不同营养途径对危重症病人营养和免疫功能的影响

目的:观察比较不同营养支持途径对危重症病人的治疗效果.方法:选择ICU危重症病人45例,分为A组(PN支持) 、B组(EN支持)和C组(PN+EN支持),每组各15例.分别于营养支持前和连续营养支持治疗8 d后测体质指数(BMI)、血清总蛋白(TP)、ALB、Hb、淋巴细胞总数(TLC)、IgA、IgG和 IgM、 T细胞亚群(CD3、CD4、CD8)百分比,并进行临床营养指标和免疫指标的分析对比.结果:给予营养支持8 d后,42例(93.3%)病人康复,3例(6.7%)死于原发病.三组病人的Hb均明显升高,EN组和PN+EN组的TP、ALB较PN组有显著升高,EN组TCL和IgM、PN+EN组IgG和IgM均较PN组升高.结论:三种途径营养支持均可改善危重症病人的营养状况和免疫功能,EN或联合EN的效果更加明显.在危重症病人的治疗中,可根据病人的不同情况,合理地选择营养支持方式.     

胃肠外营养支持对乳腺癌病人术后营养和免疫功能的影响

目的:探讨胃肠外营养支持在乳腺癌病人术后康复过程中的临床作用和安全性. 方法:将80例乳腺癌手术病人随机分为对照组(行普通治疗)和观察组(行肠外营养支持).通过检测两组病人术前和术后的各项营养指标和免疫指标的变化,对两种治疗方式进行比较. 结果:观察组病人术后第7天各项营养指标和免疫功能指标均较对照组改善,差异有显著性意义(P＜0.05). 结论:胃肠外营养可有效地改善乳腺癌病人术后机体的营养状况和免疫功能,对后期的综合治疗有着重要的临床意义.     

营养支持对急性期COPD病人免疫功能的影响

目的:探讨营养支持对急性期慢性阻塞性肺病(COPD)并发营养不良病人免疫功能的影响.方法:将急性期COPD病人36例,随机分为对照组与营养治疗组.对照组用常规治疗,营养治疗组在常规治疗的基础上加用静脉营养支持,治疗2周.结果:治疗后营养治疗组T细胞亚群、淋巴细胞总数、OT试验明显高于对照组(P＜0.05),IgG、IgA、IgM无明显变化(P＞0.05).结论:营养支持治疗可以明显改善急性期COPD病人的免疫功能,促进疾病的康复.     

危重症病人肠内与肠外营养支持的对比观察

目的:对比研究危重症病人EN与PN支持的效果.方法:将48例危重症病人随机分为EN组和PN组,对比观察营养支持后两组病人的Hb、PA、血清总蛋白(TP)、ALB等营养指标以及腹泻、腹胀、胃肠道出血、肝功能损害、高血糖等并发症的发生率.结果:经EN支持后,病人的Hb、TP和PA明显升高(P<0.05);而PN组与营养支持前比较,病人各指标无显著性差异.PN组并发症的发生率高于EN组.结论:EN支持可较好地改善病人的营养状况,并发症少,是危重症病人较好的营养支持方式.     

慢性阻塞性肺疾病急性呼吸衰竭期病人的肠内营养支持治疗

目的: 观察EN支持治疗在慢性阻塞性肺疾病(COPD)急性呼吸衰竭期病人的临床疗效. 方法: 将60例病人随机分为治疗组和对照组,每组30例.两组病人均给予正常饮食、抗感染、吸氧、解痉平喘、化痰、纠正酸碱失衡和电解质紊乱等治疗,治疗组病人在正常饮食的基础上,给予整蛋白型营养液(立适康)口服营养支持治疗. 结果: 治疗组病人与对照组比较,人体测量值增加,肺功能改善,血清ALB升高,差异有显著性统计学意义(P<0.05). 结论: 营养支持治疗可明显改善COPD并发呼吸衰竭病人的临床症状和体征,提高血清ALB,血气分析和肺功能改善明显.     

