营养支持的不同途径对重症急性胰腺炎治疗结局的影响

目的评价经鼻空肠内营养支持在重症急性胰腺炎(SAP)治疗中应用的安全性和有效性。方法通过鼻空肠管实施肠内营养(EN)支持加肠外营养(PN)15例,和完全胃肠外营养(TPN)25例进行比较。结果EN+PN组较TPN组的并发症少(6人次vs43人次,P<0.05),营养状况改善明显,胰腺感染(1人次vs7人次,P<0.05)和二重感染(0人次vs8人次,P<0.05)发生率低,住院时间短(24.20dvs35.46d,P<0.05),住院费用低(3.74万元vs5.82万元,P<0.05)。结论SAP患者实施EN支持是安全和有效的,对消化道功能的恢复,保护肠道粘膜屏障,防止感染,改善机体营养状况大有裨益,但需注意EN的时机。     

重症急性胰腺炎早期肠外营养与肠内营养支持对预后的影响

目的探讨早期肠外营养(PN)和早期肠内营养(EN)支持对重症急性胰腺炎(SAP)患者的疗效及预后的影响。方法选取我院2016年3月至2017年1月收治的58例SAP患者,随机分为PN组和EN组。观察两组患者治疗前及治疗2周后的ALB、CRP水平及APACHEⅡ评分,并比较两组患者的感染、MODS发生率及死亡率。结果治疗前,两组患者的ALB、CRP水平及APACHEⅡ评分比较均无统计学差异(P>0.05)。治疗后,EN组的ALB水平高于PN组,CRP水平及APACHEⅡ评分均低于PN组,差异有统计学意义(P<0.05)。EN组的感染、MODS发生率及死亡率均低于PN组(P<0.05)。结论与PN比较,早期EN支持对SAP患者具有更为显著的疗效。     

老年重症急性胰腺炎患者早期肠内营养与完全肠外营养疗效的比较

目的探讨早期肠内营养治疗对老年重症急性胰腺炎(severe acute pancreatitis,SAP)患者临床预后的影响。方法收集2008年9月—2014年9月本院收治的42例老年SAP患者,随机分为观察组(EN组),采用早期肠内营养,和对照组(PN组),采用完全肠外营养,对两组患者的外周血CRP、血清白蛋白、住院时间、住院费用、并发症发生率、胰周感染率进行统计分析。计数资料使用χ2检验,计量资料以±s表示,使用t检验,P0.05为差异有统计学意义。结果 EN、PN组患者住院时间分别为(15.5±3.1)、(18.43±2.6)d,住院费用分别为(1.4±1.2)、(2.1±1.5)万元,两组患者住院时间、住院费用比较差异均有统计学意义(均P0.05)。EN、PN组患者并发症发生率分别为4.55%、30%,胰周感染率分别为4.55%、25%,EN患者并发症发生率、胰周感染率小于PN组。两组患者在外周血CRP、血清白蛋白方面差异均无统计学意义(均P0.05)。结论早期应用肠内营养治疗缩短疾病病程,减少住院费用,降低并发症发生率。     

肠内与肠外营养对住院患者营养状况影响的研究

目的:比较肠内营养(EN)与肠外营养(PN)对住院患者营养状况的影响。方法:回顾性调查并比较北京和上海6所综合性医院的胃肠外科、心胸外科、消化内科、呼吸内科、神经内科、神经外科和重症监护病房接受EN或PN的1142例住院患者在营养支持前后体重(BW)、血红蛋白(Hb)和血清白蛋白(sALB)的变化。结果:两组BW、Hb及sALB在营养支持后均显著降低,EN组BW和sALB的下降差值显著低于PN组(BW:-1.58±2.36kgvs-2.09±2.66kg,P<0.002;sALB:-2.10±4.13g/Lvs-3.03±4.04g/L,P<0.001),而Hb的变化没有显著性意义。EN组低体重指数(BMI)和低白蛋白血症的患病率在支持后较PN组显著地降低(低体重指数:11.63%vs17.90%,P<0.01;低白蛋白血症:20.51%vs26.24%,P<0.01)。贫血的患病率在EN或PN后均增高,两组间差异无显著性意义。结论:与PN比较,EN在减少体重丢失和减少血清白蛋白降低方面,以及在改善住院患者营养不良患病率方面疗效基本一致或稍好。     

