早期肠内营养耐受性分级干预在重症病人中的应用

目的:探讨早期肠内营养(EEN)耐受性分级干预护理方案在重症病人中的应用效果。方法:选取内外科重症监护病房符合标准的重症病人214例,按照入院时间分为干预组和对照组,对照组采用常规肠内营养及干预措施;干预组采用EEN耐受性分级干预方案进行护理;观察两组第4天、7天热卡达标率、喂养中断次数、喂养不耐受症状、营养指标。结果:干预组第7天热卡达标率显著高于对照组,差异具有统计学意义(P 0.05);干预组喂养中断次数与喂养不耐受症状少于对照组(P 0.05);两组肠内营养第7天营养学指标差异有统计学意义(P 0.05)。结论:重症病人在EEN同时进行耐受性分级干预可以减少不必要的喂养中断、改善喂养不耐受症状,并尽早达到目标热卡。     

基于容量的喂养策略对ICU重症患者临床预后的影响

目的 比较基于容量的喂养策略和基于速率的喂养策略对重症患者临床预后的影响。方法 选择2020年1月—2021年12月杭州市富阳区第一人民医院重症监护室(intensive care unit,ICU)收治的200例重症患者作为研究对象,随机分为对照组和观察组各100例。对照组采用基于速率的喂养策略,观察组采用基于容量的喂养策略。比较两组患者的能量摄入情况和营养指标变化情况。结果 经肠内营养支持治疗14 d后,观察组血清白蛋白和前白蛋白高于对照组,差异有统计学意义(P<0.05);观察组肠内热卡和蛋白质摄入量高于对照组,差异有统计学意义(P<0.05);观察组每日喂养中断时长低于对照组,目标喂养达标率高于对照组,差异有统计学意义(P<0.05);两组不良反应比较差异无统计学意义(P>0.05)。结论 基于容量的喂养策略较基于速率的喂养策略,能够进一步改善肠内营养实施期间频繁中断的问题和患者短期营养状况。     

基于信息化的肠内营养耐受性动态管理对重症病人喂养效果的影响

目的:探讨基于信息化的肠内营养(EN)耐受性动态管理方案在重症病人喂养实践中效果。方法:选取浙江省人民医院ICU自2018年4月1日至2019年3月31日收治的EN病人,按入科先后分为对照组和观察组,每组各72例。对照组采用常规EN护理方案,观察组在常规EN护理基础上,实施基于信息化的EN耐受性动态管理方案。比较两组病人EN一周内喂养中断例数、第3天和第7天喂养达标率,喂养不耐受发生率,血清白蛋白、血红蛋白,机械通气时间、ICU住院时间。结果:观察组EN一周内喂养中断例数较对照组少;观察组第3天喂养达标率(58.8±13.9)%较对照组(53.6±13.3)%高,第7天喂养达标率(82.4±16.3)%较对照组(75.8±15.1)%高;观察组喂养不耐受发生率(9.7%)较对照组(40.3%)低,观察组血清白蛋白、血红蛋白指标较对照组高,ICU住院时间、机械通气时间较对照组短,差异均有统计学意义(P 0.05)。结论:基于信息化的EN耐受性动态管理方案可减少重症病人喂养中断,增加喂养达标率,降低喂养不耐受发生率,改善病人营养状况,缩短重症病人ICU住院时间,提高EN护理质量。     

合生元联合谷氨酰胺对重症急性胰腺炎病人行早期肠内营养耐受性及营养状况的影响

目的：探讨合生元制剂联合谷氨酰胺对重症急性胰腺炎(SAP)病人行早期肠内营养(EEN)肠道耐受性及营养状况的影响。方法：前瞻性选取2020年1月至2021年6月,联勤保障部队第九〇〇医院普通外科收治的78例SAP病人为研究对象,随机分为对照组(n=39)与实验组(n=39)。入院24～48 h内置入鼻空肠管进行EEN治疗。对照组给予含谷氨酰胺的肠内营养混悬液,实验组在前者基础上给予合生元制剂（双歧杆菌三联活菌+蔗果低聚糖）。比较两组病人干预后的每日胃排空情况（胃残余量）,干预7 d后肠内营养喂养不耐受症状、营养指标[血清运铁蛋白(TF)、白蛋白(ALB)、前白蛋白(PA)]。结果：干预后,实验组每日胃排空情况明显优于对照组,差异有统计学意义(P <0.05)。干预7 d后,实验组腹胀、腹痛、腹泻发生率显著低于对照组,差异有统计学意义(P <0.05),而恶心、呕吐发生率与对照组比较无统计学意义(P> 0.05)。两组营养状况指标较干预前均有明显提升,且实验组干预后明显高于对照组,差异有统计学意义(P <0.05)。结论：给予合生元制剂联合谷氨酰胺的肠内营养混悬液...     

