Total parenteral nutrition in obstetrics

Total parenteral nutrition was provided to ten patients during pregnancy. No obstetrical or fetal complications attributable to the nutrition therapy occurred. All infants were at or above the tenth percentile in weight for gestational age. Total parenteral nutrition appears to be safe for the mother and fetus when given after the first trimester; the safety of total parenteral nutrition in the first trimester requires further study.     

严重腹部创伤患者的全肠外营养支持

对28例严重腹部创伤患者应用全肠外营养(TPN)支持,结果显示,第二、三、四周每周累积氮平衡值较第一周高,血清白蛋白、前白蛋白、纤维连接蛋白及转铁蛋白值较使用TPN前有升高。18例创伤后发生肠痿的患者中,有8例瘘口自愈。结果提示,对严重腹部创伤的部分病例应用TPN支持,有利于提高救治的成功率。     

Total parenteral nutrition in malnourished infants with intractable diarrhea

Thirty-four infants (25 Inuit and 9 Caucasians) with protein-energy malnutrition and intractable diarrhea were treated with total parenteral nutrition (TNP) consisting of a casein hydrolysate, a soybean emulsion and dextrose. Initially peripheral veins were used in all the infants, and 22 were treated successfully without resort to a central venous catheter. The mean duration of treatment by the peripheral route was 29 days. Although mean energy intake and protein intake were high, weight gain was poor and growth continued at the prehospitalization percentiles. There were two deaths, both from complications of the use of central lines. Specific diagnoses were established for 7 of the 9 Caucasian infants but only 2 of the 25 Inuit infants. Concentrations of serum glutamic oxaloacetic transaminase (SGOT) were elevated in 80% of the patients at the time of admission, increased further in 82% when TPN was begun, but decreased towards normal before discharge in all patients. Eosinophilia was common during TPN. Liver biopsy in seven patients with elevated SGOT values showed eosinophilia, increased pigment in the Kupffer cells and slight lymphocytosis in the portal tract. Intercurrent infections occurred frequently and were often preceded by a short period of lipid intolerance or neutropenia, or both. Tolerance to lipids returned after the infections resolved. Thus, peripheral TPN is a safe and relatively simple method of providing adequate nutrition during episodes of diarrhea in malnourished infants.     

肠外与肠内联合营养治疗重症急性胰腺炎

目的探讨肠外营养(TPN)与肠内营养(EN)联合应用对重症急性胰腺炎(SAP)的影响。方法 126例重症急性胰腺炎患者分为3组:TPN组(n=42)行全胃肠外营养治疗;TPN+EN组(n=42)先行TPN,再过渡为PN+EN,最后EN;EN组(n=42)行肠内营养治疗。肠内营养选短肽型制剂,通过空肠造瘘管或鼻空肠管给予,观察3组临床指标变化。结果治疗前,3组APACHEⅡ评分、Ranson评分和C-反应蛋白浓度差异无统计学差异;治疗后,TPN组血总胆红素明显升高(P<0.05),而治愈率、病死率、血浆白蛋白、前白蛋白、尿素氮、肌酐、胆固醇、三酰甘油、血糖差异无统计学意义。与TPN组、EN组相比,TPN+EN组平均住院时间缩短,感染并发症发生率降低(P<0.05);与TPN组相比,EN组感染并发症发生率明显降低(P<0.05)。结论肠外与肠内营养联合应用能缩短平均住院时间、降低SAP患者并发症的发生率,是合理、有效的营养治疗方法。     

重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

目的 观察重症急性胰腺炎（SAP）完全胃肠外营养（TPN）与肠外营养（PN）联合肠内营养（EN）治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组（14例）和PN＋EN组（15例）,并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白（ALB）、总蛋白（TSP）、血钙（Ca2＋）、谷丙转氨酶（ALT）、谷草转氨酶（AST） 较营养支持前均显著升高（P〈0.05）;各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降（P〈0.05）;各组血总胆红素（TB）治疗前后差异无统计学意义（P〉0.05）;PN＋EN组血WBC显著低于TPN组（P〈0.05）,其余化验指标组间比较差异无统计学意义（P〉0.05）;各组APACHEⅡ评分较治疗前显著降低（P〈0.05）,PN＋EN组评分显著低于TPN组（P〈0.05）.PN＋EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组（P〈0.05）.结论 PN联合EN治疗SAP优于TPN.     

重症急性胰腺炎全胃肠外营养(TPN)支持治疗45例分析

目的总结以全胃肠外营养(TPN)支持治疗为主的重症急性胰腺炎的临床经验.方法回顾性分析45例重症急性胰腺炎的病情、TPN治疗及其它综合治疗情况.结果患者病情大多重危,病程长,平均64d,最长179d,并发症多,代谢紊乱和营养问题突出.用TPN进行代谢营养支持平均23.8d,最长72d,多数从病程早期开始,覆盖整个消化道功能障碍时期,直到恢复经肠营养.综合治疗包括早期抗休克和多脏器功能支持,以及其它内科救治措施,10d内行手术引流22例,术中或/和后胰床和腹腔灌洗13例,后期胰腺脓肿引流及坏死组织清除11例.39例治愈(86.7%),死亡6例(13.3%),死因为胰腺脓毒症并发感染性休克4例、衰竭合并肺部感染而发生多脏器功能不全2例.结论TPN是重症急性胰腺炎的基本治疗措施,应从病程早期开始,覆盖整个消化道功能障碍时期,直到恢复经肠营养.     

胰十二指肠切除术后早期全肠外营养与肠外联合肠内营养疗效比较

目的:研究经全肠外营养(TPN)及肠外联合肠内营养(EPN)对胰十二指肠切除术后早期的临床疗效。方法:选取弋矶山医院2013年10月~2016年9月收治的胰十二指肠肿瘤患者并行胰十二指肠切除术85例。按随机表法分为TPN组42例和EPN组43例。对比分析两组术后营养指标、肝功能指标、术后恢复情况及住院费用。结果:在术后恢复情况方面,EPN组肛门排气时间及术后进流质时间比TPN组短,差异有统计学意义(P<0.05),EPN组住院时间低于TPN组,但差异无统计学意义(P>0.05);两组术后并发症及住院费用方面比较差异无统计学意义(P>0.05);两组患者术后营养指标及肝功能指标较术前比较差异均有统计学意义(P<0.05);EPN组术后3 d白蛋白(ALB)水平与TPN组比较差异有统计学意义(P<0.05),余营养指标组间比较差异无统计学意义(P>0.05);两组术后谷草转氨酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBIL)比较差异有统计学意义(P<0.05),术后3 d直接胆红素(DBIL)比较差异有统计学意义(P<0.05)。结论:肠外联合肠内营养方式相对于全肠外营养能有效改善预后,更适合患者胃肠道且安全经济,值得在临床上进一步研究。