脓毒症病人血清微量元素改变与预后的关系

目的：研究微量元素铜、铁、锌硒在脓毒症疾病过程中的变化，探讨这些变化与疾病的严重度和预后的关系。 方法：选择３０例脓毒症病人作为治疗组，另选３０例健康人作为对照组。在脓毒症病人发病的第１、４、７、１４天测定血清铜、铁、锌、硒水平，同时评估脓毒症病人的ＡＰＡＣＨＥⅡ评分。血清铜、铁、锌的检测采用原子吸收光谱火焰法，血清硒的检测采用原子吸收光谱氢化物发生法。 结果：①脓毒症病人血清铜水平明显升高，存活     

微量元素锌硒与免疫

微量元素与人类疾病的相关性已日益受到重视。大量的研究证实：锌、硒元素的不足与过量，均可导致免疫系统功能的严重紊乱。研究锌、硒元素对机体免疫功能的影响，既有助于对疾病成因的分析，又可从免疫药理学角度及时、合理的补充微量元素，发挥其免疫调节的正向作用，达到防治疾病的目的，故具有广泛的理论和应用价值。     

微量元素铁锌铜硒铬含量与新生儿体重的关系

应用火焰原子吸收分光光度法（ＦＡＡＳ）检测１１８例临产孕妇的血清及其新生儿脐血清以及分娩后胎盘组织中铁、锌、铜、硒、铬的含量。结果表明，新生儿脐血清及胎盘组织中铁含量，与新生儿体重有关；孕妇血清、新生儿脐血清及胎盘组织中锌含量，与新生儿体重无相关性；孕妇血清中铜含量，与正常体重儿体重呈明显负相关；新生儿脐血清中硒含量低，有可能是发生低体重儿的一个因素；胎盘组织中铬含量，与正常体重儿体重呈负相关。     

微量元素与肝癌

1　硒肝癌高发区启东市多次研究表明 ,肝癌发病率 (死亡率 )与机体内外环境的硒水平呈负相关。但世界上有些地区虽低硒但肝癌发病率并不增加 ,提示缺硒可能不是肝癌的直接原因。也只有当环境中存在大量致癌物质时 ,肝癌才高发。据报道 〔1〕硒对 Novikoff肝癌等肿瘤细胞有抑制效应 ,证实硒能阻碍或完全抑制各种移植性癌细胞的增殖。在启东进行的鸭肝癌实验研究表明 ,在饲料中加入 0 .5～ 2 .0 μg/ kg亚硒酸钠 ,明显降低癌前变异肝细胞灶和结节的发生。大鼠在 AFB1 致癌作用下 ,当服用富硒麦芽能使谷胱甘肽硫转移酶 (GST)活性升高而起解…     

妊娠丢失与微量元素的关系

[目的]观察了解早期妊娠丢失与血微量元素锌(Zn)、铜(Cu)、铁(Fe)、锰(Mn)、铅(Pb)及钙(Ca)离子的关系；[方法]测定110例妊娠丢失者及90例正常早期妊娠孕妇血清Zn、Cu、Fe、Mn、Pb及Ca离子的含量。[结果]组两测量结果相比较，①病例组血Fe较低(F＝4．205，P＝0．04)；血Zn也较低(F＝3．685，P＝0．05)；②综合两种元素(Fe、Zn)看，多因素分析Hotelling T^2检验结果：精确F＝3．409，P＝0．035，两组差异显著，病例组表现为Fe、Zn偏低，而Cu偏高。[结论]早孕期孕妇血Fe、Zn含量的降低，与妊娠丢失的发生有一定关系。     

充血性心力衰竭与血清微量元素铜、铁、锌、硒、镁含量相关性的研究

1 对象与方法1.1 对象选择 心衰组为本院住院充血性心力衰竭病人36例,其中男性28例、女性8名,年龄40～66岁;对照组为佳木斯地区身体健康、体检无其它疾病的人群70例。1.2 测定方法 取患者、健康者晨空腹静脉血3～4ml置预先经HNO_3、去离子水清洁处理并干燥的试管中(严禁溶血),离心(3000r/min)分离出全部血清。然后取上清亮血清1ml置5ml具塞刻度试管中,用0.14mol/L HNO_3定容,供Cu、Fe、Zn、Se测     

