胰十二指肠切除术后不同营养支持方式的疗效比较

目的:比较胰十二指肠切除术(PD)后病人肠内营养(EN)和肠外营养(PN)支持的临床疗效.方法:将71例在我院接受PD的病人随机分为EN组(n=36)和PN组(n=35).比较两组病人手术前后血肝功能相关指标、营养指标以及术后并发症的发生率、肛门排气时间、住院时间和营养支持费用的差异. 结果:两组病人术后血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)等均较术前明显降低(P＜0.05),术后第12天降低更加明显(P＜0.01).而在术后第8和12天,EN组病人ALT、AST、TBil、DBil较PN组明显降低(P＜0.05),总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)均升高(P＜0.05);术后第12天EN组的血淋巴细胞计数(LY)明显高于PN组(P＜0.05).EN组病人较PN组术后平均住院时间缩短、肛门排气时间早、并发症发生率低、营养支持费用少(P＜0.05). 结论:PD术后EN支持能明显改善病人的营养状态,促进术后恢复,降低住院费用.     

老年人胃癌术后早期肠内营养支持的临床研究

目的:研究老年人胃癌术后早期肠内营养支持的安全性和合理性.方法:选择年龄60岁以上胃癌手术的26例病人,随机分为肠内营养(EN)组和肠外营养(PN)组,每组13例.检测手术前后人体测量学指标及血红蛋白(Hb)、血浆清蛋白(ALB)、转铁蛋白(TFN)和纤维连接蛋白(Fn),同时观察胃肠功能恢复情况.两组营养支持均为等热量.结果:术后两组病人的人体测量学指标和Hb、ALB差异均无显著性意义(P＞0.05);术后第8 d病人均由负氮平衡转为正氮平衡;术后第4、8 d时,两组的Fn比术前明显升高(P＜0.05、P＜0.01),而且术后第8d时EN组的上升比PN组更明显(P＜0.05);肛门排气时间EN组比PN组早(P＜0.05).结论:老年人胃癌术后给予早期肠内营养支持,可促进病人胃肠功能的恢复和改善营养代谢.     

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.     

肠内肠外营养在胃癌病人术后临床价值的分析

目的:探讨胃癌病人术后给予肠内营养(EN)与肠外营养(PN)在临床应用价值方面的差异. 方法:回顾性分析200例胃癌病人术后经EN和PN支持治疗的效果.将胃癌术后病人根据营养支持治疗方式的不同分为EN组(130例)和PN组(70例).比较两组病人营养支持前、后血红蛋白、红细胞计数、淋巴细胞计数、血清总蛋白、清蛋白、血肌酐、总胆固醇、三酰甘油、血钙、IgA、IgG、IgM水平的变化以及各种并发症发生率、营养支持时间、营养支持平均每天费用及平均住院时间的差异. 结果:术后第7天,EN组病人的血红蛋白和红细胞计数明显升高,与PN组比差异有统计学意义(P＜0.05).血清总蛋白、清蛋白和IgA、IgG、IgM水平升高显著,差异有统计学意义(P＜0.05);与PN相比,EN组在经7d营养支持后,白细胞计数、肌酐、总胆固醇、三酰甘油、血钙水平比较均无显著性差异(P ＞0.05);EN组术后切口感染和肠梗阻发生率均低于PN组,肛门排气时间和术后平均住院时间,平均住院费用均少于PN组. 结论:与PN支持比,EN可有效地改善胃癌术后病人的营养状态,提高机体免疫功能.     

不同营养支持方法在胃癌病人术后的应用

目的:探讨不同营养支持方法在胃癌术后病人中的应用价?方法:将60例胃癌根治术后病人随机分为三组,分别进行肠外营养支持(PN组)、肠内营养支持(EN组)和肠外联合肠内营养支持(PN-EN组).观察在治疗过程中三组病人并发症的发生率、术后肠功能恢复时间、术后平均住院天数、肝功能、血糖及营养评定等各项指标,进行对比分析.结果:三组病人术后并发症的发生率、平均住院天数、肝功能、血糖无明显差异;EN组病人术后胃肠道功能恢复时间明显早于PN组和PN-EN组(P＜0.05).各组术后血清清蛋白、前清蛋白和转铁蛋白在营养支持后均明显升高(P＜0.05),负氮平衡均得到有效纠正.结论:三种营养支持方法均能明显改善胃癌术后病人机体营养状况,肠外联合肠内营养尤其适用于不能耐受术后早期肠内营养的病人.     

