慢性阻塞性肺病患者营养素摄入和营养状态的研究

通过对34例慢性阻塞性肺部疾病(COPD)患者每日膳食中营养素摄入量的调查和营养状态评定表明,虽然患者的习惯饮食中热量摄入超过被推荐的标准供应量(RDA),但仍普遍存在营养不良.研究提示,给与COPD患者合理的营养支持能改善营养不良,增强治疗效果,对预后产生积极作用.     

慢性阻塞性肺疾病稳定期患者营养支持的研究进展

慢性阻塞性肺疾病（COPD）病程长、易复发,许多患者常伴随发生营养不良,这不仅会直接影响患者的肺功能,还会对患者的预后产生负面影响,故适当的营养干预如肠内肠外营养支持、健康管理对COPD患者非常重要。目前COPD相关营养干预研究的目标人群主要聚焦在临床急性期患者,缺乏对稳定期患者的研究。为探索适合COPD稳定期患者的营养干预手段,本文对国内外关于COPD患者营养支持的研究进展进行综述,结果显示,适当的营养干预方式的确能够有效改善COPD患者的治疗效果及预后,且各种营养干预方式联合使用或结合康复管理干预效果更佳,其中营养干预联合社区康复管理对于COPD稳定期患者的预后更为有利。这表明社区或将成为未来COPD防治的主阵地,相关学者需加强在此方面的研究。     

慢性阻塞性肺疾病患者的营养支持治疗

慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)是一种以气道和(或)肺实质受累导致气流阻塞为特征的慢性进展性疾病,其症状和并发症可包括气促、运动耐力差、慢性(有痰或无痰)咳嗽、喘鸣、呼吸衰竭及肺心病.COPD在美国已位居死亡原因第3位,在全球居第4位,患者多数为吸烟者[1].营养不良是影响COPD患者预后的一个重要因素,有效的营养支持治疗可明显降低感染和呼吸衰竭的发生率,降低病死率,改善生活质量.本文就COPD患者营养不良状况及如何正确进行营养支持治疗等问题进行评述.     

慢性阻塞性肺疾病患者的营养支持

本文分析了营养不良与COPD的相关性,介绍了评估COPD患者的营养状况的体测量评定指标,介绍了COPD缓解期及急性期营养不良病人的营养支持及营养支持途径的选择,主要包括肠内营养及肠外营养支持,提出肠内营养支持是优选选择.     

营养支持在危重症患者的应用

营养不良是危重症患者普遍存在的问题,并且与危重症患者的不良预后密切相关。因此,营养支持已成为危重症综合治疗的一个重要组成部分。认识危重症患者营养与代谢状态的改变,掌握合理的营养支持方法与时机,并通过调整能量的供给、控制高血糖和应用免疫营养素等措施,提高危重症患者营养支持的安全性、有效性,可获得改善危重症患者预后的效果。     

壶腹癌术后合并胃瘫围手术期营养支持一例

壶腹癌是预后较差的消化系统肿瘤之一。壶腹癌患者营养不良的发生率较高,部分进展期患者常有恶液质征象。我院近期对1例患者应用营养风险筛查2002（Nutritional Risk Screening 2002,NRS2002）,选择合理的营养支持方式、途径及制剂纠正营养不良状态,提高患者手术耐受力,降低术后并发症的发生,使患者最终痊愈出院。特别是营养支持对术后并发症（如较长时间的胃瘫）的治疗起了重要作用,现报道如下。     

呼吸衰竭患者的营养状态及营养支持疗法

介绍呼吸衰竭患者营养不良的发生率,类型及发病原因,营养不良对患者免疫,呼吸肌功能,通气驱动等生理功能及预后的影响。呼吸衰竭患者营养状态的评价及进行营养疗法的指征。营养支持疗法的原则及呼吸衰竭患者营养疗法的特殊要求。营养支持疗法可能产生的危害与处理以及营养疗法的疗效。认为正确估价呼吸衰竭患者的营养状态,给予恰当的营养疗法,是提高此类患者存活率和生活质量的重要一环。     

不同营养支持在重症颅脑外伤患者的疗效比较

重症颅脑外伤患者早期出现的高代谢状态和严重负氮平衡，加上因意识障碍、手术等原因长时间不能正常进食，易使患者发生营养不良和电解质紊乱，这已成为这类患者病情恶化或死亡的重要原因。良好的营养支持可促进病人的神经功能恢复，减少并发症和病死率。传统的营养支持不能满足机体需要，单一肠外营养（PN）支持和肠内营养（EN）支持各有利弊。因此，采用肠内外营养联合供给的方法，与传统单一的营养供给进行对比分析，评价营养状况、治疗效果和预后情况。     

观察个体化营养支持治疗对重症患者营养状态及预后的效果

目的:观察个体化营养支持治疗对重症患者营养状态及预后的影响效果.方法:将我院收治的120例重症需要提供营养支持患者为研究对象,其中60例患者接受标准配方整蛋白肠内营养液提供营养支持设作对照组,另外60例患者接受个体化营养支持治疗治疗,按患者病情程度选择不同配方和浓度营养液提供营养支持设作观察组,比较两组营养状态及预后情...     

