稳定期慢性阻塞性肺疾病和肺心病患者营养状况分析

目的 通过对稳定期COPD和肺心病患营养状况的分析，为开展有针对性的饮食干预治疗提供参考依据。方法 采用24h膳食回忆法，并进行营养测量、生化检验和肺通气功能检查，及其与营养指标的相关性分析。结果 88名患热能和蛋白质、脂肪等营养素的摄入明显不足；碳水化合物摄入偏高。21．59％体重偏低。营养及生化指标均与肺通气功能存在不同程度的正相关。纬论 热能和多种营养素的摄入不足是导致营养不良的重要原因之一。     

心电图检查结果正常的冠心病患者冠脉病变特点分析

目的:观察研究心电图检查结果正常的冠心病患者冠脉病变特点。方法:选择41例心电图检查正常的冠心病患者作为A组,另选择同时期心电图检查结果显示存在异常的41例冠心病患者作为B组,对两组患者诊疗资料进行对比分析,总结冠脉病变特点。结果:A组出现稳定性心绞痛几率明显高于B组(P<0.05)。比较两组ST段抬高型心肌梗死发生率,A组明显低于B组(P<0.05)。A组患者多为单支病变,与B组相比差异明显(P<0.05)。结论:心电图检查结果未见异常的冠心病患者多为单支病变,狭窄程度较轻,更易出现稳定性心绞痛,而ST段抬高型心肌梗死发生率相对心电图检查结果显示存在异常的冠心病患者而言更低。     

心电图检查结果正常的冠心病患者冠脉病变特点分析

目的:观察研究心电图检查结果正常的冠心病患者冠脉病变特点。方法:选择41例心电图检查正常的冠心病患者作为A组,另选择同时期心电图检查结果显示存在异常的41例冠心病患者作为B组,对两组患者诊疗资料进行对比分析,总结冠脉病变特点。结果:A组出现稳定性心绞痛几率明显高于B组(P<0.05)。比较两组ST段抬高型心肌梗死发生率,A组明显低于B组(P<0.05)。A组患者多为单支病变,与B组相比差异明显(P<0.05)。结论:心电图检查结果未见异常的冠心病患者多为单支病变,狭窄程度较轻,更易出现稳定性心绞痛,而ST段抬高型心肌梗死发生率相对心电图检查结果显示存在异常的冠心病患者而言更低。     

Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS)

(1) Background. Visceral adiposity index (VAI) has been recently identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidaemia. The aim of the present paper was to evaluate the relationship between VAI, daily energy intake and metabolic syndrome (MetS) in a cohort of obese Caucasian children and adolescents, aged 8 to 15 years. (2) Methods. Consecutive Italian children and adolescents with obesity, according to World Health Organization were enrolled. Anthropometric parameters and blood pressure were measured. Fasting blood samples have been analyzed for lipids, insulin and glucose levels. MetS was diagnosed using identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) or International Diabetes Federation (IDF) criteria according to age. Homeostatic model assessment index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), A body shape index (ABSI) and VAI were calculated. Multivariable logistic regression analyses with sex, age and each anthropometric parameter (body mass index (BMI) z-score, ABSI, waist-to-height ratio (WHR)) or VAI was performed to predict MetS. Receiver operation curve (ROC) analysis was used to define the optimal VAI cut-off to identify MetS. Multiple regression was performed to predict the BMI z-score and VAI from daily energy intake after adjusting for age and sex. (3) Results. Six hundred and thirty-seven (313 boys and 324 girls) children and adolescents with obesity with median age 11 (interquartile range 10–13) years were included in the analysis. MetS was diagnosed in 79 patients. VAI correlated with BMI, WHR, ABSI, HOMA-IR, QUICKI, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides and triglycerides-to-HDL ratio (p < 0.050). Optimal VAI cut-off (AUC) values to identify MetS were 1.775 (0.774), 1.685 (0.776) and 1.875 (0.797) in the whole population, boys and girls, respectively. Energy intake was positively associated with BMI z-score but no association was found with VAI. (4) Conclusion. VAI is a promising tool to identify MetS in children and adolescents with obesity and should be used in the management of abdominal obesity together with dietary assessment.     

Relation of Poor Nutritional Status to Mild Cognitive Impairment in Patients with Coronary Artery Disease

The journal of nutrition, health & aging - Nutritional status affects cerebral circulation and cognitive function. More attention needs to be paid to nutritional status in coronary artery...     