基于喂养流程的脓毒症病人早期肠内营养耐受性的评估与管理

目的:探讨基于重症病人肠内营养(EN)喂养流程的早期肠内营养(EEN)耐受性评估与管理对脓毒症病人的影响,为EN实施及管理提供合理依据,以提高病人耐受性及改善疾病预后。方法:抽样选取2018年5月至2019年7月入住山东省青岛市市立医院ICU A病区与B病区的诊断为脓毒症且行EEN病人80例,按入院顺序分为对照组40例与实验组40例,对照组行常规EN治疗,实验组据重症病人EN喂养流程实施EN。结果:EN一周后,实验组前白蛋白(PA)、血红蛋白(Hb)高于对照组,两组间比较差异具有统计学意义(P 0.05)。实验组不耐受例数与不耐受率均低于对照组(P 0.05),实验组目标喂养量达标时间低于对照组[(2.33±2.83)vs (3.93±3.64),P 0.05]。实验组住ICU时间、机械通气时间及28 d病死率与对照组相比,差异均无统计学意义(P 0.05)。结论:脓毒症病人采用基于喂养流程的EEN耐受性评估与管理方案,不仅可提高病人耐受性从而保障EN顺利实施,而且可缩短目标喂养量达标时间,有效地改善病人营养状态,对指导临床治疗具有重要意义。     

集束化干预在急性脑出血病人肠内营养中的应用效果观察

目的 研究集束化干预措施在急性脑出血病人肠内营养中的应用效果。方法 选择2019年5月-2021年5月在钦州市第一人民医院重症医学科住院的64例急性脑出血病人作为研究对象,采用随机数字表法将病人随机分为观察组和对照组,每组32例病人。对照组给予常规的肠内营养护理措施,观察组在对照组的基础上施加集束化护理干预措施。比较两组病人肠内营养启动时间、目标量达成时间、喂养不耐受发生率、治疗满意度情况。结果 观察组病人肠内营养启动时间早于对照组病人,观察组病人目标量达成用时短于对照组病人,观察组病人喂养不耐受情况低于对照组病人,观察组病人治疗满意度高于对照组病人,差异均具有统计学意义(P<0.05)。结论 采用集束化护理干预措施有利于尽早启动急性脑出血病人的肠内营养,促进喂养目标量的达成,减少肠内营养喂养不耐受的发生率,提高治疗满意度,可在临床中进一步推广应用。     

经鼻空肠管早期肠内营养在重症胸外伤老年病人中的应用

目的:探讨经鼻空肠管早期肠内营养(EEN)在伴呼吸功能衰竭的重症胸外伤老年病人中的应用.方法:将42例伴呼吸功能衰竭的重症胸外伤老年病人随机分为试验组和对照组.试验组经鼻空肠管行EEN;对照组病人早期给予全胃肠外营养(TPN)支持,比较两组营养、炎症、免疫和临床观察各项指标.结果:两组病人在机械通气开始时营养、炎症、免疫指标均无显著性差异.经营养支持后,试验组病人营养指标和免疫功能指标均优于对照组(P＜0.05,P＜0.01),炎症指标均低于对照组(P＜0.05,P＜0.01);病死率、肺部感染率和机械通气时间显著低于对照组(P＜0.01).结论:伴呼吸功能衰竭的重症胸外伤老年病人经鼻空肠管EEN安全可行,可提高免疫功能,改善营养状况,减轻炎症反应,减少伤后并发症的发生率,从而提高生存率.     

综合干预治疗在食管癌病人术后早期肠内营养耐受性及机体康复的研究

目的:探讨综合干预方案在食管癌病人术后早期肠内营养(EEN)耐受性及机体康复中的应用效果。方法:将入选的93例病人按入院时间顺序分为综合干预组和传统对照组。综合干预组病人进行综合干预治疗,传统对照组病人给予常规护理,比较两组病人术后EN不耐受的发生率、首次闻及肠鸣音时间、首次排气和排便时间以及并发症等临床指标。结果:综合干预组47例病人中有36例(76.60%)能耐受EEN支持;传统对照组46例病人中有24例(52.17%)耐受EEN支持,两组比较差异有显著性统计学意义(P0.05)。综合干预组病人首次闻及肠鸣音时间、首次排气和排便时间、住院天数等均优于传统对照组(P0.01)。且综合干预组病人切口感染、肺部感染发生率均低于传统对照组(P0.05)。结论:采用综合干预方案治疗食管癌术后病人可有效降低EEN不耐受性的发生率,促进病人机体恢复,缩短住院时间,降低术后并发症,提高病人术后生活质量。     

含GM肠内营养对重症脑卒中患者营养状态及胃肠功能的影响

目的 观察含半乳甘露聚糖（GM）的肠内营养应用于重症脑卒中患者的价值。方法 100例重症脑卒中患者随机分为两组,对照组采用常规肠内营养,观察组采用含GM肠内营养。比较两组的营养指标、喂养不耐受发生情况以及胃肠道功能。结果 干预10 d后,观察组的TP、 PA、 Hb水平均高于对照组（P <0.05）。观察组的胃潴留、腹泻、腹胀发生率均低于对照组（P <0.05）。干预10 d后,观察组的AGI分级1级占比高于对照组（P <0.05）。结论 含GM肠内营养可改善重症脑卒中患者的营养状态及胃肠功能,降低其喂养不耐受的发生风险。     

