肠外营养技术的评估

Koretz等收集1974年以来30年间有关肠外营养RCT的研究报告,按照严格的标准进行荟萃分析研究.作者简介了这一研究的结果,表明在许多临床状况下,并不能确定肠外营养这一治疗性干预措施的确切疗效.因此,不支持在住院病人中常规应用肠外营养疗法,而仅适用于一定的选择性病人.一般可适用于经口或经胃肠不能获得足够营养素的病人,以防止营养不良可能产生的各种不良作用.     

Canadian home parenteral nutrition (HPN) registry: validation and patient outcomes

Background: In Canada, there are an estimated 400 home parenteral nutrition (HPN) patients. In 2006, a registry was created to gather patient outcome information. The aim of this study was to validate the registry and report on HPN patient outcomes. Methods: Several demographic, clinical parameters were collected. For the validation, paired t test and intraclass correlation coefficient (ICC) were used to assess agreement between repeat entries. For the outcome report, paired t test was used to assess changes, and survival analysis was performed using the Kaplan‐Meier method. Results are expressed as mean ± SEM. Results: On validation, there was high correlation/agreement (P < .05) for most parameters except vascular access/line sepsis, liver disease (ultrasound, biopsy, diagnoses), and hospitalizations. For the outcome report, 96 patients had their data entered at 2.24 ± 0.11 years after baseline. Over the period, there was a significant reduction in PN calories (P = .001) and proteins (P < .001). There were no significant changes in nutrition parameters and laboratory results except for lower platelet counts (P = .028), lower plasma potassium (P = .030), and a trend toward an increase in bilirubin from 19.29 ± 4.65 to 29.06 ± 8.73 µmol/L (P = .071). The QOL decreased significantly over time (P < .001) and the survival on HPN was 17.67 ± 1.89 years. Conclusions: The registry is a valid tool to assess several clinical parameters. On follow‐up, HPN patients maintain good nutrition status while PN is reduced but do have a reduced quality of life.     

早期全肠外营养及肠内、外混合营养对神经外科危重患者免疫功能的影响

目的探讨早期给予全肠外营养（TPN）及肠内营养（EN）、肠外营养（PN）混合支持对神经外科危重患者免疫功能的影响。方法采用前瞻性对照研究将神经外科危重患者按入院顺序随机分为TPN组及EN＋PN组,并对比营养支持前后两组CD3、CD4、CD8、CD4／CD8、CD3／CD25、IgA、IgG、IgM、血清白蛋白的变化。结果给予神经外科危重患者两种营养支持均可提高其CD3、CD4、CD8及CD3＋／CD25＋比值（P〈0．05,P〈0．01）;两种营养支持方式均可显著升高IgA、IgG、IgM、（P〈0．05）及血清白蛋白浓度（P〈0．01）。与TPN组比较,EN＋PN组CD3、CD4、CD8、CD4／CD8比值、IgA、IgG、IgM浓度及血清白蛋白水平均显著升高（P〈0．05,P〈0．01）。结论早期TPN及EN＋PN支持均可促进神经外科危重患者免疫功能的恢复及提高,EN＋PN的作用优于TPN,对于神经外科危重患者应早期给予营养支持治疗。     

全胃肠外营养治疗胎儿宫内发育迟缓的临床观察

目的:应用全胃肠外营养(TPN)治疗胎儿生长受限(FGR)并观察其疗效。方法:将125例FGR孕妇分为TPN组63例和复方丹参组62例,观察治疗前后的宫高、腹围、体重及胎儿双顶径变化及新生儿出生体重。结果:TPN组治疗后的各项指标均高于复方丹参组(P<0.05),差异显著。结论:TPN组治疗FGR疗效显著。     

还原型谷胱甘肽预防全肠外营养所致肝损害的临床观察

目的:探讨还原型谷胱甘肽(GSH)预防伞肠外营养(TPN)肝损害的临床价值.方法:将82例接受TPN的病人随机分为两组,即对照组(n=42)给予TPN;试验组(n=40),在TPN的同时给予GSH治疗.观察治疗后第7和第14天时静脉血总胆红素(TBIL)、总胆汁酸(TBA)、谷丙转氨酶(ALT)、碱性磷酸酶(AKP)、...     

