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目的:评价急性重症胰腺炎患者早期肠内外营养支持有无差异。方法:将我院近两年收治的急性重症胰腺炎患者39例分为早期肠内营养组(EN组13例)和早期肠外营养组(TPN组14例),对照组(12例)。在常规治疗基础上,EN组早期留置液囊空肠营养管行空肠营养,TPN组早期行静脉高糖氨基酸治疗,对照组早期未行肠内外营养支持。分别在治疗1、2、3周后比较三组总胆红素、WBC、APACHEⅡ评分、Ranson评分和C-反应蛋白(CRP)、血淀粉酶、尿淀粉酶恢复时间、白蛋白变化情况,于出院时比较感染并发症率、病死率、平均住院时间等。结果:三组患者APACHEⅡ评分和Ranson评分差异无统计学差异;第2周时,EN组及TPN组白细胞和CRP水平显著低于对照组,第2、3周时.EN组和TPN组血清白蛋白水平明显高于对照组(P〈0.05);EN组及TPN组感染率、感染并发症、平均住院时间明显低于对照组(P〈0.05),EN组更优,但TPN组肠胀气及消化道出血发生率低于EN组及对照组,尤其是较高龄人群。结论:早期营养支持可以显著改善急性重症胰腺炎患者营养状况,缩短病程、减低感染率、病死率、并发症发生率。但针对不同年龄人群,可选择不同营养支持方法。 相似文献
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重症急性胰腺炎并发胰性脑病的护理 总被引:1,自引:0,他引:1
目的:探讨提高重症胰腺炎合并胰性脑病的救护成功率的方法。方法:根据患者具体情况,按照个体化的原则,严密观察病情,合理营养支持,加强基础护理,减少并发症发生。结果:本组17例,死亡8例,治愈5例,好转4例。结论:重症急性胰腺炎并发胰性脑病,预后差,需严密观察病情,精心护理,加强营养支持,预防并发症。提高生存质量。 相似文献
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重症急性胰腺炎术后营养支持的观察与护理 总被引:1,自引:0,他引:1
目的 探讨重症急性胰腺炎患者术后进行营养支持的观察与护理要点.方法 术后早期实施完全胃肠外营养,一旦患者胃肠功能恢复,血、尿淀粉酶正常,病情得以控制,就可由肠外营养向肠内营养过渡,尽早实施全肠内营养.观察营养指标及营养支持并发症.结果 10例患者实施营养支持后血总蛋白、白蛋白均高于营养支持前.营养支持期间,发生高血糖1例、胃返流1例、腹胀1例、腹泻2例、空肠造瘘管堵塞1例.以上均被及时发现和处理,无不良后果.未发生误吸.结论 重症急性胰腺炎患者术后进行营养支持可明显改善患者营养状况,护理工作中严密观察、预防和及时处理并发症是营养支持顺利实施的保证. 相似文献
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重症急性胰腺炎营养支持治疗的效果观察 总被引:2,自引:0,他引:2
目的探讨重症急性胰腺炎经鼻肠管肠内营养的效果。方法将患者分为治疗组和对照组。治疗组(肠内营养组,n=41)采用留置鼻肠管,肠功能恢复后经鼻肠管滴百普力1000-1500ml/d;对照组(肠外营养组,n=40)行TPN治疗,以全营养混合液形式,配成3L袋,经中心静脉途径持续均匀输注。两组患者均于营养支持前和营养支持10d后测体重和上臂肌围(AMC),采集外周静脉血监测血清白蛋白(ALB)、血红蛋白(Hb)和血淀粉酶,并观察并发症。结果治疗组与对照组比较,并发症的发生差异有显著意义(P〈0.05)。治疗组(EN组)患者营养支持10d的血红蛋白(Hb)、血清白蛋白(ALB)水平较TPN组明显升高(P〈0.05)。结论重症急性胰腺炎早期肠内营养治疗能有效改善机体营养状况,提高免疫力,减少并发症,节省费用,值得临床推广。 相似文献
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重症急性胰腺炎病人早期肠内营养的探讨及护理 总被引:1,自引:0,他引:1
目的:探讨重症急性胰腺炎病人早期肠内营养。方法:对15例重症急性胰腺炎病人(SAP)行早期肠内营养(EN)进行回顾性分析。结果:及时充分的营养支持虽不能改变SAP的病理过程及病情发展,却可以使患者较顺利地渡过并发症期。结论:EN有利于SAP患者肠道粘膜及其功能的完整性,有助于胰腺的修复。 相似文献
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余芳芳 《实用中西医结合临床》2021,21(21):24-25,65
目的:分析大黄灌肠联合早期鼻空肠营养支持治疗重症急性胰腺炎的临床价值。方法:选取2017年6月~2020年6月收治的98例重症急性胰腺炎患者,按照随机数字表法分为对照组49例和观察组49例。对照组接受早期鼻空肠营养支持治疗,观察组在对照组基础上加用大黄灌肠辅助治疗,比较两组营养状况、胃肠道功能及炎症指标。结果:治疗1周后,观察组血清白蛋白(ALB)、转铁蛋白(TRF)和前白蛋白(PA)水平均高于对照组,差异有统计学意义(P<0.05);观察组腹胀缓解时间、肠鸣音恢复时间及排便时间均短于对照组,差异有统计学意义(P<0.05);观察组血清白介素-6(IL-6)、C反应蛋白(CRP)、白细胞计数以及血清淀粉酶(AMS)水平均低于对照组,差异有统计学意义(P<0.05)。结论:大黄灌肠联合早期鼻空肠营养支持治疗不仅可以有效改善重症急性胰腺炎患者营养状况,还可促进患者胃肠道功能恢复,降低患者体内炎症水平。 相似文献
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母乳性黄疸的识别与处理 总被引:6,自引:1,他引:5
