营养支持治疗在ICU中的应用

报告１４例危重病人给予全胃肠外营养和肠内营养收到良好效果。１４例中ＭＳＯＦ１０例，衰竭脏器≥个者５例。９例入ＩＣＵ时呈昏迷状态。１１例气管切开，９例给予人工机械通气，其中４例同时进行连续性静脉－静脉血液滤过透析治疗。营养支持治疗后艰病人手术切口的愈合，呼吸肌功能的恢复以及全身营养状况的改善均起到良好的作用。     

早期不同营养支持方式对ICU患者康复效果的影响

目的探讨ICU患者早期营养支持方式对其康复效果的影响。方法对35例ICU患者进行早期肠内营养支持(EEN),对另外35例ICU患者进行早期完全肠外营养支持(EPN),对两组不同早期营养支持方式的患者进行治疗效果的评价,并对评价效果进行统计学分析。结果与早期完全肠外营养支持组相比,早期肠内营养支持患者组上消化道出血率、腹泻率及苏醒后拒食率及体重丢失减少明显减少,血清总蛋白指标良好。结论 ICU患者早期肠内营养支持方式的介入可明显提高患者的胃肠适应性,提高营养支持效果,对ICU患者的康复具有显著的促进作用。     

营养支持护理对ICU患者的临床价值

目的:研究分析ICU患者应用营养支持护理的临床价值.方法:选取某医院接收的81例ICU患者,通过采用计算机产生随机数字,分为干预组和常规组,其中常规组40例患者,采用常规ICU护理.干预组41例患者,在常规护理的基础上,予以营养支持护理,比较两组患者ICU停留时间、胃肠功能障碍发生情况以及营养各指标变化情况.结果:干预组患者营养状态以及免疫功能改善十分显著,且优于常规组;干预组患者胃肠功能障碍发生率以及ICU停留时间,也优于常规组(P<0.05).结论:对ICU患者的护理过程中,积极应用营养支持,有利于患者改善预后效果,具有极佳的应用价值.     

Impact of Medicare prospective reimbursement system on nutritional support service patients: the importance of pass throughs

The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass-through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because of the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non-Medicare patients. When data from all Medicare patients (which includes both NSS and non-NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass-through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements.     

Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

ObjectiveThis multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).MethodsA consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing, China were recruited from March 2007 to July 2008. Data were collected on the nutritional risk screening (NRS-2002), the application of perioperative nutritional support, surgery, complications, and length of stay. A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support.ResultsIn total 1085 patients were recruited, and 512 of them were at nutritional risk. Of the 120 patients with an NRS score at least 5, the complication rate was significantly lower in the preoperative nutrition group compared with the control group (25.6% versus 50.6%, P = 0.008). The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group (13.7 ± 7.9 versus 17.9 ± 11.3 d, P = 0.018). Of the 392 patients with an NRS score from 3 to 4, the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support (P = 1.0 and 0.770, respectively).ConclusionThis finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate.     

营养支持对有营养风险患者结局的影响

营养支持的内涵包括3个部分,即补充、支持和治疗.何时及如何给予患者营养支持均与 改善患者结局有关.美国以1967年全美外科医师大会上Dudrick等报道静脉营养为起点,静脉营养在美国临床实用为43年;我国以1978年全国外科大会上蒋朱明等报道静脉营养为起点,为32年;虽然在国内外医疗单位也把肠外、肠内营养作为标准医疗技术之一,但是对于营养支持改善结局的客观临床研究证据仍然不够.Kondrup等建立的营养风险筛查为合理营养支持改善结局的研究开辟了一个平台.在一项前瞻性队列研究中,根据营养风险筛查2002评价营养支持(肠外营养和肠内营养)对有营养风险患者感染性并发症发生率的影响显示,营养支持组总并发症发生率与无营养支持组相比明显降低,主要由于感染性并发症的发生率降低.有营养风险或已经有营养不良的患者给予适当的营养物质的支持,有可能减少感染性并发症的发生率.希望今后有更多更大样本的队列和随机对照研究,提供更可靠的营养支持可能改善结局的依据.     

营养支持对有营养风险患者结局的影响

营养支持的内涵包括3个部分，即补充、支持和治疗。何时及如何给予患者营养支持均与改善患者结局有关。美国以1967年全美外科医师大会上Dudrick等报道静脉营养为起点，静脉营养在美国临床实用为43年；我国以1978年全国外科大会上蒋朱明等报道静脉营养为起点，为32年；虽然在国内外医疗单位也把肠外、肠内营养作为标准医疗技术之一，但是对于营养支持改善结局的客观临床研究证据仍然不够。Kondrup等建立的营养风险筛查为合理营养支持改善结局的研究开辟了一个平台。在一项前瞻性队列研究中，根据营养风险筛查2002评价营养支持（肠外营养和肠内营养）对有营养风险患者感染性并发症发生率的影响显示，营养支持组总并发症发生率与无营养支持组相比明显降低，主要由于感染性并发症的发生率降低。有营养风险或已经有营养不良的患者给予适当的营养物质的支持，有可能减少感染性并发症的发生率。希望今后有更多更大样本的队列和随机对照研究，提供更可靠的营养支持可能改善结局的依据。     