肠内营养联合肠外营养对结肠癌手术后患者免疫功能的影响

目的比较结肠癌术后肠内营养(EN)联合肠外营养(PN)与全肠外营养(TPN)对患者术后应激和免疫指标的影响。方法将64例结肠癌患者随机分成两组,术后分别接受肠内外联合营养(EN+PN)和全肠外营养(TPN),所有患者分别于术前1d和术后第1、第7d测定补体C3,IgA,IgM,IgG,CD3,CD4,CD8,CD4/CD8。结果 6d后补体C3,IgA,IgM,IgG,CD3,CD4,CD8,CD4/CD8的恢复程度,EN+PN组与TPN组差异有统计学意义(P0.05)。结论与TPN对比,联合使用EN和PN更能有效促进结肠癌术后机体免疫功能的恢复。     

重症急性胰腺炎早期肠内营养支持

目的 探讨早期肠内营养在重症急性胰腺炎(SAP)治疗中的安全性和有效性.方法 回顾性分析71例SAP患者临床资料,经综合治疗观察患者血清白蛋白、前白蛋白、TNF-α、CD4/CD8、IgG水平.随机分为肠内营养组(EN组,36例)和全肠外营养组(11PN组,35例).结果 EN组治疗后14 d患者血清CD4/CD8及IgC水平比TPN组明显升高(P＜0.05);EN组治疗后7、14 d时TNF-α水平与治疗前比较明显下降(P＜0.05),且与TPN组比较明显减少(P＜0.05);EN组治疗后血清前白蛋白水平较治疗前明显增高(P＜0.05),且与TPN组比较亦有显著性增高(P＜0.05).结论 早期肠内营养对SAP治疗是安全、有效的,可提高血清前白蛋白水平,改善其营养状况,增强肠道黏膜屏障,抑制炎性因子释放,增强患者的免疫功能,改善SAP的预后.     

不同方式营养支持对重症急性胰腺炎患者血浆内毒素水平的影响

[目的]探讨不同方式营养支持对重症急性胰腺炎患者血浆内毒素水平的影响。[方法]采用单纯随机抽样方法将符合入选标准的47例重症急性胰腺炎患者随机分为肠内营养联合肠外营养组(PN+EN组,n=24)和完全肠外营养(TPN组,n=23)。两组病人接受同样的基础治疗,所有病人均于营养支持前及营养支持后d3、d7、d10检测血浆内毒素(LPS)浓度,并观察并发症发生情况。结果EN+PN组治疗后血浆内毒素水平较治疗前逐渐降低,而TPN组较治疗前逐渐增高。治疗d7和d10EN+PN组显著低于TPN组,且差异有统计学意义(P﹤0.01)。PN+EN组的并发症发生率低于TPN组,且腹胀和腹泻发生率显著降低(P﹤0.05)。[结论]早期肠内营养可维持肠道黏膜屏障功能,显著降低SAP患者血浆LPS浓度,减少并发症发生。     

老年重症肺炎病人营养支持治疗的疗效观察

目的:探讨两种不同的营养支持治疗对老年重症肺炎病人临床治疗疗效的影响。方法:将我院收治的老年重症肺炎病人84例随机分为两组,每组各42例。一组肠内营养(EN)组病人给予EN以鼻饲营养液治疗;另一组采用EN+肠外营养(PN)治疗为EN+PN组。治疗第4周,比较两组病人的营养指标改善情况、肺炎治愈率以及治疗期间并发症的发生率。结果:EN+PN组病人治疗后血红蛋白和清蛋白明显高于EN组,两组比较差异有显著性统计学意义(P0.05)。两组病人治愈率分别为92.86%和95.24%,无显著性差异(P0.05)。EN组病人的不良反应发生率明显高于EN+PN组(16.67%vs 7.14%),差异有显著性统计学意义(P0.05)。结论:采用EN+PN治疗的方法更加容易改善老年重症肺炎病人的营养指标,且不良反应发生率较低。     