吸烟对某些微量元素及相关抗氧化酶活性的影响

调查了吸烟者体内抗氧化酶活性的改变是否依赖其辅助因子的浓度。测定吸烟者血浆硒、铜、锌、铁的浓度以及与其相关的抗氧化酶如铜－锌超氧化物歧化酶、过氧化氢酶和谷胱甘肽过氧化物酶的活性，并与非吸烟者相比较。测定血浆硫（代）氰酸盐的水平作为衡量吸烟严重程度的指标。结果显示，吸烟者血浆铜浓度和红细胞铜－锌超氧化物歧化酶活性明显高于非吸烟者，而血浆硒浓度和红细胞谷胱甘肽过氧化物酶活性明显低于非吸烟者，但两组血浆铁和锌的浓度及红细胞过氧化氢酶活性无显著差别。吸烟者的红细胞谷胱甘肽过氧化物酶和血浆硒、铜－锌超氧化物歧化酶和铜及过氧化氢酶活性和铁的浓度之间存在明显的正相关，而血浆硫（代）氰酸盐水平与硒浓度之间存在负相关。结论为：吸烟者体内抗氧化酶类活性的改变依赖于它们的辅助因子。     

特殊营养物质:微量元素监测

简要介绍了目前广泛用于诊断某些特殊微量元素（铬、铜、铁、锰、钼、硒、锌）缺乏的实验室检测技术。     

Diarrhea in Critically Ill Patients

This tutorial presents a systematic approach to the management of diarrhea in the critical care setting. Diarrhea is a common and prevalent problem in critically ill patients. Despite the high prevalence, its management is far from simple. Professionals are confronted with a myriad of definitions based on frequency, consistency, and volume. The causes are complex and multifactorial, yet enteral tube feeding formula is believed to be the perpetrator. Potential causes for diarrhea are discussed, and 3 case reports provide context to examine the treatment from a nutrition perspective. Each scenario is comprehensively addressed discussing potential causes and providing specific clinical strategies contributing to improved bowel function in this patient group. The approach used for diarrhea management is based on a complete understanding of enteral tube formula, their composition, and their impact in the presence of gut dysfunction. Choosing the right feeding formula may positively influence bowel function and contribute to improved nutrition.     

Advances in Trace Element Supplementation for Parenteral Nutrition

Parenteral nutrition (PN) provides support for patients lacking sufficient intestinal absorption of nutrients. Historically, the need for trace element (TE) supplementation was poorly appreciated, and multi-TE products were not initially subjected to rigorous oversight by the United States Food and Drug Administration (FDA). Subsequently, the American Society for Parenteral and Enteral Nutrition (ASPEN) issued dosage recommendations for PN, which are updated periodically. The FDA has implemented review and approval processes to ensure access to safer and more effective TE products. The development of a multi-TE product meeting ASPEN recommendations and FDA requirements is the result of a partnership between the FDA, industry, and clinicians with expertise in PN. This article examines the rationale for the development of TRALEMENT^® (Trace Elements Injection 4*) and the FDA’s rigorous requirements leading to its review and approval. This combination product contains copper, manganese, selenium, and zinc and is indicated for use in adults and pediatric patients weighing ≥10 kg. Comprehensive management of PN therapy requires consideration of many factors when prescribing, reviewing, preparing, and administering PN, as well as monitoring the nutritional status of patients receiving PN. Understanding patients’ TE requirements and incorporating them into PN is an important part of contemporary PN therapy.     

Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients

Background

Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self‐propelled spiral nasoenteric tube is quite low.

Methods

This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self‐propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x‐ray scan 24 hours after tube insertion. Chi‐square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models.

Results

Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model.

Conclusion

Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self‐propelled spiral nasoenteric tube insertion.     

急诊危重患者院内安全转运探讨

急诊危重患者由于病情特殊性具有较大的潜在危险性，院内转运其救治效果机会和风险是并存的。采取有效护理措施维持患者生命体征的稳定、减少并发症，保证患者安全、顺利地到达目的科室。     

微量元素和人体免疫功能

微量元素对正常免疫功能的维持具有重要作用。反复感染时不仅有免疫功能受损，而且伴有多种微量元素缺乏或失衡，临床上及时补充多种维生素、微量元素制剂，能改善免疫功能，防治反复感染。     

Calorie Intake of Enteral Nutrition and Clinical Outcomes in Acutely Critically Ill Patients