Characterization of posthospital bloodstream infections in children requiring home parenteral nutrition

Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter‐associated bloodstream infections (CA‐BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA‐BSI in children receiving HPN are limited. Objective: To determine the incidence and characteristics of CA‐BSI in children receiving HPN. Methods: Medical records of 44 children receiving HPN during a 3‐year period were reviewed. End points were CA‐BSI during the initial 6 months after discharge. CA‐BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. Results: The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA‐BSI, polymicrobial infections accounted for 52%; gram‐positive, 29%; gram‐negative, 17%; and fungal, 2%. CA‐BSI incidence per 1000 catheter‐days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4–109.6). CA‐BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA‐BSI (odds ratio [OR], 4.4 [95% CI, 1.13–16.99] and 6.6 [1.50–28.49], respectively; P < .05). Conclusions: The incidence of CA‐BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.     

不同时间开始的肠外营养与肠内营养对急性胰腺炎影响的对比

目的 探讨并对比不同时间开始的肠外营养与肠内营养对急性胰腺炎的影响.方法 在MEDLINE、EMBASE、Cochrane图书馆、万方期刊库和中国期刊网检索1966年1月至2011年1月发表的有关全胃肠外营养和肠内营养治疗急性胰腺炎的随机对照研究.由2名评价者对入选研究的研究设计、研究对象的特征、研究结果等内容独立进行摘录,采用RevMan4.2软件进行分析.结果 有14项研究纳入本研究.本研究结果显示,入院24h后,与全胃肠外营养相比,肠内营养能显著降低感染(P=0.0004)、手术(P=0.0200)、器官衰竭(P=0.0400)及死亡率(P=0.0002);入院48h内,与全胃肠外营养相比,肠内营养能显著降低感染(P =0.0000)、手术(P=0.0001)、器官衰竭(P=0.0006)及死亡率(P =0.0300).结论 肠内营养的疗效可能受营养开始时间的限制,急性胰腺炎患者入院24～48h开始肠内营养优于入院24 h内或48h后开始.     

全胃肠外营养对重型颅脑损伤的应用观察

采用早期全胃肠外营养治疗重型颅脑损伤２５例，观察其血糖、血浆白蛋白、机体营养指标及氮平衡动态变化，并与经胃肠道营养的２５例重型颅脑损伤相对照。发现重型颅脑损伤病人能从胃肠外营养的途径中获得较充分的能量和蛋白质，死亡率为４％，显著低于经胃肠道营养的对照组２４％（Ｐ〈０．００５）。实验表明，胃肠外营养液能在不升高血糖的情况下提供较高的热量和蛋白质，为颅脑损伤病人的病情恢复创造了有利条件。     

优化营养支持手段与单纯肠外营养对老年肝癌切除患者术后临床结局的影响

目的评价优化营养支持手段对老年肝癌切除患者改善临床结局的意义。方法对我院2007至2009年（研究组52例）接受肝癌切除手术老年患者采用优化营养支持的手段,包括住院后进行营养风险筛查,评分≥3分给予营养支持、术前1～3d肠内营养（EN）口服补充、术后肠外营养（PN）联合EN支持等,并与2005至2007年（对照组30例）同类手术后单纯接受PN的老年患者比较,观察术后营养指标变化、术后住院时间、总住院费用和并发症的发生率。结果两组术后第7天体重、蛋白水平变化相似（P〉0．05）;研究组感染并发症发生率及住院时间显著低于对照组（P〈0．05）。结论老年患者接受肝癌切除手术,应先进行营养风险筛查,围手术期优化营养支持手段能够改善临床结局。     

全胃肠外营养的安全护理措施的探讨

为确保全胃肠外营养（TPN）在临床正确实施和安全应用,通过对我科3年期间配置10420袋全营养混合液应用于2500例病人,结果各例病人均未发生发热、寒战、胸闷、恶心、呕吐、呼吸困难等不良反应。结论：严格遵守全营养混合液的配置、储存及配液室的管理确保了营养混合液的质量;加强中心静脉置管前后的护理,减少了与导管有关并发症的发生。     

