肠内营养启动时间对危重症病人炎症反应的影响

目的:观察恢复肠内营养(EN)对不同时间禁食病人全身炎症反应的影响.方法:根据恢复EN前禁食的时间,把病人分为长期禁食组(恢复EN前禁食＞15 d,n=20)和短期禁食组(禁食＜1周,n=20),比较两组病人恢复EN前及恢复后1周内全身炎症反应的变化.在病人恢复EN前和恢复EN后第1,3,5和7天,记录病人的心率、呼吸...     

ω-9单不饱和脂肪酸在精准肝切除术病人中的应用

目的:研究使用ω-9单不饱和脂肪酸对精准肝切除术后病人恢复的影响。方法:选择接受精准肝切除的病人70例,随机、双盲分为两组,术后使用等氮、等热量PN支持。研究组病人使用ω-9单不饱和脂肪酸脂肪乳,对照组病人单纯使用中长链脂肪乳。分别于术后第l、3、7天清晨抽取静脉血,检测肝功能、前清蛋白、C反应蛋白、降钙素原、细胞因子(IL-6)和丙二醛等;同时记录病人术后感染性并发症的发生率、术后住院时间和住院费用等指标。结果:研究组病人术后肝功能恢复优于对照组;两组病人手术后前清蛋白和C反应蛋白无显著性差异;研究组病人术后C反应蛋白、降钙素原、细胞因子(IL-6、IL-10)和丙二醛等均优于对照组(P0.05);两组病人感染性并发症的发生率、术后住院时间和费用均无显著性差异。结论:ω-9单不饱和脂肪酸有助于改善精准肝切除病人术后肝功能的恢复和减轻氧化应激损伤。     

n-3多不饱和脂肪酸与免疫系统关系的研究进展

随着过去数十年脂肪酸摄入模式的改变和免疫性疾病发生的明显增加,n-3多不饱和脂肪酸(n-3PUFA)的摄入与免疫系统关系的研究日益受到重视。目前普遍认为n-3PUFA及其代谢产物均可通过直接或间接的途径对免疫系统发挥作用,继而抑制免疫系统作用的发挥和炎症反应的发展。但近年来也有报道指出n-3PUFA在特定情况下也可促进免疫细胞发挥其功能。本文根据相关文献资料,对该领域研究进展予以介绍。     

083 n-3多不饱和脂肪酸与免疫系统关系的研究进展

随着过去数十年脂肪酸摄入模式的改变和免疫性疾病发生的明显增加，n-3多不饱和脂肪酸（n-3 PUFA）的摄入与免疫系统关系的研究日益受到重视。目前普遍认为n-3 PUFA及其代谢产物均可通过直接或间接的途径对免疫系统发挥作用，继而抑制免疫系统作用的发挥和炎症反应的发展。但近年来也有报道指出n-3 PUFA在特定情况下也可促进免疫细胞发挥其功能。本文根据相关文献资料，对该领域研究进展予以介绍。     

单不饱和脂肪酸对心血管的保护作用

单不饱和脂肪酸(MUFA)是脂肪酸的一种,其碳链上只有一个双键。研究发现MUFA能够正向调节血脂代谢,降低低密度脂蛋白胆固醇(LDL)的氧化敏感性,保护血管内皮和降低血液高凝状态。本文将从以上几个方面介绍MUFA对心血管的保护作用。     

危重症病人的营养调理治疗

危重症病人营养支持的难点在于因病人存在程度不一的高分解代谢、免疫反应失衡以及器官功能障碍,单纯的营养支持并不能改善危重症病人的营养状态,此时给予过多的营养热量既无用且有害。但短时间缺乏营养支持,在恢复期将需要更长的时间来纠正营养不良。目前,危重症病人的临床营养支持,其目的从单纯的"供给细胞代谢所需要的能量与营养底物,维持组织器官结构与功能",拓     

危重症病人肠内营养并发症的护理

肠内营养(EN)是通过口服或管饲经胃肠道补充营养物质的支持治疗方法.EN支持符合生理状态,可维持肠道的完整性,避免肠道细菌易位,降低感染并发症的发生率[1],且因使用方法灵活、便于监护、安全经济,已广泛应用于临床,尤其是对危重症病人.但在EN治疗过程中常会因各种原因出现相应并发症.近年来,我们在危重症病人EN支持治疗过程中对并发症采取优化管理策略[2],取得较为满意的效果,现将护理体会总结报道如下.     

