营养支持疗法对消化道癌症术后患者生活质量的改善作用

目的 观察营养支持疗法对消化道癌症术后患者生活质量的改善作用，分析其改善的机制。方法 对消化道癌症术后患者127例，分为观察组66例，对照组61例，观察 组患者术后在常规治疗的基础上配合营养支持疗法，对比观察两组患者的效果和生活质量。结果2个月后，观察组患者的术后效果和生活质量的改善情况与对照组差异均有显著性意义(X^2=5．2013，P&;lt;0．05)。结论 消化道癌症术后患者可及早进行营养支持疗法，效果较好，无并发症。     

营养支持疗法对消化道癌症术后患者生活质量的改善作用

目的观察营养支持疗法对消化道癌症术后患者生活质量的改善作用,分析其改善的机制。方法对消化道癌症术后患者127例,分为观察组66例,对照组61例,观察组患者术后在常规治疗的基础上配合营养支持疗法,对比观察两组患者的效果和生活质量。结果2个月后,观察组患者的术后效果和生活质量的改善情况与对照组差异均有显著性意义(χ2=5.2013,P<0.05)。结论消化道癌症术后患者可及早进行营养支持疗法,效果较好,无并发症。     

恶性肿瘤患者营养状况分析

恶性肿瘤是一类消耗性疾病,随着肿瘤的发展,机体的营养成分不断被消耗,患者的营养状况逐渐恶化。综述了癌症手术患者、癌症化疗患者、癌症放疗患者以及晚期恶性肿瘤患者的营养状况,通过对引起营养不良的因素的分析提出合理的、针对性的营养支持方案,以增加营养,延长患者生命。     

135例癌症康复期患者营养状况的分析

绝大部分癌症患者都存在不同程度的营养不良,这不利于患者康复.患者的营养不良可由癌症本身或治疗的副作用所引起,因此,营养支持在癌症康复医疗中是一个重要的环节.为了解癌症患者康复期营养摄入的实际情况, 2000年对我院收治的 135例癌症康复期患者的膳食营养及忌口情况作了调查与分析,现报道如下.     

老年癌症患者营养支持的护理

积极治疗与护理老年肿瘤患者,对提高他们的生命质量有着重要意义。通过临床护理实践,我们认为,根据老年癌症患者的生理、病理特点,有的放矢地给予营养支持护理,能起到药物所不能起到的作用。1.营养支持护理的基本原则　因癌症患者的治疗需延续相当长的时间,因此,对老年癌症患者营养支持的护理应保持连续性、整体性和有效性,要将该项护理措施列入总体治疗方案内,由护士、家庭及社会共同参与,在医师和营养师的指导下,定期对患者的营养状况做出评价,包括生理检查、生化测定,并根据病情与治疗措施及时修正、补充护理方案。对体质弱、手术效果差…     

个性化营养支持可以将癌症患者两月内的死亡率降低17％

近日,瑞士巴塞尔大学医学院P.Schuetz教授领衔的研究团队在著名期刊《外科肿瘤学年鉴》发表重要研究成果,为癌症患者的营养护理提供了新的依据.他们发现,个性化营养支持可以让癌症患者获益,显著改善癌症患者的生存率和生活质量.他们的研究支持将营养护理纳入癌症管理指南.     

头颈部癌症患者家庭肠内营养的研究进展

家庭肠内营养是头颈部癌症患者居家营养支持的重要方式,但临床实践中存在营养支持开展不规范、专业指导和随访缺乏等问题。本研究借鉴国内外家庭肠内营养相关指南以及研究经验,从头颈部癌症患者家庭肠内营养的开展情况、管理团队、给予途径、配方的选择、给予方式、并发症的预防及处理、效果的监测与随访等方面进行综述,以期为我国头颈部癌症患者家庭肠内营养的规范化实践提供参考依据。     

晚期癌症患者锁骨下静脉置管的护理体会

晚期癌症患者由于长期化疗、放疗和多次手术 ,思想压力大 ,心理承受能力差 ,情绪不稳易变性大。尤其是长期高营养支持 ,周围静脉血管硬化变细 ,不易进行静脉穿刺 ,患者往往惧怕甚至拒绝输液。我院自 1999年至 2 0 0 2年对晚期癌症患者 2 5例行锁骨下静脉置管术 ,不仅减少了患者     

晚期癌症患者50例临终关怀护理

对50例晚期癌症患者给予心理护理、疼痛护理、营养支持等临终关怀,解除了患者对死亡的顾虑和不安,提高了生存质量,能正确的对待死亡。临终关怀护理能减轻临终患者的精神和肉体的痛苦,提高其生命质量。     

晚期癌症患者50例临终关怀护理

对50例晚期癌症患者给予心理护理、疼痛护理、营养支持等临终关怀,解除了患者对死亡的顾虑和不安,提高了生存质量,能正确的对待死亡.临终关怀护理能减轻临终患者的精神和肉体的痛苦,提高其生命质量.     