营养风险理念解读

营养风险是指与营养因素有关的出现临床并发症的风险,而不是出现营养不良的风险。通过发现患者的营养风险,预测患者的临床结局,监测患者使用临床营养支持的效果。     

营养支持治疗在慢性肝功能衰竭病中效果观察

目的探究营养支持治疗在慢性肝衰竭上在治疗上的效果。方法对住入我院的40例慢性肝衰竭患者的营养状况进行综合的分析评价,对这些患者进行治疗时,以现代的内科综合治疗为主,再辅助以相对专业的营养支持治疗,结合患者自身情况选用肠内或肠外或者是两者相结合的方法进行具体的治疗。以生化指标的具体变化以及营养状况作为对比条件,对患者的情况进行治疗前后的比较,进而来判断其临床疗效到底如何。结果在未进行治疗的时候,40例患者中有38例都存在着营养不良的状况,但是这些患者营养不良的程度各自之间都有所差别,经过一段时间的治疗,其营养不良的现象均有所好转,只是好转的程度各有差异。结论在进行对慢性肝病患者的治疗时,要结合患者自身的不同差异,根据患者具体的病情以及病情的发展情况,采取适合于患者的营养支持方案,如果患者能够很好地再配合内科医生进行综合地治疗,就一定会取得相当好的疗效。     

Arbre décisionnel du soin nutritionnel

Undernutrition is a frequent complication of acute and chronic diseases, and is correlated with disease prognosis and patients’ quality of life. Undernutrition has a major impact on health care costs. Screening of undernutrition and nutritional care are recommended in current clinical practice and the identification of undernutrition-related costs is of prime importance. The management of nutritional care depends on nutritional risk and status, protein and energy needs, and spontaneous oral intake. The goal of nutritional care is to avoid the onset of malnutrition in patients at risk, and in undernourished patients to prevent its worsening and to correct it. Three different levels of nutritional intervention do exist: dietary counseling and oral nutritional supplements, enteral nutrition, and in case of enteral nutrition's contra-indications, intolerance or insufficiency, total or supplemental parenteral nutrition. The choice of feeding routes depends mainly on the expected duration of nutrition support. In every case, nutritional strategy should be regularly re-evaluated and adapted according to nutritional efficacy and disease evolution.     

营养支持对慢性阻塞性肺疾病轻度营养不良患者临床观察

目的研究营养支持在慢性阻塞性肺疾病（COPD）轻度营养不良治疗中的l艋床作用。方法笔者所在医院内科于2008年8月～2010年8月期间,对确诊为COPD的轻度营养不良患者取88例分为治疗组46例及对照组42例,在常规治疗的基础上,治疗组加用静脉营养支持,观察其临床治疗效果。结果治疗组46例COPD患者总有效率显著高于对照组（P〈0．01）,治疗组患者平均住院时间明显短于对照组（P〈0．001）。结论静脉营养支持对治疗COPD的轻度营养不良患者有比较明显的疗效,并且可以缩短疗程。     

Nutrition au cours des radiothérapies et chimiothérapiesNutritional support during cancer chemotherapy and radiotherapy

Nutritional support for cancer patients treated with radiotherapy and chemotherapy are strongly requested with regard to the frequent malnutrition at time of diagnosis. Furthermore, the malnutrition often progresses with adverse effects of therapy and disease progression. Nutritional screening and assessment are essential. Dietetic care is mandatory for patients with malnutrition or at risk of malnutrition when they are still able to eat. But this oral nutritional support is frequently unable to maintain sufficient nutritional intakes with regard to tumour effect or treatment toxicity. Enteral or parenteral nutrition must be provided to patients unable to absorb adequate quantity of nutrients for a prolonged period. The primary goal is to avoid, especially for malnourished patients, further nutritional degradation which can lead to treatment interruptions, complications or increased risk of death. Routine administration of artificial nutrition has been tested during radiotherapy and chemotherapy but results are conflicting and data are missing for severely malnourished patients. No benefits in terms of treatment toxicity, tumour response, risk of complications and finally mortality have been demonstrated for routine use of artificial nutrition. Most decisions for indication of nutritional support, route of administration and quality of artificial nutrition in this field can't rely today on evidence-based medicine. However, artificial nutrition can provide nutrients and hydration necessary to maintain comfort and to improve survival for patients unable to eat sufficient nutrition for a prolonged period.     