老年机械通气病人肠内肠外营养支持的比较

目的:观察老年机械通气病人肠内肠外营养支持的效果.方法:将60例老年机械通气病人随机分为全肠内营养(TEN)组和全肠外营养(TPN)组,每组30例,在摄入同等热量和氮量的条件下进行比较.结果:TEN组血清清蛋白、血红蛋白、氮平衡方面明显优于TPN组(P＜0.05).机械通气时间和临床费用低于TPN组(P＜0.05).两组并发症的发生率无显著性差异(P＞0.05).结论:老年机械通气病人肠内营养较肠外营养能更好的提供营养,缩短机械通气时间,而且费用低.     

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。     

营养支持在肝移植病人术后治疗中的应用

目的：探讨肝移植术后病人营养支持的作用和方法选择。方法：3例肝移植术后第2天开始给予全肠外营养（TPN），后在PN基础上加肠内营养（EN），并逐渐过渡到全肠内营养（TEN），最挂一漏万转为完全经口饮食。结果：术后病人肝功能恢复，黄疸减轻，血浆蛋白提高，氮平稀改善，康复良好。结论：肝移植术后病人需要营养支持，并从TPN→PN EN→TEN逐渐过渡；胃肠功能一旦恢复，早期EN有利于促进肝移植术后病人尽快恢复。     

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.     

肠外瘘合并胆或胰外瘘时的营养支持研究

目的 :研究肠外瘘合并胆或胰外瘘时的营养支持方法及其作用。　方法 :2 3例肠外瘘合并胆或胰外瘘病人行TPN→PN +EN→TEN→EN +口服饮食序贯营养支持。收集各阶段的营养物质供给量、天数、所占比例及各营养支持阶段末期的肝酶谱 ;统计肠内营养给予途径、全组病例的预后及并发症发生情况 ;比较TPN支持前、TEN支持后 1 5天病人的体重、上臂中点周径、血清总蛋白、白蛋白和前白蛋白浓度。　结果 :2 3例病人住院总天数为 1 498天 ,使用TPN 90 1天 (60 1 % ) ,供给非蛋白质热量 (1 35 .9± 2 3 .4)kJ/(kg·d) ,氮 (0 .2 1± 0 .0 6) g/(kg·d) ;使用PN +EN 445天 (2 9.7% ) ,供给非蛋白质热量 (1 2 3 .4± 1 4 .2 )kJ/(kg·d) ,氮 (0 .1 8± 0 .0 3) g/(kg·d) ;使用TEN 1 52天 (1 0 .2 % ) ,供给非蛋白质热量 (1 1 6 .3± 1 9.6)kJ/(kg·d) ,氮 (0 .1 7± 0 .0 4 ) g/(kg·d) ,肠内营养途径依次是鼻肠管1 3例 ,空肠造口管 5例 ,堵瘘 3例 ,鼻胃管 2例。全组死亡 4例 ,治愈 1 9例 ;中心静脉导管感染 2例 ,肝酶谱改变 6例 ,腹胀、腹泻 3例 ;TEN支持后阶段营养指标明显改善。　结论 :TPN→PN +EN→TEN→EN +口服饮食的序贯营养支持模式是肠外瘘合并胆或胰外瘘病人的合理、有效营养支持方法 ,其中PN是主要手段     

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.     

Ceramide in Lipid Emulsions Used in Parenteral Nutrition

Parenteral nutrition-associated liver disease is a prevalent and severe complication of long term parenteral nutrition. We present here for the first time data on the presence of ceramide, a bioactive compound involved in a variety of metabolic processes, in different lipid emulsions used in parenteral nutrition. Further research is needed to determine whether this potential harmful bioactive compound is involved in parenteral nutrition-associated liver disease.     

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.     

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols.Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices.Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important.Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.     

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.