应用人体成分分析仪评价COPD住院患者营养状况

营养不良是多数慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后不良的危险因素,且随病情发展程度会逐渐加重,导致治疗时间延长,病死率增加.因此,评价COPD患者营养状况尤为重要.生物电阻抗法(bioelectrical impedance analysis,BIA)是目前应用前景较好的营养状况检查方法,本研究用该Inbody-S20人体成分分析仪测量本院61例COPD住院患者的体质成分并进行营养状况评价.     

慢性肾脏病伴冠心病冠状动脉介入后行血液透析护理

目的 分析慢性肾脏病合并冠心病患者接受冠状动脉介入术治疗后进行血液透析的护理方法与效果.方法 2019年3月-2020年3月选取本院收治的72例慢性肾脏病合并冠心病患者,全部患者都接受冠状动脉介入术治疗后进行血液透析处理,按照双盲法分为两组,对照组予以常规护理,观察组实施系统护理,并对两组患者生活质量评分、临床症状评分...     

Association of Dietary Proportions of Macronutrients with Visceral Adiposity Index: Non-Substitution and Iso-Energetic Substitution Models in a Prospective Study

We aimed to investigate associations between dietary macronutrient proportions and prospective visceral adiposity index changes (ΔVAI). The study included 1254 adults (18–74 years), from the Tehran Lipid and Glucose Study (TLGS), who were followed for three years. Dietary intakes were assessed twice using food frequency questionnaires. Associations of dietary macronutrient with ΔVAI and risk of visceral adiposity dysfunction (VAD) after three years were investigated. The percentage of energy intake from protein in the total population, and from fat in women, were associated with higher increases in VAI. A 5% higher energy intake from protein substituted for carbohydrate, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) was associated with higher ΔVAI. Higher energy intake from animal protein substituted for PUFAs was positively associated with ΔVAI. Substituting protein and PUFAs with MUFAs were related to higher ΔVAI. The associations were similar in men and women, but reached significance mostly among women. Risk of VAD was increased when 1% of energy from protein was replaced with MUFAs. Substituting protein for carbohydrate and fat, and fat for carbohydrate, resulted in increased risk of VAD in women. Higher dietary proportions of protein and animal-derived MUFA may be positively associated with ΔVAI and risk of VAD.     

冠状动脉旁路移植手术与经皮冠状动脉介入治疗多支血管病变合并糖尿病患者的预后比较

目的比较冠状动脉旁路移植手术(CABG)与经皮冠状动脉介入(PCI)治疗多支血管病变(MVD)合并糖尿病(DM)患者的预后结果。方法连续收集2010年1月至2012年12月于咸阳市中心医院住院接受CABG和PCI的MVD合并DM患者入组。收集并获取患者基线资料,包括性别、年龄、既往病史、左心室射血分数、血生化指标、住院天数、住院费用、出院诊断等信息,并进行术后定期随访。结果本研究共收集MVD合并DM患者625例,其中接受CABG的共205例,接受PCI的共420例。与PCI组相比,CABG患者冠状动脉狭窄程度及左主干狭窄程度更严重(P<0.001),患者遭受的并发症更多(P<0.001);CABG组的主动脉内球囊反搏使用率高,住院总花费也显著偏高(P<0.001);CABG组患者的住院死亡率(1.5%)略高于PCI组患者(0.5%),但差异不显著(P>0.05);CABG组的五年生存率(98.0%)显著高于PCI组(74.5%);CABG组患者的预后显著优于PCI组,五年内发生心梗和心脑血管不良事件的概率也更低(P<0.05)。结论对于MVD合并DM患者,CABG手术的长期预后结局优于PCI手术。     

An Evaluation of Nutritional Status and Problems with Dietary Compliance in Polish Patients with Celiac Disease