0～6岁单纯性肥胖儿童血浆单不饱和脂肪酸的变化

目的:观察不同年龄段单纯性肥胖儿童血浆单不饱和脂肪酸(monounsaturated fatty acid,MUFA)水平的变化,进而探讨MUFA及体重指数(Body mass index,BMI)与硬脂酰辅酶A去饱和酶(Stearoyl-CoA desaturase,SCD)活性(C16∶1n-7/C16∶0及C18∶1n-9/C18∶0)之间的关系。方法:选取北京酒仙桥地区2005年5月～2007年5月在清华大学第一附属医院保健科进行健康体检的儿童共152名,其中0～6月龄和7～12月龄婴儿各40名,1～6岁儿童72名;所有儿童中肥胖儿73名、体重正常儿79名。利用气相色谱分析方法测定其血浆脂肪酸组成。结果:6月龄以下肥胖儿童血浆MUFA水平与正常儿童之间无明显差异;7～12月龄肥胖儿童血浆棕榈油酸(palmitoleate acid,C16∶1n-7)、单不饱和脂肪酸总量(MUFAs)及SCD活性均较正常儿童升高(P<0.05);1岁以后,血浆油酸(oleate acid,C18∶1n-9)亦较正常儿童明显升高(P<0.05)。相关性分析显示,儿童血浆C16∶1与SCD活性呈正相关(P<0.001),肥胖儿童BMI与SCD活性呈正相关(P<0.01)。结论:随着年龄的增长,肥胖儿童血浆MUFA水平紊乱情况逐步加重,这种变化可能是机体为降低血脂水平、以及抵抗其它病理生理反应而进行的适应性调节现象。     

生长抑素对溃疡性结肠炎患者炎症反应及氧化应激的调节作用

目的 探讨生长抑素对溃疡性结肠炎(UC)患者炎症因子和氧化应激的改善作用.方法 收集2019年1—12月法库县卫生健康服务中心收治的活动期U C患者40例,随机分为对照组和观察组各20例.对照组采用常规治疗方案,观察组在其基础上加用生长抑素,0.1 mg/次,1次/8 h,两组均治疗14 d.比较两组治疗后炎症水平和氧...     

危重症病人肠内营养支持治疗并发症的护理

随着人们对肠内营养(EN)支持治疗重要性的认识,EN支持治疗已广泛应用于临床.EN不仅能为病人提供营养物质,而且还具有免疫调控、减轻氧化应激、维护胃肠的结构和功能、降低炎性反应等作用[1].但危重症病人在实施EN过程中,常会发生一些并发症.文献报道较多的有病人不耐受EN而引发的胃肠道并发症,如腹痛、腹胀、腹泻和呕吐等,而一些与病人医疗护理安全密切相关的并发症也常有发生.为进一步引起医护人员的重视,现做如下总结.     

危重病人早期肠内营养的临床应用分析

目的:分析早期肠内营养在危重病人中的临床应用状况. 方法:回顾3年半中住ICU>10天的278例病人资料,分析各类病种及各种途径早期肠内营养的实施情况,观察开始时间、达到营养目标点时间、并发症等. 结果:87.1%的危重病人可早期给予肠内营养,早期肠内营养开始时间、达到营养目标点时间与营养途径有关. 结论:早期肠内营养在危重病人中可以实施,并可能有助于降低病死率.     

Dietary virgin olive oil protects against lipid peroxidation and improves antioxidant status in the liver of rats chronically exposed to ethanol

Excessive ethanol intake induces severe tissue damage particularly in the liver through the generation of reactive oxygen species. The aim of this study was to determine the effect of a virgin olive oil–rich diet on oxidative stress induced by chronic ethanol exposure in rats. Wistar rats were treated daily with a 35% ethanol solution for 6 weeks and fed with a standard chow or a diet containing 5% virgin olive oil. By administering ethanol to rats, a severe toxicity occurred in their liver, as assessed by the significantly elevated levels of serum transaminases. The hepatic malondialdehyde level, indicator of lipid peroxidation, was also increased in ethanol-treated rats, whereas the hepatic antioxidant enzyme activities, namely, superoxide dismutase, glutathione peroxidase, and catalase were significantly reduced. The activity of glutathione reductase remained unchanged in rats. Fatty acid composition of the liver was also significantly changed with ethanol intake. In contrast, virgin olive oil intake during ethanol treatment in rats resulted in a higher antioxidant activity and inhibited toxicity to the liver, as monitored by the reduction of transaminases levels and hepatic lipid peroxidation. Rats showed a better profile of the antioxidant system with normal glutathione peroxidase activity and ameliorated superoxide dismutase and catalase activities. In conclusion, results of this study indicate that olive oil ingestion by rats protects the liver from ethanol-induced oxidative damage by affecting the cellular redox potential.     

