含谷氨酰胺双肽的肠外营养对危重病的改善作用

目的：了解谷氨酰胺双肽（Gln）增强的肠外营养（parenteral nutrition，PN）对普外科危重病患者病情的改善作用。方法：将40例符合诊断标准的普外科危重和大手术后患者随机分成治疗组和对照组，各20例，均给予常规外科治疗，并于术后第1～3天后开始肠外营养，连续7d，其中治疗组的氮量由20％L-丙氨酰-L-谷氨酰胺溶液供给[0．5g／（kg·d）]，其余部分由7％～11．4％的氨基酸溶液供给。两组患者分别于肠外营养前和营养后7d抽取外周血测量血红蛋白（Hb）、白蛋白（Alb）、转铁蛋白（TRF）、免疫球蛋白G（IgG），IgA，IgM，并进行急性生理和慢性健康评分系统（APACHEⅡ）评分。结果：治疗组经肠外营养治疗后IgG和TRF分别由治疗前（9．2±3．1）g／L和（1．17±0．3）g／L增高至（14±2．8）和（1．36±0．7）g／L，差异显著（P〈0．05），且治疗组APACHEⅡ评分又较对照组下降（P〈0．05）。结论：Gln增强的肠外营养能改善普外科危重病患者蛋白质代谢,提高机体免疫功能，减轻病情的危重程度。     

含谷氨酰胺双肽肠外营养对危重病的改善作用

目的 了解谷氨酰胺双肽(Gln)增强的肠外营养(parenteral nutrition,PN)对普外科危重病患者病情的改善作用.方法 将40例符合诊断标准的普外科危重和大手术后患者随机分成治疗组和对照组,各20例,均给予常规外科治疗,并于术后第1～3天后开始肠外营养,连续7 d,其中治疗组的氮量由20%L-丙氨酰-L-谷氨酰胺溶液供给[0.5 g/(kg·d)],其余部分由7%～11.4%的氨基酸溶液供给.两组患者分别于肠外营养前和营养后7 d抽取外周血测量血红蛋白(Hb)、白蛋白(Alb)、转铁蛋白(TRF)、免疫球蛋白G(IgG),IgA,IgM,并进行急性生理和慢性健康评分系统(APACHEⅡ)评分.结果 治疗组经肠外营养治疗后IgG和TRF分别由治疗前(9.2±3.1)g/L和(1.17±0.3)g/L增高至(14±2.8)和(1.36±0.7)g/L,差异显著(P＜0.05),且治疗组APACHEⅡ评分又较对照组下降(P＜0.05).结论 Gln增强的肠外营养能改善普外科危重病患者蛋白质代谢,提高机体免疫功能,减轻病情的危重程度.     

n-3多不饱和脂肪酸对重症感染患者炎症反应的随机对照研究

目的探讨n-3多不饱和脂肪酸对重症感染患者的治疗作用及效果。方法通过随机对照研究,对80例重症感染患者肠外营养治疗时进行相关炎症指标监测,其中试验组的静脉营养液中添加n-3多不饱和脂肪酸。结果治疗7 d后,试验组与对照组之间的C-反应蛋白、转铁蛋白、免疫球蛋白(IgAI,gGI,gM)等免疫和炎症指标有显著性差异(P<0.05)。结论 n-3多不饱和脂肪酸对重症感染患者的炎症反应调控具有积极作用。     

个体化营养支持对全身性炎症应答综合征患者的影响

目的探讨个体化营养支持对全身性炎症应答综合征(SIRS)患者营养指标的影响。方法将符合研究标准的72例患者随机分为对照组(n=36)和治疗组(n=36),住院后24~72 h内分别给予普通的营养支持和个体化营养支持。动态监测两组患者的营养指标和相关并发症发生率。结果住院第14天,治疗组患者营养指标的改善与对照组比较,差异有统计学意义(P<0.05),治疗组腹胀、腹泻、胃肠道出血和高血糖发生率明显低于对照组,两组比较,差异有统计学意义(P<0.05)。结论个体化营养支持对SIRS患者营养指标改善作用显著,并发症较低,有益于患者的康复。     

短肠综合征患儿全肠外营养的护理

短肠综合征系指小肠广泛切除后（保留的小肠长75cm以下）残存的功能性肠管不能维持营养需要所引起的营养吸收不良综合征。我科于2000年6月至今收治5例因消化道疾病行肠切除术后剩余肠管约50cm（保留回盲瓣）的患儿，针对术后出现的短肠综合征，施行全肠外营养（TPN）疗法，现将护理体会报告如下。     

全身炎症反应综合征的治疗现状

全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)是由不同疾病,包括微生物感染、创伤、烧伤等感染性疾病所引起的全身性的非特异性炎症反应,最终导致机体对炎症反应失控.     