Celiac disease (CD, enteropathy) is a genetic autoimmune disease (abnormal immune response that attacks healthy tissues) associated with gluten intolerance. The aim of this study was to evaluate and monitor the nutritional status of CD patients, explore the problems associated with diet planning and dietary adherence among children and adults, and assess the impact of these factors on the persistence of CD symptoms. This study was carried out as part of the project entitled “A gluten-free diet without obstacles—eating well and healthy” (POWR 03.01.00-00-T153/18), conducted in Lublin Voivodeship. The study involved 87 persons, including 23 children younger than 18. At the beginning of the study and after nine months, all adult participants (older than 18) were subjected to a body composition analysis with the SECA mBCA 515 analyzer. During the project, the participants attended three consultations with a dietician. During each visit, the subjects’ body weight, nutritional status and diets were evaluated; their diets were modified, and problems relating to dietary adherence were resolved. The initial body composition analysis revealed a risk of sarcopenic obesity in 30% of adult participants, in particular in women (p = 0.003) older than 45 (p = 0.001). The risk of being underweight was diagnosed in 25% of the subjects, in particular, in women younger than 35 (p = 0.0023) and in participants who had been affected by short stature and underweight in childhood, i.e., before CD diagnosis (p = 0.0024). The analysis demonstrated that patients with gastrointestinal symptoms (abdominal pain, diarrhea, vomiting) of CD were significantly more likely to avoid even accidental exposure to gluten and were more likely to strictly follow GFD recommendations (1.97; 95CI:1.56–2.12, p = 0.0001) and safety guidelines when preparing meals at home (1.76; 95CI: 1.34–192, p = 0.0023). Parents, in particular, parents of toddlers and preschoolers who are at significantly higher risk of CD, adhered strictly to dietary guidelines and did not allow for any exceptions when preparing meals (1.88; 95CI: 1.53–2.09, p = 0.001). Persons at risk of malnutrition were also far less likely to deliberately choose gluten-containing foods (0.74; 95CI: 0.53–0.91, p = 0.021), in particular, patients with Marsh type 3a and 3b classification (p = 0.01) and persons whose intestinal histology scores did not fully improve after switching to a GFD. An assessment of the effectiveness of diet therapy based on the phase angle revealed that dietary recommendations had a positive impact on patients who had been recently diagnosed with CD. In all age groups, the main problem was accidental exposure to gluten, in particular in foods that were not labeled with the crossed grain symbol. A comparative analysis of CDAT questionnaires revealed that dietary advice on eating out significantly improved adherence to a GFD and reduced the frequency of unintentional gluten exposure in all age groups.     

Acute EGCG Supplementation Reverses Endothelial Dysfunction in Patients with Coronary Artery Disease

Background: Epidemiological studies demonstrate an inverse relation between dietary flavonoid intake and cardiovascular risk. Recent studies with flavonoid-containing beverages suggest that the benefits of these nutrients may relate, in part, to improved endothelial function.

Objective: We hypothesized that dietary supplementation with epigallocatechin gallate (EGCG), a major catechin in tea, would improve endothelial function in humans.

Design: We examined the effects of EGCG on endothelial function in a double blind, placebo-controlled, crossover design study. We measured brachial artery flow-mediated dilation by vascular ultrasound at six time points: prior to treatment with EGCG or placebo, two hours after an initial dose of EGCG (300 mg) or placebo, and after two weeks of treatment with EGCG (150 mg twice daily) or placebo. The order of treatments (EGCG or placebo) was randomized and there was a one-week washout period between treatments.

Results: A total of 42 subjects completed the study, and brachial artery flow-mediated dilation improved from 7.1 ± 4.1 to 8.6 ± 4.7% two hours after the first dose of 300 mg of EGCG (P = 0.01), but was similar to baseline (7.8 ± 4.2%, P = 0.12) after two weeks of treatment with the final measurements made approximately 14 hours after the last dose. Placebo treatment had no significant effect, and there were no changes in reactive hyperemia or the response to sublingual nitroglycerin. The changes in vascular function paralleled plasma EGCG concentrations, which increased from 2.6 ± 10.9 to 92.8 ± 78.7 ng/ml after acute EGCG (P < 0.001), but were unchanged from baseline after two weeks of treatment (3.4 ± 13.1 ng/ml).

Conclusion: EGCG acutely improves endothelial function in humans with coronary artery disease, and may account for a portion of the beneficial effects of flavonoid-rich food on endothelial function.     

老年冠心病患者接受全麻胃镜检查安全性分析

目的探讨老年冠心病患者接受患者全麻胃镜检查安全性。方法选取接受胃镜检查的老年冠心病患者145例,分为对照组(72例)及观察组(73例),对照组患者行常规胃镜检查,观察组患者在全麻下行胃镜检测,对患者生命体征、心电图改变、心肌酶水平进行监测并比较。结果对照组患者收缩压(SBP)及舒张压(DBP)、心率(HR)较术前有显著升高(P0.05),观察组患者术后SBP及DBP较术前有显著下降,且较对照组有显著性下降(P0.05)。对照组患者术后乳酸脱氢酶(LDH)、谷草转氨酶(AST)、磷酸肌酸激酶(CK)水平较术前显著升高(P0.05),观察组患者术后LDH、AST、CK水平较对照组显著下降(P0.05)。对照组患者室性早搏、传导阻滞、ST段改变分别有4例、2例、7例,观察组分别有3例、2例、4例,两组比较差异具有显著统计学意义(χ2=0.242,P0.05)。结论老年冠心病患者接受全麻胃镜检查可减轻冠脉缺血,减少心血管事件的发生。     