目的 探讨母乳性黄疸的诊断和治疗。方法 对102例母乳性黄疸婴儿的临床表现、实验室检查及治疗进行回顾性分析。结果 ①患儿的黄疸出现时间为生后2~15d,平均4.64d±2.76d,黄疸高峰时间为5~20d,平均9.22d±5.14d,停母乳2~5d或加光疗等治疗后黄疸消退的时间为生后2wk~10wk,平均32.60d±15.72d,无核黄疸发生;②排除了导致黄疸的其他病理因素;③患儿血清胆红素呈不同程度增高,均以未结合胆红素增高为主,其中血清总胆红素<205.2μmol/L56例,205.3μmol/L~256.4μmol/L29例,256.5μmol/L~341.9μmol/L13例,>342.6μmol/L4例,血清总蛋白轻度降低者48例,占总数的47.06%。结论 母乳性黄疸的诊断要点①排除了各种黄疸的病因;②高胆红素血症;③停母乳2~5d后黄疸迅速减轻或消退或血清胆红素迅速下降40%~50%以上;近半数患儿血清总蛋白轻度降低,可能与本病的发生存在一定的关系。本病治疗简便,临床经过及预后均良好。 相似文献
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动脉化疗栓塞治疗恶性梗阻性黄疸 总被引:4,自引:0,他引:4
目的:探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效,研究影响黄疸复发时间和患者生存期的预后因素。方法:51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE),观察手术并发症,血清胆红素下降程度,随访黄疸复发时间和患者生存期。分析性别,年龄,肿瘤类型,术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度,梗阻时间,梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果:51例共计放置支架64枚,行TACE术86次,技术成功率为100%。1例于术后1个月死亡,在治疗过程中,4例出现肝脓肿。4例失访,51例生存期为1~34个月,平均9.0个月,中位值8.0个月。22例黄疸复发,复发率43.2%,黄疸复发时间2~14个月,平均11.0个月,中位值9.0个月。单因素(P=0.010)和多因素(P=0.010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0.035)。结论:MOJ患者放置胆道支架后进行TACE术,可以延缓黄疸复发,延长患者生存期。术前血清总胆红素浓度高的患者生存期较短;肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长,黄疸复发率亦低于后者。 相似文献
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Serum gamma-glutamyl transferase (GGT, EC. 2.3.2.2. was measured in 173 patients with diseases of the hepatobiliary system (including metastatic cancer) and in 90 patients who were subsequently shown to have primary diseases of other etiology. All patients had been selected because they had abnormal alkaline phosphatase, aspartate aminotransferase or bilirubin on SMA 12/60 screening. Serum GGT was elevated in 97% of patients with primary hepatobiliary disease. The magnitude of the increase in GGT was variable in all groups and was unhelpful in differential diagnosis, even between medical and surgical cases. Moreover, GGT was abnormal in 69 patients who did not have primary hepatobiliary disease (77%), an incidence higher than that for other enzyme tests performed. We conclude that because GGT was more susceptible than other tests to spurious elevation in the absence of hepatobiliary disease and was unhelpful in differential diagnosis, it has little value apart from monitoring alcohol abuse and enzyme induction. 相似文献
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目的:探讨阻塞性黄疸血清白介素-18的变化及其临床意义。方法:将37例阻塞性黄疸患者及16例总胆红素正常病人分别分组。(1)按良恶性分为:良性阻塞性黄疸组25例、恶性阻塞性黄疸组12例、对照组16例。(2)按总胆红素高低分为:低胆红素组21例(总胆红素≤85.5mmol/L),高胆红素组16例(总胆红素>85.5mmol/L),对照组16例。分别抽血测定:总胆红素、白蛋白、球蛋白、IgG、IgA、IgM,补体CH50、C3、C4、白介素-18等。结果:良性阻塞性黄疸组、恶性阻塞性黄疸组、低胆红素组、高胆红素组的白介素-18、IgA较对照组升高,IgG、补体CH50、C3较对照组降低。白介素-18与IgG、CH50、C3呈负相关。结论:阻塞性黄疸病人白介素-18水平升高具有重要意义,可能对机体的免疫功能产生一定影响。 相似文献