Nutritional support and risk status among cancer patients in palliative home care services

Goal of work  The aim of this study was to investigate the nutritional risk status and use of nutritional support among cancer patients enrolled in palliative home care services. Differences in the use of nutritional support in relation to nutritional, social and clinical factors, as well as survival were also investigated. Patients and methods  Structured telephone interviews were conducted with cancer patients enrolled in all 21 palliative home care services in the Stockholm region. An interview guide was designed to investigate topics related to the patient’s nutritional situation. Main results  Interviews with 621 patients were analysed. Sixty-eight percent of the patients were scored as at nutritional risk according on a modified version of NRS-2002. Nutritional support was used by 55% of the patients, with oral nutritional supplements most common and 14% using artificial nutrition. Use of nutritional support was related to low BMI and severe weight loss and was more common in patients with shorter survival times. Conclusions  These findings demonstrate that nutritional support is used to treat already malnourished patients with shorter survival time, rather than to prevent malnutrition. A more structured approach to nutritional issues for patients in palliative phases, which considers life expectancy and psycho-social aspects of nutritional issues, could help identify potential candidates for nutritional support.     

内科住院患者营养不足、营养风险和营养支持状况

目的调查内科住院患者营养不足、营养风险和营养支持应用状况。方法采用定点连续抽样,选择内科系统住院患者398例,采用欧洲肠外肠内营养学会推荐的营养风险筛查工具NRS2002做营养不足和营养风险筛查,NRS2002≥3分为有营养风险,体质量指数(BMI)<18.5 kg/m2并结合临床一般情况差判定为营养不足。同时调查患者住院期间的肠内肠外营养支持情况。结果 398例内科住院患者营养不足和营养风险发生率分别为14.1%和33.7%;营养不足发生率居前两位的是消化内科(19.6%)和肿瘤内科(16.9%);免疫科(8.6%)发生率低。营养风险发生率占前3位的是肿瘤内科(47.5%),消化内科(42.9%)和神经内科(41.7%),内分泌科(21.4%),免疫科(13.8%)发生率低。398例患者中,31例应用肠内营养(EN),92例应用肠外营养(PN),8例同时应用肠内肠外营养,PN∶EN=3∶1;有营养风险患者营养支持率为70.9%,无营养风险患者营养支持率为13.6%;有营养不足患者营养支持率为96.4%,无营养不足患者营养支持率为22.5%。结论消化内科、肿瘤内科、神经内科营养不足或营养风险发生率较高。建议重视肠内营养支持,提高肠内营养应用比例。     

The critically ill surgical patient: nutritional considerations

The nutritional care of the patient in the surgical intensive care unit is one of the most challenging in the field of nutritional support. Each patient must be assessed individually and specific goals of nutritional support established. Specialized nutritional solutions may be needed for the patient with significant renal, hepatic, or pulmonary disease, as well as patients in a chronic septic state. Knowledge of the infectious and metabolic complications that frequently occur in this population is essential in order to keep nutritionally related morbidity at a minimum. Finally, the realization that, in the surgical intensive care unit, nutritional therapy is often a supportive measure used in an attempt to gain time to eradicate the primary process will enable the clinician to establish the proper approach to the nutritional care of these patients.     

