;患者发生VAP的时间：治疗组平均为入ICU后（76±3.2）h,对照组为（45±8.9）h;治疗组VAP患者治疗有效率为88.46%,对照组为55.00%;两组患者VAP的发病率、发生时间、治疗有效率比较,差异均有统计学意义（均P＜0.05）。两组患者治疗前后血常规、肝肾功能、尿常规、粪便常规、ECG结果比较,差异均无统计学意义（均P＞0.05）。结论应用中药排痰液对机械通气患者进行干预,可降低VAP发病率,对患者疾病及肺部感染的预后均具有积极作用。     

Year‐long Changes in Protein Metabolism in Elderly Men and Women Supplemented With a Nutrition Cocktail of β‐Hydroxy‐β‐methylbutyrate (HMB), L‐Arginine,and L‐Lysine

Background: A major contributing factor to the loss of mobility in elderly people is the gradual and continuous loss of lean body mass. Objectives: To determine whether supplementation of an amino acid cocktail daily for 1 year could improve the age‐associated changes in protein turnover and lean body mass in elderly people. Design: Elderly (76± 1.6 years) women (n = 39) and men (n = 38) were recruited for a double‐blinded controlled study. Study participants were randomly assigned to either an isonitrogenous control‐supplement (n = 37) or a treatment‐supplement (HMB/Arg/Lys) consisting of β‐hydroxy‐β‐methylbutyrate, L‐arginine, and L‐lysine (n = 40) for the 1‐year study. Lean tissue mass was measured using both bioelectrical‐impedance analysis (BIA) and dual energy x‐ray absorptiometry (DXA). Rates of whole‐body protein turnover were estimated using primed/intermittent oral doses of ¹⁵N‐glycine. Results: In subjects taking the HMB/Arg/Lys supplement, lean tissue increased over the year of study while in the control group, lean tissue did not change. Compared with control, HMB/Arg/Lys increased body cell mass (BIA) by 1.6% (P = .002) and lean mass (DXA) by 1.2% (P = .05). The rates of protein turnover were significantly increased 8% and 12% in the HMB/Arg/Lys‐supplemented group while rates of protein turnover decreased 11% and 9% in the control‐supplemented subjects (P < .01), at 3 and 12 months, respectively. Conclusions: Consumption of a simple amino acid‐related cocktail increased protein turnover and lean tissue in elderly individuals in a year‐long study.     

慢性阻塞性肺疾病患者超敏C-反应蛋白检测的临床意义

目的探讨慢性阻塞性肺疾病(COPD)患者血清超敏C-反应蛋白(hs-CRP)测定的临床意义。方法选择2008年1月～2010年2月在我院内科住院的COPD患者72例及健康对照者35例,分别对COPD组及对照组进行血清hs-CRP水平的测定。结果 COPD患者急性加重期和治疗稳定期血清hs-CRP水平均显著高于对照组(P<0.01),而COPD治疗稳定期血清hs-CRP水平则较急性加重期明显降低(P<0.01),但与对照组比较仍明显升高(P<0.01)。结论血清hs-CRP水平检测可以作为评估COPD病情、观察治疗效果的一个敏感指标。