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目的探讨胆道闭锁Kasai手术的治疗效果、判断标准和预后。方法对2009年3月至2010年3月在我院行Kasai手术后存活2年以上22例Gross分型III型胆道闭锁患儿的肝功能、胆管炎是否发作、B超肝纤维化评分、食道吞钡、病原学检查以及T细胞功能测定进行随访。结果22例均获得胆红素完全消退,黄疸完全消退时间为(4.64±1.33)周;17例转氨酶(ALT)正常,5例未降至正常;胆管炎发作2例,分别为术后2周和5周;5例出现超声肝纤维化评分增高;吞钡未出现食管静脉曲张病例;7例检出明确病毒抗体阳性;7例存在细胞免疫异常(CD8+增高,CD4/CD8值下降)。肝功能、病原感染以及免疫机制与肝纤维化存在相关性(P〈0.05)。结论胆道闭锁Kasai术后获得良好的胆汁引流和胆红素的完全消退是决定生存的条件,黄疸术后约6周完全消退者预后较好。良好的胆汁引流和合理的术后预防用药可避免和减少胆管炎的发生。长期生存患儿仍有部分出现肝纤维化活动,与病毒感染活动和免疫机制异常有关。 相似文献
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冯珊 《国际检验医学杂志》2012,33(4):422-423
目的 观察高间接胆红素血症新生儿心肌损伤标志物治疗前后变化,探讨高间接胆红素血症新生儿是否存在心肌损伤.方法 分别测定30例无黄疸新生儿(健康组)与42例高间接胆红素血症患儿(观察组)治疗前后血清总胆红素(TBIL)、直接胆红素(DBIL)及磷酸肌酸激酶同工酶(CK-MB)、肌红蛋白MYO、肌钙蛋白(CTNI)、乳酸脱氢酶(LDH)活性,比较3组数据之间的差异.结果 观察组与健康组比较,CK-MB、CTNI活性明显升高,差异有显著性(P<0.05);对比观察组治疗前与治疗后,治疗后胆红素及心肌损伤各指标显著降低 (P<0.05).结论 高间接胆红素血症的确有一定的心肌损伤,提示临床医生这种心肌损伤是可逆的,对于间接胆红素过高的患儿有必要进行心肌损伤标志物监控,注意对心肌的保护与治疗,预防心肌损伤. 相似文献
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Non-resolving jaundice: bilirubin covalently attached to serum albumin circulates with the same metabolic half-life as albumin 总被引:1,自引:0,他引:1
In hepatobiliary disease and biliary obstruction, bilirubin often becomes covalently bound to albumin circulating in serum, producing a nondissociable complex. To determine how long this complexed bilirubin remains in the circulation, we compared the metabolic clearance of bilirubin-albumin complexes with the clearances of free bilirubin and unmodified albumin. Radiolabeled bilirubin, albumin, and covalent bilirubin-albumin were injected into the circulation of Sprague-Dawley rats and serial samples of plasma were analyzed for the injected compounds. The half-life of bilirubin was 6.2 min. The half-life of bilirubin covalently bound to rat serum albumin was 1.9 to 2.1 days, identical to that of unmodified rat albumin. We conclude that bilirubin covalently attached to albumin is maintained in the circulation with the long half-life of albumin rather than the short half-life of bilirubin. Because albumin in humans has a half-life of 19 days, covalent attachment of bilirubin to human albumin could result in persistence of hyperbilirubinemia long after the resolution of disease. 相似文献
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T Chiba I Mochizuki M Hanamatsu R Ohi M Kasai 《The Tohoku journal of experimental medicine》1985,146(1):17-25
In biliary atresia, one-fourth of the patients showed prolonged jaundice in spite of a good excretion of bile after surgery. To investigate the cause of jaundice, factors related to the serum bilirubin level were examined in 28 recent cases. Furthermore, clinical analysis was performed in 86 cases of good excretion of bile after surgery. The following results were obtained: The daily amount of bilirubin excretion in bile and bilirubin concentration play an important role in decreasing the serum bilirubin level. The most important factor for prolonged jaundice is ascending cholangitis. Shortening of the life span of the red blood cells is one of the causes of prolonged jaundice. 相似文献