破伤风病人早期肠内营养支持的效果研究

[目的]观察肠内营养支持对破伤风病人的干预作用。[方法]对3 3例破伤风病人(肠内营养组)于入院48h内给予肠内营养支持,观察其对营养指标以及对愈后的影响,并与未用肠内营养支持的3 8例破伤风病人(对照组)进行比较。[结果]肠内营养组病人在营养支持后,体重指数、上臂肌围、三头肌皮褶厚度均高于对照组,但无统计学意义(P >0 .0 5 ) ;对照组病人血红蛋白、血清蛋白和外周血淋巴细胞的下降较肠内营养组明显,有统计学意义(P <0 .0 5 ) ;肠内营养组并发症发生率(15 .2 % )低于对照组(3 9.5 % ) ,两组比较有统计学意义(P <0 .0 5 )。[结论]肠内营养支持可以改善破伤风病人营养状况,降低并发症发生率。     

老年肺结核患者营养状况及其影响因素研究

目的 了解老年肺结核患者营养状况并分析其影响因素,为临床医护人员实施个体化营养干预方案提供依据。方法 采用一般资料调查问卷、微型营养评定法（MNA）、24小时膳食回顾（连续三天）、食物频率调查（三个月内）、心理状况评估表、社会支持量表、家庭功能评定量表对上海市肺科医院结核科共134例老年肺结核患者进行调查。结果 老年肺结核患者MNA营养评估得分为（19.79±4.89）分,其中存在营养不良的风险及营养不良得分分别为（21.10±0.96）分和（13.42±2.75）分。不同年龄、文化程度、婚姻状况、月收入、经济来源、月医药费用、医疗付费方式、结核确诊时长的患者MNA营养评估单因素分析中,差异无统计学意义(P>0.05)。患者的性别、居住情况、患病情况、服药情况、耐药状况的不同,其MNA营养评估单因素分析中,差异有统计学意义 (P<0.05)。多元线性回归分析显示,耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构是老年肺结核患者营养状况的重要影响因素。结论 老年肺结核患者的营养状况不容乐观,影响老年肺结核患者营养状况的因素可能与其耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构有关。建议临床医生及营养师针对老年肺结核患者营养不良的特点及膳食营养素的摄入状况,尽早采取临床营养管理工作,制定个体化、精准的营养干预方案,给予合理的膳食结构建议,纠正其营养不良,改善营养状况。     

Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool

In patients suffering from advanced neoplastic disease, malnutrition is a common complication affecting both the survival and quality of life. In order to monitor early dietary interventions, an assessment of patients' nutritional status is essential. We assessed the nutritional status of 46 patients using two different methods: 1) an objective method of nutritional assessment and 2) the subjective global assessment (SGA) technique. It was found that 28 patients were characterized as malnourished by means of the objective method and 30 patients according to the SGA. The correlation of the results of the assessments between the two methods was high and a validation test of the SGA gave a sensitivity of 96% and specificity of 83%. The most frequent symptoms affecting food intake were anorexia, early satiety, dry mouth, pain and nausea. The results show that the SGA represents an easy method for assessment of the nutritional status in such cancer patients and that it can therefore be used as a screening tool. The high incidence of malnutrition in this group of patients, and their rare use of nutrient supplements, both indicate the importance of early nutritional assessment, and nutritional intervention when appropriate.     

Optimizing nutrition in intensive care units: empowering critical care nurses to be effective agents of change

Observational studies have consistently revealed wide variation in nutritional practices across intensive care units and indicated that the provision of adequate nutrition to critically ill patients is suboptimal. To date, the potential role of critical care nurses in implementing nutritional guideline recommendations and improving nutritional therapy has received little consideration. Factors that influence nurses' nutritional practices include the lack of guidelines or conflicting evidence-based recommendations pertaining to nurses' practice, strategies for implementing guidelines that are not tailored to barriers nurses face when feeding patients, strategies to communicate best evidence that do not capitalize on nurses' preference for seeking information through social interaction, prioritization of nutrition in initial and continuing nursing education, and a lack of interdisciplinary team collaboration in the intensive care unit when decisions on how to feed patients are made. Future research and quality improvement strategies are required to correct these deficits and successfully empower nurses to become nutritional champions at the bedside. Using nurses as agents of change will help standardize nutritional practices and ensure that critically ill patients are optimally fed.     