A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.     

肠内营养支持的应用进展

营养不良是住院患者常见的症状之一,对患者造成巨大的不良影响,能降低患者免疫力,延缓伤口愈合,影响正常肌力,导致心理障碍,最终造成患者病情迁延,住院时间延长和费用增加。如果患者胃肠道功能不全则无法通过正常的饮食来维持自身的营养需求,必须借助营养支持。营养支持方式主要分为口服营养补充、肠内及肠外营养支持。肠内营养支持是为无法通过口服补充所必需的的营养物质或通过口服仍无法满足营养需求的患者提供的一种营养支持方式,对患者疾病的治疗以及生存具有重要意义,目前已广泛应用于临床。本文收集整理近几年肠内营养支持的相关文献,从肠内营养支持的适应证及禁忌证、常见制剂、输注途径、临床应用等方面进行归纳总结,从而为肠内营养支持的临床应用提供参考依据。     

慢性放射性肠损伤病人的围手术期营养支持

目的:探讨慢性放射性肠损伤(CRII)病人围手术期营养支持情况。方法:采用主观全面评价(SGA)系统回顾性总结206例CRII病人围手术期营养支持情况,并对CRII病人的营养状况进行评估。结果:206例CRII病人接受手术229例次,86.16%的病人入院时有营养不良。经围手术期营养支持和手术治疗后,病人的营养状况得到了明显改善,但营养不良发生率仍然较高。结论:CRII病人的营养不良发生率甚高,围手术期营养支持时间较长,围手术期营养支持和手术能明显改善病人的营养状况。     

PN对COPD急性期合并营养不良患者的营养支持效果

目的：探讨肠外营养（PN）对慢性阻塞性肺病急性加重期合并营养不良患者的治疗效果，及血清游离氨基酸在营养支持中的变化。方法：21例慢性阻塞性肺病（COPD）急性加重期合并营养不良患者随机分为两组，肠外营养组（PN组）和对照组。结果：两组患者与正常值比较皆存在广泛的血清游离氨基酸（SFAA）含量及各类组分含量显著低下（P＜0．01）。PN支持两周后，PN组的血清绝大部分游离氨基酸含量发生显著改善（P＜0．01），对照组改变不明显。结论：PN对COPD急性加重期合并营养不良患者的营养支持有效，并为临床营养提供依据及指导。     

Elucidating effective ways to identify and treat malnutrition

There is a clear rationale for elucidating effective ways of identifying and treating disease-related malnutrition (DRM), given the physiological and financial consequences of this common condition and its treatability. Evidence indicates the efficacy of nutritional support methods (oral, tube and intravenous) in increasing total nutritional intake while having little effect on appetite, satiety, appetite mediators (e.g. leptin) and voluntary food intake. When used as the only source of nutrition, artificial nutrition can effectively maintain nutritional intake, and yet many patients find enteral or parenteral feeding alone is unable to relieve distressing appetite sensations, and unusual temporal patterns (including dissociation between hunger and desire to eat) occur. Despite the positive impact of these feeding methods on intake, controversy about whether nutritional support can affect patient outcome has remained. Systematic reviews and meta-analyses indicate that improvements in function and clinical (mortality, complication rates) outcome can occur in a number of patient groups (including hospitalised patients, the elderly, patients who have had gastrointestinal surgery, patients at risk of pressure ulcers). In order to target those patients who will benefit from nutritional support, and overcome the ongoing problem of poor detection and recognition of DRM, simple routine screening to identify risk followed by practical evidence-based treatment is recommended.     

New nutritional approach to inflammatory bowel disease: the nutraceuticals

The clinical course of inflammatory bowel disease (IBD) is characterised by periods of quiescent disease interspersed with episodes of active inflammation; consequently, malabsorption and malnutrition are the most important problems in IBD patients. It has been widely demonstrated that nutritional support allows more tolerability both to drugs and surgery therapy increases the duration of remission. Among enteral formula enriched in specific nutraceuticals like glutamine or transforming growth factor β2 used in IBD, we tested those enriched with omega 3, soluble fibre and arginine. We observed a high compliance and a statistically significant improvement of symptoms, nutritional status, inflammatory index and Crohn’s disease activity index. A specific nutritional intervention, in particular specific enteral nutrition formula, is essential in the prevention and treatment of malnutrition caused by IBD.