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Origin of mammalian biliprotein and rearrangement of bilirubin glucuronides in vivo in the rat. 总被引:2,自引:3,他引:2
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In hepatobiliary disease bilirubin becomes bound covalently to serum albumin, producing a nondissociable bile pigment-protein complex (biliprotein). To elucidate the mechanism of biliprotein formation we studied the bile pigment composition of blood from animals with experimental cholestasis and carried out comparative studies on the rate of biliprotein formation in vivo and in vitro during incubation of bilirubin glucuronides with albumin. Bile duct ligation in the rat and guinea pig led to rapid accumulation in the circulation of bilirubin, heterogeneous bilirubin esters of glucuronic acid, and a biliprotein that migrated along with albumin on high performance liquid chromatography. When the obstruction was removed, biliprotein remained longer in the circulation than did the other bile pigment species. Biliprotein and heterogeneous bilirubin esters of glucuronic acid were not formed in bile duct-ligated homozygous Gunn rats but they were formed when bilirubin glucuronides were incubated with Sprague-Dawley rat serum or human serum albumin at 37 degrees C in vitro. Bilirubin glucuronide rearrangement in vitro was accompanied by nonenzymic hydrolysis. We conclude that the formation of biliprotein in vivo is probably nonenzymic and suggest that mammalian biliprotein is formed by acyl migration of bilirubin from a bilirubin-glucuronic acid ester to a nucleophilic site on albumin. 相似文献
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Summary Serum bile acid measurements now available by radioimmunoassay have proven to be the most sensitive procedure developed to
assess diseases of the hepatobiliary system in both adult and pediatric liver disease. Their clinical utility appears to hold
particular promise in SGOT, alkaline phosphatase, bilirubin and albumin are still normal. Serum bile acid determinations have
been shown to be particularly useful in the diagnosis of alcoholic liver disease, drug-induced liver disease, viral hepatitis
and cholestasis of intra- and extrahepatic origin. In infants, serum bile acid measurements can be used to establish the diagnosis
of biliary atresia. When serum bile acids are determined post-prandially, they are the most sensitive indicator of liver dysfunction
developed to date. 相似文献