序贯性肠内营养治疗在重症急性胰腺炎病人中的应用

目的:探讨序贯性肠内营养治疗(ENT)在重症急性胰腺炎(SAP)病人治疗中的应用及临床效果.方法:将41例确诊为SAP并保守治疗的病人随机分为两组.研究组(n=21)采用短肽型EN制剂过渡至整蛋白型EN制剂的序贯性ENT方案;对照组(n=20)直接采用整蛋白型EN制剂的ENT方案,喂养过程按照相关指南实施.比较两组病人达到目标能量时间、喂养并发症的发生率、同期营养指标情况以及平均入住ICU时间的差异.结果:两组病人在一定时间内均能达到目标热量.研究组病人达到目标能量的时间早于对照组(P＜0.05);研究组病人喂养并发症的发生率明显低于对照组(P＜0.05);研究组病人营养指标改善情况明显好于对照组(P＜0.05);研究组平均入住ICU时间短于对照组,但差异无统计学意义(P＞0.05). 结论:序贯性ENT在SAP病人治疗中耐受性更好,能更快地改善病人的营养状况.     

Infant feeding and HIV

Mother-to-child HIV transmission is the main cause of HIV infection in children. About two thirds of children infected vertically are infected during pregnancy and around the time of delivery, while the remainder are infected during breast-feeding. Although breast-feeding tends to be the best way to feed infants, substituting breast-feeding can reduce the risk of mother-to-child HIV transmission when mothers are HIV-seropositive. However, when breast milk substitutes are used, infants are 5 times more likely to have bacterial infections than are breast-fed infants, even in the context of good hygiene. Where hygiene is poor, artificially fed infants may be 20 times more likely to die from diarrhea than are breast-fed infants. HIV-positive women need information on the risks and benefits of breast-feeding and of the various alternatives, and support in deciding which method is best. Infant feeding options are discussed.     

Enteral feeding contamination: comparison of diluents and feeding bag usage

This quasi-experimental study compared bacterial growth in enteral feeding solution in six Kangaroo feeding bags filled with enteral formula diluted with sterile water vs six of the same diluted with tap water. Feeding bags, which were on continuous pumps in patient-occupied rooms, were rinsed and refilled every 8 hours, and formula cultures were obtained at 0, 24, and 48 hr. Acceptability of cultures was based on published recommended standards. Low levels of nonpathogenic staphylococci were found in sterile water bags; high levels of bacilli and Gram negative rods were found in tap water bags. No significant differences were found in the relationship between type of formula diluent and outcomes. Type of water diluent and acceptability were not related. There was a systematic relationship between length of use and outcome; with both diluents, bags used over 24 hr became unacceptably contaminated. Further study with a larger sample is needed to determine the effects of using tap water rather than sterile water as diluent.     

Parent-reported feeding and feeding problems in a sample of Dutch toddlers

Little is known about the feeding behaviors and problems with feeding in toddlers. In the present questionnaire study, data were collected on the feeding behaviors and feeding problems in a relatively large (n = 422) sample of Dutch healthy toddlers (i.e. 18-36 months old) who lived at home with their parents. Results show that three meals a day was standard and the mean mealtime duration was 22 minutes. Most children eat independently and sit in a high chair. All of the generally recommended foods were consumed with a decreasing tendency across age groups. Of the total sample, 65% had at least one type of feeding problem. In seven percent of the cases feeding problems were moderate to severe and significantly related to parental concern. However, few had sought professional help. Two dimensions of feeding problems (i.e. pickiness and disturbing mealtime behavior) and three dimensions of parental management techniques could be identified. Several significant associations were found. For example, associations were found between pickiness and variables such as parental concerns, difficulties in learning to eat solid foods, and several food items. No associations were found between pickiness and mealtime duration. In conclusion, implications of the findings are discussed in relation to the treatment of severe feeding problems in toddlers with developmental disabilities.     

幼儿睡眠异常与饮食行为关系研究

探讨幼儿睡眠问题与饮食行为的关系,为改善幼儿睡眠质量和饮食行为提供参考.方法 基于分层整群抽样,采用儿童睡眠习惯问卷(Children's Sleep Habit Questionnaire,CSHQ)、儿童饮食行为问题问卷对贵州省761名幼儿进行调查.结果 儿童饮食行为问题受到年龄、母亲学历、整体养育风格、养育观念一致程度的影响(β值分别为-0.210,-0.122,-0.121,-0.201,P值均<0.05),共解释饮食行为问题总分13.6%的变异(△R2 =0.136).在控制以上因素后,CSHQ问卷的日间困倦、睡眠阻抗、异态睡眠、睡眠持续时间、入睡延迟对饮食行为的影响均有统计学意义(β值分别为0.189,0.166,0.106,0.059,0.058,P值均<0.05),共解释饮食行为问题总分11.6%的变异(△R2=0.116).结论 幼儿饮食行为问题与睡眠问题存在密切关系,且受到年龄、母亲学历、家庭养育因素的影响.