Background: The appropriate calorie intake to be provided to critically ill patients via enteral nutrition (EN) remains unclear. We performed a meta‐analysis of randomized controlled trials to compare the effect of initial underfeeding and full feeding in acutely critically ill patients. Materials and Methods: We searched the Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared underfeeding with full feeding in critically ill patients. The primary outcome was overall mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, duration of mechanical ventilation, incidence of pneumonia, Clostridium difficile colitis, other infectious complications, and gastrointestinal intolerance. Results: In total, 4 studies were included in this meta‐analysis. There was no significant difference in overall mortality between the underfeeding and full‐feeding groups (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.74–1.19; I² = 26.6%; P = .61). Subgroup analysis of the underfeeding subgroup that was fed ≥33.3% of the standard caloric requirement indicated that overall mortality was significantly lower in this underfeeding subgroup than in the full‐feeding group (OR, 0.63; 95% CI, 0.40–1.00; I² = 0%; P = .05). In contrast, no difference in overall mortality was noted between the underfeeding subgroup that was fed <33.3% of the standard caloric requirement and the full‐feeding group. The length of hospital stay and length of ICU stay did not differ between the 2 groups. Moreover, no differences in other secondary clinical outcomes were noted. Conclusions: None of the analyzed clinical outcomes for the acutely critically ill patients were significantly influenced by the calorie intake of the initial EN.     

危重患者抗氧化维生素血浆水平观察

目的了解危重患者体内抗氧化维生素水平。方法2002年5月～2003年2月间新华医院外科ICU收治的112例危重患者,采用高效液相法测定体内抗氧化维生素水平。结果112例危重患者抗氧化维生素水平明显低于正常对照组眼维生素A:(33.8±25.1)μg/dLvs(78.2±31.2)μg/dL,P=0.000;维生素E:穴6.5±4.4雪mg/Lvs(10.1±6.2)mg/L,P=0.000;β-胡萝卜素:(184±185)μg/Lvs(756±794)μg/L,P=0.000;维生素C:(5.0±4.2)mg/Lvs(6.7±3.9)mg/L,P=0.000演。危重患者中各维生素缺乏症发生率高于正常人,分别为维生素A:25.9%vs0%(P=0.000);维生素E:44.6%vs17.0%(P=0.000);β-胡萝卜素:46.4%vs12.8%(P=0.000);维生素C:62.5%vs31.2%(P=0.000)。危重患者中男性维生素A水平明显高于女性眼分别为(38.8±26.2)μg/dLvs(26.2±21.5)μg/dL,P=0.012演,且随年龄增长,维生素A水平显著降低(r=-0.234,P=0.015)。抽血日前禁食天数>7d组患者与≤7d组患者相比,各抗氧化维生素呈下降趋势,但无统计学差异。结论危重患者血浆维生素A、E和β-胡萝卜素水平明显低于正常人,且该人群中抗氧化维生素缺乏非常普遍。     

Feasibility of Implementing a Reduced Fasting Protocol for Critically Ill Trauma Patients Undergoing Operative and Nonoperative Procedures

Background: This prospective, observational cohort study was designed to determine the feasibility of implementing a reduced enteral fasting protocol in mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures. Methods: Critically ill, mechanically ventilated trauma patients undergoing selected operative and nonoperative procedures received enteral nutrition up until the time of the procedure, if receiving small bowel feeds, or received enteral nutrition that was discontinued 45 minutes before the procedure, if receiving gastric feeds. Results: Measures of delivery of nutrition such as total enteral nutrition delivered and days required to reach nutrition goal were collected. Complications measured were death, incidence of ventilator‐associated pneumonia, urinary tract infection, catheter‐related bloodstream infection, wound infection, hypoglycemia, and emesis during procedures. No significant demographic differences were observed between the 2 groups. Patients in the intervention group showed trends toward greater total enteral nutrition delivered and faster attainment of target nutrition goals, although these measures were not statistically significant. Patients in the intervention group had rates of infective complications similar to those in the standard group. The median (interquartile range) for intensive care unit length of stay in the intervention group vs standard group was 7 (5, 15) vs 7 (5, 12) (P = 0.94), and the ventilator days were 8 (4.2, 14) vs 7 (3, 11) (P = 0.37). Conclusions: A reduced fasting protocol was feasible for selected operative procedures, with trends toward improving nutrition delivery and no increase in adverse outcomes. A larger randomized study of this approach is warranted before adoption of this practice can be advocated.