危重病人留置鼻空肠管行早期肠内营养

目的:探讨留置螺旋形鼻空肠管行早期肠内营养在危重病人中的应用价值.方法:对该院ICU收治的30例危重病人随机分为A组和B组,每组各15例.分别留置螺旋形鼻空肠管和鼻胃管进行早期肠内营养.入科后第1天和第8天分别测定血液T淋巴细胞亚群变化,并进行比较.结果:入科后第1天,A、B组间CD3 、CD4 和CD4 /CD8 ,差异无显著性意义(P＞0.05);第8天A组CD3 、CD4 和CD4 /CD8 比第1天均显著增加(P＜0.05),惟CD8 无显著差异(P＞0.05);而B组上述指标无明显变化(P＞0.05).当天两组间CD3 、CD4 和CD4 /CD8 也存在显著差异(P＜0.05),惟CD8 无显著差异(P＞0.05).而且A组胃内潴留、急性胃黏膜病变等并发症显著减少(P＜0.05);A组在ICU时间较B组缩短(P＜0.05).结论:危重病人留置鼻空肠管行早期肠内营养对细胞免疫有积极影响,能减少并发症的发生,并能缩短入住ICU的时间.     

含橄榄油的新型脂肪乳剂对危重症病人免疫功能和炎性反应的影响

目的:通过对危重症病人分别应用含有橄榄油的新型脂肪乳与传统的中/长链脂肪乳,比较两种脂肪乳剂对病人免疫功能和炎性反应的影响. 方法:将50例入住ICU行肠外营养(PN)支持7d以上的危重症病人(APACHEⅡ评分＞12分),按前瞻、随机、对照原则分为研究组和对照组,两组病人按等氮、等热量进行全胃肠外营养(TPN)支持.于TPN前1d和TPN后第7天检测血清蛋白质、免疫和炎症指标. 结果:①TPN后两组病人的血清前清蛋白、视黄醇结合蛋白、转铁蛋白明显增加,与TPN前比有显著性差异(P＜0.05).②TPN后两组病人的C-反应蛋白下降,血总淋巴细胞计数、T淋巴细胞亚群中的T辅助性淋巴细胞(CD4)、T辅助性淋巴细胞/抑制性淋巴细胞(CD4/CD8)比值升高,研究组与对照组比有显著性差异(P＜0.05). 结论:含橄榄油的新型脂肪乳剂能提高危重症病人的免疫功能和降低炎性反应.     

危重症患儿胃肠功能衰竭诊断指标价值的探讨

目的 探讨危重症患儿胃肠功能衰竭不同实验室诊断指标的价值.方法 76例危重症患儿,合并胃肠功能衰竭48例,测定其血浆D-乳酸、血清及尿液肠型脂肪酸结合蛋白(IFABP)浓度,筛选出对胃肠功能衰竭诊断有价值的指标,计算其灵敏度、特异度及ROC曲线下面积,比较其诊断价值.结果 血浆D-乳酸浓度≥9.63 mg/L,诊断危重症胃肠功能衰竭的灵敏度为85.2%,特异度为70.9%,ROC曲线下面积为0.822;血清IFABP浓度≥0.129μg/L,诊断危重症胃肠功能衰竭的灵敏度为65.2%,特异度为63.8%,ROC曲线下面积为0.744;尿液IFABP浓度≥0.330μg/L,诊断危重症胃肠功能衰竭的灵敏度为78.3%,特异度为72.3%,ROC曲线下面积为0.820.血清及尿液IFABP浓度ROC曲线下面积比较差异无统计学意义(P＞0.05);血浆D-乳酸浓度与血清IFABP浓度ROC曲线下面积比较差异无统计学意义(P＞0.05).结论 血浆D-乳酸、血清及尿液IFABP对危重症患儿胃肠功能衰竭有诊断价值,但血浆D-乳酸、尿液IFABP可能更适合于临床.     