全肠外营养添加免疫调节剂黄芪对梗阻性黄疸病人术后的影响

目的 :观察中药黄芪与全肠外营养 (TPN)联合应用能否改善围手术期梗阻性黄疸病人营养状况及提高病人免疫功能。　方法 :梗阻性黄疸病人 30例 ,男 18例 ,女 12例 ,平均年龄 (5 6 .4± 5 .2 )岁。术后随机分三组 ,即对照组 :常规输注葡萄糖和电解质溶液 ;TPN组 :全肠外营养支持 ;实验组 :给予TPN +黄芪。　结果 :术后对照组营养指标和免疫指标均降低 ,易发生并发症 ;TPN组可使氮平衡及血清蛋白改善 ;实验组营养指标和免疫指标明显改善。　结论 :梗阻性黄疸病人营养不良和免疫功能低下 ,术后并发症增加 ,TPN +黄芪可以弥补TPN的不足 ,使病人营养指标和免疫功能恢复     

胃癌病人术后早期营养支持对营养等状况恢复的比较

目的:探讨胃底贲门癌病人术后早期应用全肠外营养(TPN)和肠内营养(EN)对营养等状况恢复的比较分析.方法:将73例胃底贲门癌病人随机分为EN组(37例)和PN组(36例).于术后48 h内开始给予等氮、等热量营养支持,观察两组病人手术前、后的营养和免疫指标、术后肠鸣音恢复、肛门排气时间和并发症发生的情况.结果:两组病人术后营养支持的营养及免疫指标明显改善(P＜0.05),EN组前清蛋白和免疫指标较PN组明显提高(P＜0.05);EN组较PN组术后胃肠道功能恢复的更早,同时并发症的发生率亦明显减低.结论:胃底贲门癌病人术后早期肠内营养支持,既能促进胃肠道功能尽早恢复,又可改善病人术后营养状况和免疫功能.     

老年胃肿瘤病人术后早期肠内营养的应用

目的:探讨早期肠内营养对改善老年胃肿瘤病人术后的营养免疫状况及减少并发症的作用.方法:将84例老年胃肿瘤病人随机分为肠内营养(EN)组及肠外营养(PN)组,于术后24 h开始予以相同热量及氮量营养支持,分别观察营养支持前后的营养和免疫指标及术后并发症.结果:两组的营养及免疫指标于营养支持后明显改善(P＜0.05),免疫指标EN组较PN组明显提高(P＜0.05);EN组与PN组相比,明显促进病人术后胃肠道功能恢复,减少并发症的发生及住院费用.结论:老年胃肿瘤病人术后早期肠内营养是一种安全、有效、简便、经济和理想的营养治疗方法.     

早期肠内营养在危重症病人营养支持中的临床价值

目的:通过对危重症病人行早期肠内营养(EEN),观察病人的临床转归和评价EEN的应用价值.方法:将46例危重症病人随机分为治疗组和对照组.治疗组病人在入住ICU的24～48 h内行EN,对照组病人在入ICU的48 h后开始EN.比较两组病人对营养支持的耐受性、营养指标、肝功能、EN可耐受的起始时间、达EN目标喂养点所需...     

低糖类肠内营养制剂对高血糖危重症病人的影响

目的:评价低糖类肠内营养制剂对高血糖危重症病人的影响.方法:将52例病人随机分成研究组和对照组,分别给予相同热量和氮量的肠内营养支持.研究组用康全达,对照组用能全力.观察治疗前后血糖、血浆清蛋白、血红蛋白、血脂、二氧化碳分压和氧分压的变化.结果:研究组病人空腹血糖水平变化小,无需加用胰岛素;对照组病人空腹血糖明显升高,需加用胰岛素治疗.研究组治疗后与对照组比较,血气分析指标变化差异有显著性意义(P＜0.05).两组病人肠内营养支持后的清蛋白和血红蛋白水平明显升高,而血脂变化差异无显著性意义.结论:低糖类肠内营养制剂对控制危重症病人的高血糖、改善呼吸功能和营养状况有一定的作用.     

Nutritional and pulmonary function assessment in patients with chronic obstructive lung disease

This investigation was undertaken to determine the prevalence and degree of malnutrition among patients with chronic obstructive pulmonary disease and to determine if a relationship exists between nutritional assessment parameters and pulmonary function. Thirty-seven patients admitted for the treatment of chronic obstructive pulmonary disease to a respiratory care unit of a Veterans Administration facility were studied. Nutritional status was evaluated using anthropometric measurements, laboratory data and immunologic assay. Deficits in anthropometric measurements were frequent and severe in this group of patients. Furthermore, our data demonstrated that patients with a forced vital capacity <30% of predicted value had significantly reduced lean body mass as measured by the mid-arm muscle circumference (p<0.05). Investigation of the nutritional status of patients with chronic obstructive pulmonary disease using controlled nutrition intervention trials may elucidate the relationship of nutritional state to pulmonary function in this group of patients.     