胃癌手术后早期肠内肠外营养支持效果

目的探讨胃癌手术后早期肠内肠外营养(EN-PN)与完全肠外营养(TPN)的治疗效果。方法对2000年1月～2004年12月在我院普外科行胃癌根治术198例患者进行回顾性分析,其中97例(EN-PN组)采用术后早期肠内肠外营养治疗,101例(TPN组)采用完全肠外营养治疗,比较两组患者的术后营养指标(体重、血浆白蛋白、前白蛋白、视黄醇结合蛋白)、肛门排气时间、胃排空恢复时间、住院时间和总住院费、并发症发生率。结果EN-PN组术后第7天的血浆前白蛋白和视黄醇结合蛋白(302.54±58.65)g/L和(39.21±6.54)mg/L均显著高于TPN组的(236.89±48.84)g/L(P<0.05)和(25.36±5.37)mg/L(P<0.01);EN-PN组的肛门排气时间、胃排空恢复时间、住院时间分别为(56.8±7.1)小时、(6.6±3.8)天、(15.5±5.8)天,均显著少于TPN组的(79.6±14.6)小时(P<0.01)、(13.2±6.2)天(P<0.05)和(22.6±5.6)天(P<0.05);EN-PN组的并发症发生率18.6%和总住院费16568.35元均显著少于TPN组的40.6%(P<0.01)和28612.85元(P<0.01)。结论胃癌术后早期肠内肠外联合营养治疗安全可靠、简便易行、符合生理、肠功能恢复快、并发症少、费用低廉。     

食管癌术后病人两种营养支持治疗的比较

目的:观察食管癌术后病人两种营养支持疗法的效果。方法:将80例食管癌术后病人随机分为肠外营养(PN)组和肠内营养(EN)组,所有病人在手术前1 d和术后第8天检测血红蛋白(Hb)、血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)、体质指数(BMI)以及肛门排气时间、住院时间和营养费用等指标。结果:两组病人术后血清ALB,住院时间、BMI、Hb比较无显著性差异(P>0.05)。EN组病人血清PA,TF明显高于PN组(P<0.05),术后肛门排气时间明显早于PN组(P<0.05),所用营养费用低于PN组。结论:两种营养支持治疗均可改善食管癌病人的营养状况,但EN与PN比,更具有符合生理、安全、价廉的优点。     

Nutrition knowledge and attitudes of New Zealand registered midwives

Aim: The importance of nutrition for a healthy pregnancy is well established. In New Zealand, the majority of women choose midwives as their maternity provider. Therefore, it is important that midwives have an understanding of nutrition issues related to pregnancy. The purpose of the present study was to determine the nutrition knowledge of New Zealand midwives, and to assess the importance they place on nutrition during pregnancy. Methods: An 18‐question postal survey was sent to all members of the New Zealand College of Midwives (n = 1340). Results: A total of 370 questionnaires were returned (response rate of 27.6%). Less than 40% of midwives reported that they had formal nutrition education; however, nearly 75% of respondents indicated that they had received nutrition information through their midwifery education. Most midwives indicated that nutrition was important or very important during pregnancy (98.4%), and that they had a significant or very significant role in educating pregnant women (94.9%) about nutrition. Midwives generally reported a high level of confidence in dealing with nutrition‐related issues. Midwives answered most of the nutrition knowledge questions correctly. However, 64.6% of midwives (n = 369) incorrectly identified spirulina as a good source of iron for vegetarians, 28.1% (n = 104) incorrectly answered that maternal intake of cabbage and beans are often responsible for colic in breastfed infants, and 40.0% (n = 128) incorrectly answered that to reduce food allergies all lactating women should avoid peanuts and shellfish. Conclusion: Overall, midwives were knowledgeable on nutrition issues related to pregnancy and reported a high level of confidence on educating women about nutrition.     