全肠外营养处方分析与评价

目的分析、评价我院全肠外营养处方的用药情况,提高肠外营养的质量,为临床合理使用提供参考。方法对我院2008年1月至2009年10月1386张全肠外营养处方的科室分布、用药情况等进行分析评价。结果1386张全肠外营养处方主要分布在胃肠小儿科、肿瘤科、肝胆腺体外科、ICU科,平均使用时间是7．74d,50％以上处方的液体量〈1500ml,大多数处方使用维生素和微量元素较合理,但也存在糖脂能量比不合理、氨基酸浓度较低、溶液中Ca^2＋、Mg^2＋浓度偏高等问题。结论我院大多数全肠外营养处方使用合理,但也存在不足,针对存在的问题应予以改进;同时加强全肠外营养的知识普及,促进全肠外营养的合理应用和推广。     

早期营养支持对急性重症胰腺炎病人机体组成的影响

目的:探讨早期肠内营养(EN)联合肠外营养(PN)对急性重症胰腺炎(ASP)病人机体组成的影响. 方法:将30例病人随机分成治疗组和对照组.治疗组病人采取早期EN加PN,并逐渐减少PN的用量,直至停止PN.对照组病人采取完全胃肠外营养(TPN).两组病人平均治疗15 d.用皮皱测量法测定两组病人机体密度,用MRI方法测量全身各部位脂肪变化情况,核素稀释法测定全身水量(TBW)、总脂肪量(TBF)、无脂肪体重(LBM)、细胞内液(ICM)、细胞外液(ECM)的变化.同时常规测定血清清蛋白、血红蛋白、转铁蛋白和淋巴细胞数量等. 结果:治疗组在TBW、TBF、LBM、ICM、ECM、血清清蛋白、血红蛋白、转铁蛋白与对照组差异无显著性意义(P＞0.05),治疗组的淋巴细胞数高于对照组(P＜0.05). 结论:早期EN联合PN可以改善ASP病人的机体免疫功能,对机体组成的影响,与TPN无差异.     

全胃切除术后早期肠内肠外营养的对比研究

目的：探讨全胃切除术后早期肠内营养（EEN）与全肠外营养（TPN）对患者营养状况的改善及并发症发生率的影响。方法：将86例接受根治性全胃切除的胃癌患者随机分为EEN组和TPN组。EEN组手术后第1天开始分别给予营养支持,于术前1天、术后8天检测体重、血常规、肝功能、前白蛋白和C-反应蛋白,并观察并发症的发生率和平均住院费用。结果：EEN组体重、白蛋白、前白蛋白下降幅度和白细胞、转氨酶、C-反应蛋白升高幅度均少于TPN组。EEN组患者吻合口瘘、肺部感染、切口愈合不良等并发症发病率低于TPN组。EEN组的平均住院费用低于TPN组。结论：术后EEN较TPN能改善全胃切除术后患者的营养状况,降低并发症发生率,减少经济费用。     

Prediction of parenteral nutrition osmolarity by digital refractometry

Background: Infusion of high‐osmolarity parenteral nutrition (PN) formulations into a peripheral vein will damage the vessel. In this study, the authors developed a refractometric method to predict PN formulation osmolarity for patients receiving PN. Methods: Nutrients in PN formulations were prepared for Brix value and osmolality measurement. Brix value and osmolality measurement of the dextrose, amino acids, and electrolytes were used to evaluate the limiting factor of PN osmolarity prediction. A best‐fit equation was generated to predict PN osmolarity (mOsm/L): 81.05 × Brix value – 116.33 (R ² > 0.99). To validate the PN osmolarity prediction by these 4 equations, a total of 500 PN admixtures were tested. Results: The authors found strong linear relationships between the Brix values and the osmolality measurement of dextrose (R ² = 0.97), amino acids (R ² = 0.99), and electrolytes (R ² > 0.96). When PN‐measured osmolality was between 600 and 900 mOsm/kg, approximately 43%, 29%, 43%, and 0% of the predicted osmolarity obtained by equations 1, 2, 3, and 4 were outside the acceptable 90% to 110% confidence interval range, respectively. When measured osmolality was between 900 and 1,500 mOsm/kg, 31%, 100%, 85%, and 15% of the predicted osmolarity by equations 1, 2, 3, and 4 were outside the acceptable 90% to 110% confidence interval range, respectively. Conclusions: The refractive method permits accurate PN osmolarity prediction and reasonable quality assurance before PN formulation administration.