Parenteral versus enteral nutrition in cancer patients: indications and practice

 Prospective randomly controlled trials have failed to demonstrate the clinical efficacy of providing nutritional support to most cancer patients in terms of morbidity, mortality, and duration of hospitalization. Serious shortcomings in study design have limited the possibility of drawing definitive conclusions from the data. Thus, nutritional intervention needs to be seen as a method of support, with the aim of maintaining nutritional and functional status during the stress of the oncology treatment to prevent or attenuate cachexia. There is no disease during which the patient benefits from prolonged wasting. Pretreatment weight loss is quoted as a major indicator of poor survival and response to therapy of cancer patients. As a consequence, an early and serial assessment of nutritional status, perhaps followed by an immediate intervention with nutritional support is strongly recommended. There are other specific reasons for using the gut rather than the intravenous route for nutrient administration besides the often reported disadvantage of significant cost. Local intestinal stimulation prevents the mucosal atrophy and bacterial translocation that can be triggered by several precipitating factors, as frequently seen in oncologic patients. These include endotoxin, radiation therapy, cytotoxic and immunosuppressive drugs, cytokines, bowel and biliary obstruction, broad-spectrum antibiotics, and the tumour itself, as well as parenteral nutrition (PN). As the enteral route of nutritional support has been found to be as good as or preferable to PN in terms of maintenance of nutritional status or immune function, prevention of bacterial translocation, maintenance of normal gut flora, transit and histology, and prevention of hypercatabolic responses to stressful events, it is always preferable in terms of physiological response, local and systemic competence, quality of life and cost, and should be the method of choice for the nutritional support of cancer patients. Although retrospective studies of PN suggest a benefit for patients with cancer who are undergoing surgery, radiation, or chemotherapy, carefully designed, prospective studies report less conclusive findings. The failure of conventional PN to improve clinical outcomes in patients with cancer may be related to the fact that standard formulations do not address or reverse abnormalities of intermediate metabolism that result in cancer cachexia. Supplemental substances have been proposed in an attempt to improve the efficacy of PN, including insulin, growth hormone and branched chain amino acids. The difficult task is to identify those patients who are at risk for malnutrition and at the same time identify the subset of patients who will benefit clinically from parenteral nutritional repletion. Severe malnutrition in patients requiring surgery, bone marrow transplantation in patients unable to tolerate enteral supplementation and postoperative complications necessitating nutritional support are specific indications. Routine use of PN should be discouraged.     

Malnutrition and weight loss - nurse assessment of nutritional status and counselling: experiences of patients with newly diagnosed or relapsed cancer

Due to the anorexia-cachexia syndrome, cancer patients are already suffering from nutritional problems and weight loss by the time they receive their diagnosis and start chemotherapy. In the oncology outpatient clinic of a Swiss university hospital, patients currently undergo a nutritional assessment and receive individual counselling at the beginning of cancer treatment. This qualitative study explored cancer patients' experiences with weight loss and nutritional problems as well as how they experienced the assessment and the consecutive counselling by nurses. Interviews were conducted with 12 patients and qualitative content analysis was used for data analysis. Results showed that patients barely registered the weight loss and did not interpret it as an early warning signal. Nevertheless, they attempted to improve their nutritional habits soon after diagnosis, prior to receiving any counselling. The patients did not experience the assessment as troublesome. They appreciated the nurses' advice and implemented the suggestions they found appropriate. This study highlights the importance of patient education regarding weight loss and nutritional problems early in the course of an illness. Patients may not be aware of nutritional problems at this early stage and may lack the necessary specialised knowledge. Assessment and counselling provided by nurses offer targeted measures for prevention of malnutrition and weight loss.     

以护士为主导的四位一体式早期营养支持管理模式在重症脑卒中患者中的应用效果分析

目的：探讨以护士为主导的四位一体式早期营养支持管理模式在重症脑卒中患者中的应用效果。方法选取四位一体式早期营养管理模式实施前(2015年1月到2015年6月)和实施后(2015年7月至2015年12月)收治于本院的重症脑卒中病例各50例为研究对象,实施前后病例组分别设为对照组和实验组。对照组接受常规早期营养支持护理,实验组接受以护士为主导的四位一体式早期营养支持管理,对两组重症脑卒中病例干预后的各相关观察指标进行比较。结果实验组重症脑卒中病例干预后的4项营养状况指标(血清总蛋白、白蛋白、血红蛋白、血糖)均显著优于对照组,干预后的并发症发生率、平均ICU住院费日和平均机械通气时间均显著低于对照组,差异均有统计学意义( P<0.05)。结论对重症脑卒中患者实施以护士为主导的四位一体式早期营养支持管理模式干预,能显著提高营养支持效果,降低并发症发生率,节省重症监护医疗资源。