Nutritional support after liver transplantation: a randomized prospective study

Nutritional support in patients with advanced cirrhosis is difficult due to protein, fluid and salt restrictions. Successful liver transplantation should improve nutrient tolerance. We randomly assigned 28 hypoalbuminemic cirrhotic patients to receive, immediately after liver transplantation, one of three regimens: group 1, no nutritional support (n = 10); group 2, total parenteral nutrition (TPN) (35 kcal/kg/day) with standard amino acids (1.5 g/kg/day) (n = 8); or group 3, isocaloric isonitrogenous TPN with added branched-chain amino acids (n = 10). Therapy was continued for 7 days posttransplant. Jaundice resolution was unaffected by nutritional support. Nitrogen balance favored both TPN groups. Branched-chain amino acid (BCAA) aromatic amino acid ratios were highest in group 3. Coma scores and serum ammonia levels were similar in all groups. Both TPN groups achieved respirator independence earlier; this difference was not statistically significant. Group 1 patients stayed longest in ICU; the difference was statistically significant. TPN with either standard or BCAA- enriched amino acids is tolerated well immediately after successful liver transplant. Positive nitrogen balance is achieved; large protein loads do not worsen encephalopathy. Nutritional support may improve respiratory muscle function, allowing earlier weaning from ventilatory support. A shortened length of ICU stay justifies the expense of TPN.     

慢性阻塞性肺病患者营养状况与肺通气功能关系的研究

目的探讨慢性阻塞性肺病(chronicobstructivepulmonarydisease,COPD)患者营养状况对肺通气功能的影响。方法对149例COPD患者根据其营养状况分为营养正常组和营养不良组,再进行肺通气功能测定,观察指标包括最大通气量(MVV),用力肺活量(FVC),第一秒用力呼气容积(FEV1),最大呼气流量(PEF),最大呼气中段流量(MMEF)。结果营养不良组与营养正常组比较,MVV、FVC、PEF、FEV1等反映呼吸肌的指标相差非常显著(P<0.001),且两组在COPD病程同一阶段(肺气肿、肺心病)肺通气功能各值比较也显示营养不良组呼吸肌力等指标比正常组降低明显(P<0.05)。结论COPD合并营养不良对与呼吸肌有关的肺通气功能指标有明显影响。     

Prise en charge nutritionnelle et effets respiratoires des apports nutritionnels chez l''insuffisant respiratoire chronique

Pulmonary cachexia is a frequently occurring complication in patients with chronic respiratory disorders and is a determining factor of health-related quality of life and mortality. Nutritional support is indicated for depleted patients with COPD, since it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance. Patients responding to energy supplementation by showing weight gain and improvement in functional performance even demonstrated a decreased mortality. Nutritional therapy has to consider acute and chronic effects on functional performance and ventilatory capacity. A combination of oral nutritional supplements and exercise or anabolic agents as anabolic stimulus appears to be the best treatment approach in order to obtain significant functional improvement. Only limited acute adverse effects on symptoms and exercise capacity have been demonstrated after nutritional support, being related to the immediate post-prandial caloric load, but not to the macro-nutrient composition of the supplements. More studies are needed to evaluate the effects of long-term nutritional therapy in clinically stable patients as well as the effectiveness of nutritional support during acute disease exacerbation.     

慢性重症肝炎患者营养支持及疗效评价

目的: 评价慢性重症肝炎患者营养状况、营养支持及疗效。方法: 143例慢性重症肝炎患者,入院后进行SGA评估,明确营养状况。分三组,肝病综合治疗和肠内营养+肠外营养;综合治疗+肠外营养;综合治疗+肠内营养。监测0~6 w肝功能及营养指标变化,最后评价临床疗效。结果: 90%以上患者存在中重度营养不良。综合治疗+肠内和肠外营养方案改善肝功能(ALT、Tbil)及营养指标(TP、TC)效果最好,显效率明显高于另两组(P<0.05)。肠内营养略好于肠外营养方案。结论: 慢性重症肝炎患者多数存在营养不良。综合治疗的同时肠内+肠外营养支持疗效最好,应鼓励患者适量进食。     

营养支持对体外循环术后病人营养状况和免疫功能的影响

目的:探讨体外循环心内直视术后应用肠内营养支持的营养和免疫作用. 方法:将60例体外循环心内直视术后病人随机分为对照组和试验组(n=30).对照组自由进食,试验组在自由进食基础上,额外补充肠内营养3 138 kJ/d,连续7天.检测术前、术后第1、8天血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)以及术前、术后第1、4、8天T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)、自然杀伤(NK)细胞活性、可溶性白细胞介素2受体(SIL-2R)等指标. 结果:两组病人术后第1天营养状况及免疫功能均迅速下降?vP<0.01).术后第4天,试验组CD4 已恢复,D8 明显下降(P<0.05),对照组CD4 仍低于术前水平(P<0.05).两组NK细胞活性均低于术前(P<0.01),试验组术后第4天SIL-2R已恢复,与对照组比差异有显著性意义(P<0.05).术后第8天,试验组血清蛋白质水平(ALB、TF、PA)明显高于对照组,差异有显著性意义(P<0.01).试验组CD4 /CD8 比值明显高于术前(P<0.05),两组CD4 、CD8 和SIL-2R水平均已恢复至术前水平,K细胞活性均未恢复(P<0.01).对照组感染性并发症率高达13.3%(4/30),试验组无感染性并发症的发生. 结论:肠内营养支持能改善体外循环术后病人的营养状况及免疫功能.     