冠心病合并心力衰竭患者冠状动脉支架术后临床效果的研究分析

目的:分析冠状动脉粥样硬化性心脏病(简称,冠心病)合并心力衰竭患者冠状动脉支架术后的临床效果。方法:选择2017年1月~2018年3月在本院就诊的72例冠心病合并心力衰竭患者作为本次的研究对象,术前3d给予患者肠溶阿司匹+氯吡格雷术前准备,手术时患者取半卧位,选择搏动良好的桡动脉行介入治疗,介入术后行经皮冠状动脉支架植入术,术后给予氯吡格雷+阿司匹林治疗。采用超声心动图监测,比较治疗前后的心功能相关指标。行6min步行试验,评估患者的运动耐力。依据纽约心脏病协会(NYHA)分级标准对患者治疗前后的心功能进行分级。结果:治疗后,患者各项心功能指标较治疗前比较,差异有统计学意义,P<0.05。治疗前,患者的平均6min步行距离为(165.3±48.8)m,治疗后,患者的平均6min步行距离为(232.6±69.4)m,较治疗前比较,差异有统计学意义,P<0.05。依据纽约心脏病协会(NYHA)分级标准:Ⅰ级25例(34.7%),Ⅱ级26例(36.1%),Ⅲ级21例(29.2%),Ⅳ级0例(0.0%),较治疗前比较,差异有统计学意义,P<0.05。结论:使用冠状动脉支架术治疗冠心病合并心力衰竭患者,能明显改善患者的心功能,疗效确切。     

Low Fat Intake and Coronary Artery Disease in a Population with Higher Prevalence of Coronary Artery Disease: The Indian Paradox

Objective: To determine the association between saturated fat intake and prevalence of coronary artery disease (CAD) and coronary risk factors.

Design and Setting: Total community cross sectional survey of 20 urban streets out of 196 streets, in the city of Moradabad in north India.

Subjects and Methods: Adult population between 25 to 64 years inclusive comprised of 1806 subjects (904 men, 902 women) were divided into three groups according to level of saturated fat intake as assessed by 7-day dietary intake records (very low <7%, low 7 to 10%, high >10% energy (en) per day).

Results: We examined the relationship between CAD risk and levels of % en from fat intake. Low (7 to 10% en/day) and high (>10% en/day) saturated fat were positively and significantly associated with higher prevalence of CAD. The prevalence of coronary risk factors (hypertension, hypercholesterolemia, obesity and sedentary lifestyle) were significantly higher among subjects with low and high saturated fat intake compared to subjects with very low (<7%) saturated fat intake. Logistic regression analysis with adjustment for age showed that hypercholesterolemia (OR: men 0.89, women 0.68), hypertension (men 0.92, women 0.56), physical activity (men 0.80, women 0.36), obesity (men 0.82, women 0.88) and smoking (0.70 men) were significant risk factors of CAD. Low and high saturated fat intake were associated with more prestigious occupations, higher and middle income status and better educational levels compared to very low saturated fat intake.

Conclusions: The prevalence of CAD and coronary risk factors was higher in urban Indians with low and high saturated fat intake than those with lower saturated fat intake. These findings suggest that the saturated fat intake should be <7% en/day for prevention of CAD in Indians.     

Nutritional Status,Body Composition,and Inflammation Profile in Older Patients with Advanced Chronic Kidney Disease Stage 4–5: A Case-Control Study