Assessing a computerized routine health information system in Mali using LQAS

BACKGROUND: Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis. OBJECTIVE: To assess the overall coverage and quality of the data in the HIS, to identify specific health districts that needed improvements in data collection methods, and to determine particular areas of weakness in data collection. METHODS: Random samples of 20 mothers with children <5 years were selected in each of 14 health districts. Mothers were interviewed about pregnancies, live births, deaths of children <5, and children's growth monitoring and immunization status. The Lot Quality Assurance Method (LQAS) was used to identify districts in which records and interview results did not meet predetermined levels of acceptability. Data collected in the interviews were combined to estimate overall coverage and quality. RESULTS: When all variables were analyzed, all 14 lots were rejected, and it was estimated that 52% of all events occurring in the community were registered in ProMIS. Much of this poor performance was due to immunization and growth monitoring data, which were not updated due to printer problems. Coverage of events increased (92%) when immunizations and growth monitoring were excluded, and no lots were rejected. When all variables were analyzed for quality of data recorded, six lots were rejected and the overall estimation was 83%. With immunizations and growth monitoring excluded, overall quality was 86% and no lots were rejected. CONCLUSIONS: The comprehensive computerized HIS did not meet expectations. This may be due, in part, to the ambitious objective of complete and intensive monitoring of a large population without adequate staff and equipment. Future efforts should consider employing a more targeted and streamlined HIS so that data can be more complete and useful.     

The quality of nutritional information available on popular websites: a content analysis

The overall purpose of this study was to increase knowledge and understanding of the new informational landscape that is emerging on the Internet in relation to nutritional health content in order to provide policy makers with better communication and health promotion tools. We identified the sites most used by Canadians to access nutrition information and conducted content analyses to identify the sources of this nutritional information as well as its quality by systematic comparison with the main guidelines published in the Canada Food Guide. We found that commercial websites accounted for 80% of visits and time spent on seeking health and nutrition information. We also found uneven messaging about fruit and vegetable intake as well as consistent messaging undermining the 'eat a variety of foods' message, which is a central component of the Canada Food Guide. On the positive side, inappropriate or incongruent advice about salt, coffee and alcohol intake was virtually non-existent and advice congruent with the guide was found three times more often than incongruent advice. Finally, the site offering the best advice was a non-commercial government-based site. This site differed from the commercial sites not so much in its ability to deliver the 'right' advice but more in its ability to exclude articles with poor and misleading advice on their sites.     

我院计算机信息系统的建设

建立了一个客户／服务器模式的局域网，首期开发了门诊收费管理、门诊药房管理、住院病人管理、病房药房管理、病案管理、医学统计、药品库房管理等７个子系统，并且介绍了这一建设过程中在总体设计、组织实施方面的体会。     

Health-related quality of life in patients with home nutritional support

Background:  Home nutritional support (HNS) aims to improve or maintain the patient's quality of life. Given the high social cost of such treatment, however, it is important to investigate whether the perceived quality of life of patients receiving HNS does in fact reflect these objectives. The present study aimed to evaluate the health-related quality of life (HRQoL) of patients who receive HNS.
Methods:  A multicentre, cross-sectional study of 267 patients was carried out. HRQoL was evaluated using the EuroQoL-5-Dimensions (EQ-5D) questionnaire. The Visual Analogue Scale (VAS) was used to complement the EQ-5D, aiming to provide an overall estimation of patient quality of life.
Results:  The EQ-5D questionnaire showed that 25% of the subjects valued their HRQoL at between −0.08 and 0.15, 50% at between 0.16 and 0.69 and 25% at between 0.70 and 1. Results from the VAS showed that 75% of patients claimed to have a HRQoL > 40. The median for the VAS was 50.
Pathologies were oncological (44.0%), neurological (36.6%) and others (19.3%). The results obtained demonstrate that neurological patients placed a lower value on their HRQoL compared to those of other groups ( P  < 0.001). In addition, women rated their quality of life lower than men in all pathologies ( P  = 0.006).
Conclusions:  Perceived HRQoL varied depending on pathology and sex. It was difficult to draw conclusions concerning the impact of HNS because of a lack of baseline data and relevant validated measurement tools. The present study highlights the need for more research into the relationship between HNS and HRQoL.     

足量营养支持对肿瘤病人化疗后的营养状况及生活质量的影响

目的:总对比常规营养支持及足量营养支持对肿瘤化疗病人的营养状况及生活质量的影响。方法:2016年2月至2017年2月期间采用营养风险筛查工具、自评主观全面评定量表收集86例存在营养风险并且拟行化疗的肿瘤病人,随机给予常规营养支持及足量营养支持各43例,化疗结束后通过营养风险筛查工具、生命质量核心量表及分析BMI、血清总蛋白、血清白蛋白、血红蛋白等对两组病人化疗后的营养状况及生活质量进行对比评价。结果:两组营养支持顺利完成。在营养状况方面,足量营养支持组化疗后的营养风险筛查评分与同组化疗前及常规营养支持组化疗后的评分,具有统计学意义(P0.05)。另外,足量营养支持组的化疗后的血清白蛋白及血红蛋白均高于化疗前,具有统计学意义(P0.05)。通过生活质量评分,足量营养支持组的躯体功能、情绪功能、整体生命质量、症状量表中的疲倦、恶心、失眠、食欲丧失、便秘、腹泻等方面均低于常规营养支持组,具有统计学意义(P0.05)。结论:采用足量营养支持可以有效的提高存在营养风险的肿瘤化疗病人化疗后的营养状况及生活质量。     

Organophosphate and carbamate pesticide poisoning: the usefulness of a computerized clinical information system

Organophosphate (OP) and carbamate poisoning are still a worldwide health problem causing numerous fatalities in humans. Physicians who have no clinical toxicological experience with these compounds may have difficulties in promptly identifying the etiologic agent and managing the acute phase of the poisoning. We describe the potential use of a computerized medical information system that includes clinical data on 236 cases of OP and carbamate poisoning, and may improve the management of such poisoning. The methods of constructing the system, the first results of using the system, and the medical institutions that can benefit from such systems are discussed.