Treatment of protein-energy malnutrition in chronic nonmalignant disorders.

Protein-energy malnutrition (PEM) is common in connection with chronic disease and is associated with increased morbidity and mortality. Because the risk of PEM is related to the degree of illness, the causal connections between malnutrition and a poorer prognosis are complex. It cannot automatically be inferred that nutritional support will improve the clinical course of patients with wasting disorders. We reviewed studies of the treatment of PEM in cases of chronic obstructive pulmonary disease, chronic heart failure, stroke, dementia, rehabilitation after hip fracture, chronic renal failure, rheumatoid arthritis, and multiple disorders in the elderly. Several methodologic problems are associated with nutrition treatment studies in chronically ill patients. These problems include no generally accepted definition of PEM, uncertain patient compliance with supplementation, and a wide range of outcome variables. Avail-able treatment studies indicate that dietary supplements, either alone or in combination with hormonal treatment, may have positive effects when given to patients with manifest PEM or to patients at risk of developing PEM. In chronic obstructive pulmonary disease, nutritional treatment may improve respiratory function. Nutritional therapy of elderly women after hip fractures may speed up the rehabilitation process. When administered to elderly patients with multiple disorders, diet therapy may improve functional capacity. The data regarding nutritional treatment of the conditions mentioned above is still inconclusive. There is still a great need for randomized controlled long-term studies of the effects of defined nutritional intervention programs in chronically ill and frail elderly with a focus on determining clinically relevant outcomes.     

Associations between underlying disease and nutritional status following acute illness in older people

BACKGROUND & AIMS: Undernutrition in hospitalised patients is likely to be contributed to by the dual action of the underlying disease and acute catabolism associated with it. The aim of this study was to measure the association between underlying disease and nutritional status in acutely ill older patients. METHODS: Four hundred and forty-five randomly selected patients had their nutritional status assessed from anthropometric, haematological and biochemical data within 72h of admission, at 6 weeks and at 6 months. Data were also collected on age, disability, chronic illness, medications, smoking and acute-phase response. RESULTS: Patients admitted with chronic obstructive pulmonary disease (COPD), heart failure and falls had significantly lower anthropometric measurements compared with all study populations than for example those admitted with ischaemic heart disease (IHD), chest infections and for elective hip surgery. Nutritional status has deteriorated between admission and 6 weeks among those with COPD, heart failure and falls compared with all study populations. Over 6-months 33 (52%) COPD patients and 14 (39%) heart failure patients were readmitted to hospital compared with 137 (35%) patients of all study populations. Nutritional supplements lead to a limited but significant benefit in transferrin and red cell folate among patients with heart failure and IHD. CONCLUSION: In older patients, underlying diseases have variable contributions to the poor nutritional status associated with acute illness.     

高脂低糖肠内营养制剂对ICU机械通气病人营养及肺部功能影响的研究

目的:观察高脂低糖肠内营养制剂对ICU机械通气病人的营养以及肺部功能的影响。方法:将271例病人随机分为试验组和对照组,分别给予高能低糖肠内营养制剂和通用型肠内营养配方制剂,观察病人治疗前后前白蛋白、白蛋白、血气分析、IgG、CD4、CD4/CD8、机械通气时间等指标。结果:经过营养支持治疗,两组前白蛋白、白蛋白均明显改善,两组间无明显差异;两组血气分析、IgG、CD4、CD4/CD8、营养费用、机械通气时间等均明显改善,且试验组优于对照组。结论:高脂低糖肠内营养制剂可以改善ICU机械通气病人的营养状态和肺部功能,可以缩短机械通气时间、节约医疗费用,是一种理想的肠内营养制剂。     

Nutrition et mucoviscidose : de la prise en charge préventive au support nutritionnel

Nutritional status has a strong association with respiratory function and survival. Implementation of the French nationwide newborn screening program since 2002 allows an early preventive nutritional approach and nutritional support if indicated, aiming at maintaining a nutritional status similar to healthy peers during the patient's life. This review relies on international recommendations and describes the dietetic approach, pancreatic enzymes and fat-soluble vitamins supplementation and also nutritional support in case of moderate or severe malnutrition.