Nutritional status is a predictor of adverse outcomes and mortality in patients with advanced chronic kidney disease (ACKD). This study aimed to explore and evaluate risk factors related to nutritional status, body composition, and inflammatory profile in patients with ACKD compared with age- and sex-matched controls in a Mediterranean cohort of the Spanish population. Out of 200 volunteers recruited, 150 participants (64%) were included, and a case-control study was conducted on 75 ACKD patients (stages 4–5), matched individually with controls at a ratio of 1:1 for both age and sex. At enrolment, demographic, clinical, anthropometric, and laboratory parameters were measured. Bioimpedance analysis (BIA) was used to assess both body composition and hydration status. ACKD patients had lower body cell mass (BCM%), muscle mass (MM%) phase angle (PA), s-albumin, and higher C-reactive protein (s-CRP) than controls (at least, p < 0.05). PA correlated positively with BCM% (cases: r = 0.84; controls: r = 0.53, p < 0.001), MM% (cases: r = 0.65; controls: r = 0.31, p < 0.001), and inversely with s-CRP (cases: r = −0.30, p < 0.001; controls: r = −0.31, p = 0.40). By univariate and multivariate conditional regression analysis, total body water (OR: 1.186), extracellular mass (OR: 1.346), s-CRP (OR: 2.050), MM% (OR: 0.847), PA (OR: 0.058), and s-albumin (OR: 0.475) were significantly associated among cases to controls. Nutritional parameters and BIA-derived measures appear as prognostic entities in patients with stage 4–5 ACKD compared to matched controls in this Mediterranean cohort.     

The Management of Coronary Artery Disease in Ethiopia: Emphasis on Revascularization

Cardiovascular diseases are number one cause of death worldwide. Over half of the cardiovascular diseases, 51%, are due to coronary artery disease. Coronary artery disease is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial coronary arteries. Rupture of the fibrous cap of the plaque causes the majority of the deaths due to myocardial infarction. Angina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia usually precipitated by exertion. In acute coronary syndrome, the chest discomfort is either of low threshold or appears at rest and when it evolves on the background of established angina pectoris, the discomfort becomes more frequent and prolonged. Exercise electrocardiography which has been the most frequently used non-invasive test to diagnose obstructive coronary artery disease is currently shown to have inferior diagnostic performance compared with diagnostic imaging tests. The pivotal tests in patients presenting with clinical features of acute coronary syndrome are electrocardiography and determination of serum troponin I and/or T. Revascularization is the mainstay of treatment in patients with acute coronary syndrome. In chronic coronary syndrome, on top of optimal medical treatment, revascularization reduces mortality in:- 1) left main stenosis, 2) three-vessel coronary artery disease, particularly with ejection fraction of less than 40%, 3) two vessel disease with more than 75% stenosis of the proximal left anterior descending coronary artery disease.     

冠脉多支病变患者PCI术后主动脉内球囊反搏的护理

目的评价规范性护理流程,主动性护理对主动脉内球囊反搏术(IABP)治疗效果的影响。方法23例因患有冠状动脉多支严重病变的急性心肌梗塞病人PCI术后行IABP治疗,按照规范性护理流程,对这些患者进行主动性护理。结果无一例出现血栓栓塞、外周动脉缺血、严重感染和球囊破裂等IABP严重并发症,3例病人出现小血肿或皮损;无一例死亡,治疗效果明显,病情好转全部出院。结论IABP实施的效果与护理人员相关的理论和技术培训,规范性护理流程,主动性护理密切相关;IABP护理质量的高低对于患者整体治疗效果、预后有着重要的意义。     

冠脉多支病变患者PCI术后主动脉内球囊反搏的护理

目的评价规范性护理流程,主动性护理对主动脉内球囊反搏术（IABP）治疗效果的影响。方法23例因患有冠状动脉多支严重病变的急性心肌梗塞病人PCI术后行IABP治疗,按照规范性护理流程,对这些患者进行主动性护理。结果无一例出现血栓栓塞、外周动脉缺血、严重感染和球囊破裂等IABP严重并发症,3例病人出现小血肿或皮损;无一例死亡,治疗效果明显,病情好转全部出院。结论IABP实施的效果与护理人员相关的理论和技术培训,规范性护理流程,主动性护理密切相关：IABP护理质量的高低对于患者整体治疗效果、预后有着重要的意义。     

老年冠心病心律失常动态心电图监测分析

目的:探讨老年冠状动脉粥样硬化性心脏病(简称,冠心病)心律失常患者行动态心电图监测的临床价值。方法:研究资料共86例,均为本院于2017年2月~2019年2月收治的老年冠心病心律失常患者,均行常规心电图与动态心电图监测,评价监测结果及应用价值。结果:动态心电图检出心律失常阳性率显著高于对照组(82.56%,60.47%,P<0.05);与常规心电图相比,动态心电图对室早二、三联律、室早成对、房早二、三联律、房早成对、短阵室上速等检出率更高,差异具有显著性意义(P<0.05)。结论:在老年冠心病心律失常诊治中行动态心电图监测可更加详细的提供患者心律失常的变化,如发作频率、持续时间等,为治疗提供可靠的依据。