α-tocopherol concentrations, lipid peroxidation and superoxide dismutase and glutathione peroxidase activities in rat heart and liver after feeding stabilized and unstabilized fish oil

To further examine the relationship between increased consumption of n-3 polyunsaturated fatty acids (PUFAs), antioxidant defence systems and lipid peroxidation, for 6 weeks adult male rats were fed fish oil (FO)-rich diets containing one of two levels of α-tocopherol (4.5 or 1.9 IU vitamin E/g fish oil) either with or without the addition of the antioxidant mix PUFANOX® in order to stabilize the FO; rats fed corn oil or butter served as controls. Feeding FO resulted in increased proportions of the n-3 PUFAs eicosapentaenoic and docosahexaenoic acids in the phospholipids of the plasma, myocardium and liver. Rats fed the PUFANOX®-stabilized FO had higher plasma, myocardial and liver α-tocopherol concentrations compared to those fed the unstabilized FO; α-tocopherol concentrations were highest in rats fed the higher level of α-tocopherol in combination with PUFANOX®. FO feeding increased lipid peroxidation in myocardial and liver extracts. This was highest after feeding the FO diet which contained the lower amount of α-tocopherol and no PUFANOX® and was positively correlated with the n-3 PUFA content of the phospholipids. FO feeding did not alter myocardial and liver superoxide dismutase activity. Myocardial glutathione peroxidase activity was lower after feeding FO, except that containing the higher amount of α-tocopherol plus PUFANOX®. Glutathione peroxidase activity in the liver was lower after FO feeding than after corn oil with no significant differences among the different FO diets. Thus, insufficient antioxidant protection in FO results in decreased antioxidant defences and increased lipid peroxidation. Increasing the content of α-tocopherol and including a stabilizing agent (e.g. PUFANOX®) in FO can prevent at least some of these effects. The results of the present study do not support the idea that intake of FO, by increasing tissue lipid peroxidation, induces the body’s antioxidant defence system.     

高血糖与外科危重病人预后的相关分析

目的:通过分析外科危重病人高血糖与机械通气时间、SICU入住时间、医院内感染发生率以及病死率的关系以探讨高血糖与外科危重病人预后的关系. 方法:采用回顾性研究方法,测定572例病人晨起空腹血糖, 以7.78 mmol/L为临界将病人分为两组,即A组(>7.78 mmol/L);B组(≤7.78 mmol/L),比较两组的机械通气时间,SICU入住时间,医院内感染发生率,同时统计病人28天内病死率. 结果:A组的机械通气时间、SICU入住时间和医院内感染发生率均高于B组(P<0.01).病人血糖水平与病死率具有相关性,血糖水平越高,病死率越高(P<0.05). 结论:高血糖与外科危重病人预后密切相关.     

Maternal Supplementation with Cow’s Milk Naturally Enriched with PUFA Alters the Metabolism of Sows and the Fatty Acid Profile of the Offspring

The study aimed to evaluate the supplementation of gilts with cow’s milk naturally enriched with n-3 and n-6 polyunsaturated fatty acids (PUFA) on reproductive outcomes, and the serum biochemical and FA profile of swine females and their offspring. During 316 days, 30 gilts were distributed into three groups: (1) Control, fed a basal diet + milk from cows without oil; (2) n-3, fed a basal diet + milk from cows fed a diet enriched with linseed oil; (3) n-6, fed a basal diet + milk from cows fed a diet enriched with soybean oil. The gilts receiving the diets containing PUFA had higher serum urea and very-low-density lipoprotein levels and lower serum total protein and low-density lipoprotein levels compared to the Control group. Females supplemented with n-3 presented higher serum palmitic acid and γ-linolenic acid levels than those fed n-6. Piglets from the Control group were heavier at birth than those from females supplemented with enriched milk. The piglets from females receiving enriched milk had 140 g higher body weight from 1 to 21 days old compared to the Control group, and greater average daily weight gain from 7 to 14 days old. The serum eicosapentaenoic acid level of piglets fed n-3 was 69% higher than those fed n-6, which reduced the AA/EPA ratio. Gilts supplemented with PUFA-enriched cow’s milk showed changes in their serum palmitic and γ-linolenic acid levels, in addition to improved performance, EPA concentration and consequently reduced AA/EPA ratio in their piglets, demonstrating beneficial results for their progeny.