Practice Analysis of Nutrition Support Professionals

Background: The National Board of Nutrition Support Certification (NBNSC) is an independent credentialing board responsible for administering the multidisciplinary certification examination in nutrition support. For an exam to be legally and practically defensible, it must represent practice. Validation is by practice audit, the highest level of supporting evidence. Objectives: To define the role of the nutrition support professional (NSP) and the current elements (knowledge and functions) required for competent NSP practice. Methods: A survey instrument was constructed using a content validation strategy to establish the link between job tasks and the content of the examination. Internet‐based surveys were made available to 5100 NSPs. NSP duties performed and knowledge required for patient safety and welfare were analyzed for the group as a whole and for each profession separately. Results: A total of 765 surveys were completed (return rate of 15%). The results of the practice audit demonstrate a common core of practice across the nutrition support disciplines as well as a universal core of elements believed to be important for competent nutrition support practice. Conclusion: The results of this survey continue to support a common core of practice across nutrition support disciplines as well as a common core of elements believed to be important for competent nutrition support practice. Accordingly, the NBNSC will continue to offer one examination to all disciplines both nationally and internationally and confer the Certified Nutrition Support Clinician (CNSC) credential to all individuals who successfully pass this validated examination.     

营养环境与人群营养素摄入水平的相关性

完善了营养环境的概念及指标，提出可以用线性规划建立的数学模型计算营养环境的指标，即由该模型得出的营养素的理论达标率和营养素的边际成本。用天津１９８９年的营养素的理论达标率和１９８８年天津人群的营养素实际达标率进行线性回归分析，得出回归方程：实际达标率（％）Ｙ＝１５．１５（％）＋０．７８８Ｘ（Ｘ为理论达标率，％），其相关性显著（Ｒ＝０．９８６，Ｐ＜０．００１）；还发现天津营养环境中脂肪、动物性蛋白质的边际成本大于零。讨论了上述方程的意义，营养环境与营养干预的关系。认为，改善食物的营养素含量、降低价格、增加营养素含量丰富的食物品种的营养干预措施，效果较好。     

The enteral vs parenteral nutrition debate revisited

Many trials and several meta-analyses have been devoted to comparing enteral with parenteral nutrition support. In this review, these studies are subjected to critical analysis with particular emphasis on their methodology and clinical relevance. Evidence is produced to suggest that the heterogeneous patient populations of the studies and the rigid approach taken to comparing different nutrition therapies inter alia render their conclusions highly questionable and of very doubtful clinical significance. An alternative approach to nutrition research is suggested in which strategies of nutrition support rather than fixed menus are compared. It is suggested that objective measures of intestinal function be evaluated more fully in patients requiring nonvolitional nutrition support, and these are briefly reviewed. In addition, a more scientific approach to evaluating the physiological effects of nutrition support, including chemical tagging and evaluation of muscle function, is recommended.     

Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants

Background: Despite the availability of international nutrition recommendations, preterm infants remain vulnerable to suboptimal nutrition. The standard approach of assessing nutrient intakes chronologically may make it difficult to identify the origin of nutrient deficits and/or excesses. Objective: To develop a “nutrition phase” approach to evaluating nutrition support, enabling analysis of nutrient intakes during the period of weaning from parenteral nutrition (PN) to enteral nutrition (EN), called the transition (TN) phase, and compare the data with those analyzed using the standard “chronological age” approach to assess whether the identification of nutrient deficits and/or excesses can be improved. Methods: Analysis of a comprehensive nutrition database developed using actual nutrient intake data collected on an hourly basis in 59 preterm infants (birth weight ≤1500 g, gestation <34 weeks) over the period of PN delivery (range, 2–21 days). Results: The nutrition phase analysis approach revealed substantial macronutrient and energy deficits during the TN phase. In particular, deficits were identified as maximal during the EN‐dominant TN phase (enteral feeds ≥80 mL/kg/d) of the infant’s nutrition course. In contrast, the chronological age analysis approach did not reveal a corresponding pattern of deficit occurrence but rather intakes that approximated or exceeded recommendations. Conclusion: Actual intakes of nutrients, analyzed using a nutrition phase approach to evaluating nutrition support, enabled a more infant‐driven rather than age‐driven application of nutrition recommendations. This approach unmasked nutrient deficits occurring during the transition phase. Overcoming nutrient deficits in this nutrition phase should be prioritized to improve the nutrition management of preterm infants.     

Parenteral Nutrition Utilization After Implementation of Multidisciplinary Nutrition Support Team Oversight

Background: Multidisciplinary nutrition teams can help guide the use of parenteral nutrition (PN), thereby reducing infectious risk, morbidity, and associated costs. Starting in 2007 at Harborview Medical Center, weekly multidisciplinary meetings were established to review all patients receiving PN. This study reports on observed changes in utilization from 2005–2010. Materials and Methods: All patients who received PN from 2005–2010 were followed prospectively. Clinical data and PN utilization data were recorded. Patients were grouped into cohorts based on exposure to weekly multidisciplinary nutrition team meetings (from 2005–2007 and from 2008–2010). Patients were also stratified by location, primary service, and ultimate disposition. Results: In total, 794 patients were included. After initiation of multidisciplinary nutrition meetings, the rate of patients who started PN decreased by 27% (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63–0.84). A reduction in the number of patients receiving PN was observed in both the intensive care unit (ICU) and on the acute care floor (RR, 0.64; 95% CI, 0.53–0.77 and RR, 0.80; 95% CI, 0.64–0.99, respectively). The rate of patients with short‐duration PN use (PN duration of <5 days) declined by 30% in the ICU (RR, 0.70; 95% CI, 0.51–0.97) and by 27% on acute care floors (RR, 0.73; 95% CI, 0.51–1.03). Conclusions: Weekly multidisciplinary review of patients receiving PN was associated with reductions in the number of patients started on PN, total days that patients received PN, and number of patients who had short‐duration (<5 days) PN use.     

肠内营养与肠外营养支持的代谢效应

对比术后病人应用肠外(parenteral　nutrition,PN)与肠内(enteral　nutrition,EN)营养支持的代谢效应。20例病人,随机分为肠外营养组(对照组)及肠内营养组(研究组)。于手术后第5～11天给病人以传统的标准肠外营养或肠内营养剂爱伦多(Elental)支持。结果:(1)对照组病人的体重下降2.8±0.2kg,研究组病人的体重下降2.1±0.3kg,两组之间有差异(P=0.09)。(2)对照组的累积氮平衡 105.2±9.2mg·kg~(-1)/7d,研究组的累积氮平衡 184.8±33.2mg·kg~(-1)/7d。研究组明显优于对照组(p=0.03)。(3)血清谷氨酰胺(glutamine)的变化,对照组术前为630±20mmol/L,术后为594±26mmol/L,术后无显著性差异(P=0.55)。(4)血清亚油酸(linolicacid)的变化,对照组术前为101.4±37.7ug/ml,术后116.1±11.2ug/ml,术后血清亚油酸无显著性差异(P=0.65)。研究组术前为151.9±31.2ug/ml,术后101.2±16.5ug/ml,术后有降低,但没有显著性差异(P=0.11)。本研究结果表明,手术后肠功能恢复时,给予肠内营养爱伦多支持比传统的标准肠外营养支持有较好的代谢效应,但必需脂肪酸的补充量尚嫌不足。