输液引起全身炎症反应综合征

1 病例资料 男,20岁。因咽部疼痛6天入院。查体:体温37℃,血压120/80 mmHg,咽部充血,双侧扁桃体Ⅱ度肿大,无脓点、脓苔,双肺呼吸音粗,未闻及罗音,心、腹未见异常。血常规:血红蛋白110g/L,白细胞13.9×10~9/L,中性粒细胞0.68,淋巴细胞0.32。尿常规未见异常。X线胸透未见异常。诊断为急性扁桃体炎。给予生理盐水100ml+青霉素400万单位(皮试阴性)静     

烧伤后全身炎症反应综合征临床分析

对51例烧伤后全身炎症反应综合征（SIRS）进行了分析，SIRS的发生率为28．2％。烧伤越重，SIRS发生越多。休克、感染时SIRS发生率明显增高（P＜0．01），SIRS发生多器官功能不全综合征（MODS）者明显比非SIRS组多（P＜0．01），其中死亡2例。     

n－3多烯脂肪酸在创伤感染中的作用

为探讨ｎ－３多烯脂肪酸在创伤感染中所起的作用，采用盲肠结扎穿孔诱发大鼠脓毒血症，食道插管灌入液体鱼油治疗。研究结果，术前接受４ｗｋ鱼油治疗组与脓毒症组比较，前者动物枯否细胞释放的细胞因子，炎性介质及氧自由基产物明显减少，膜磷脂成分及花生四烯酸含量明显增加；同时观察到肝细胞膜脂流动性明显升高，相变温度明显降低，内皮素含量明显减少。提示，ｎ－３多烯脂肪酸有调节创伤感染动物巨噬细胞的生物学功能，减轻肝细胞和血管内皮细胞损伤的作用。     

n－3多烯脂肪酸在创伤感染中的作用

为探讨ｎ－３多烯脂肪酸在创伤感染中所起的作用，采用盲肠结扎穿孔诱发大鼠脓毒血症，食道插管灌入液体鱼油治疗。研究结果，术前接受４ｗｋ鱼油治疗组与脓毒症组比较，前者动物枯否细胞释放的细胞因子，炎性介质及氧自由基产物明显减少，膜磷脂成分及花生四烯酸含量明显增加；同时观察到肝细胞膜脂流动性明显升高，相变温度明显降低，内皮素含量明显减少。提示，ｎ－３多烯脂肪酸有调节创伤感染动物巨噬细胞的生物学功能，减轻肝细胞和血管内皮细胞损伤的作用。     

n-3系多烯酸摄取量的探讨

n-3系多烯酸具有防治心血管疾病、促进脑组织及视网膜的正常生长发育等生理作用,因此越来越引起人们摄取的兴趣。从目前的膳食结构来看,摄取n-3系多烯酸是十分必要的。如何正确的摄取,以充分发挥n-3系多烯酸对人体的健康作用及避免不良反应是人们摄取及开发这方面的保健食品和药物时值得注意的问题。     

n-3多不饱和脂肪酸类药物在心血管疾病中的临床应用进展

许多临床试验表明n-3多不饱和脂肪酸(n-3 PUFAs)对于冠心病、血脂异常和心力衰竭等人群均具有保护作用,而且已有建议推荐心肌梗死后患者和高甘油三酯血症人群口服此类提纯药物。但在应用过程中,仍有一些值得临床关注的问题,如药物安全性、药物成分和用量等。笔者认为,随着对n-3 PUFAs药物的深入研究,其将有更广阔的应用前景。     

Combination of arginine and omega-3 fatty acids enteral nutrition in critically ill and surgical patients: a meta-analysis

Immunonutrients may improve outcomes in critically ill and surgical patients. The objective of this meta-analysis was to determine if the combination of arginine and omega-3 fatty acids impacts infection rate, hospital length of stay and mortality in critically ill or surgical patients. In total, 23 studies met all of the criteria. Immunonutrition with arginine and omega-3 fatty acids was administered either pre- or post-operatively or during intensive care unit stay in seven, ten and six studies, respectively. Infection rate and length of stay were significantly lower in patients receiving immunonutrition compared with the control group. In a subgroup analysis, these differences were maintained in the pre- and post-operative populations, but were not significant in the critically ill population. Mortality was not significantly different between the immunonutrition and control groups.     

Dietary n-6 and n-3 polyunsaturated fatty acids and colorectal carcinogenesis: results from cultured colon cells, animal models and human studies

During the past few decades, many studies have been conducted to evaluate the effects of n-6 and n-3 polyunsaturated fatty acids (PUFAs) on colorectal carcinogenesis. This report provides a brief overview of the recent studies that have been performed in cultured colon cells, animal models as well as of the population-based and short-term biomarker studies with humans. No differential effect between n-6 and n-3 PUFAs has been observed in vitro. Results from animal models indicate that n-6 PUFAs have a tumor enhancing effect, predominantly during the post-initiation phase. n-3 PUFAs may protect against colorectal carcinogenesis during both the initiation and post-initiation phase. Population-based human studies show little or no associations between n-6 or n-3 PUFA intake and colorectal cancer. Short-term biomarker studies in humans suggest though that fish oil (FO) supplementation with high amounts of n-3 PUFAs may protect against colorectal carcinogenesis and that n-6 PUFA supplementation may increase the risk.     

Dietary n-6 and n-3 polyunsaturated fatty acids and colorectal carcinogenesis: results from cultured colon cells, animal models and human studies

During the past few decades, many studies have been conducted to evaluate the effects of n-6 and n-3 polyunsaturated fatty acids (PUFAs) on colorectal carcinogenesis. This report provides a brief overview of the recent studies that have been performed in cultured colon cells, animal models as well as of the population-based and short-term biomarker studies with humans. No differential effect between n-6 and n-3 PUFAs has been observed in vitro. Results from animal models indicate that n-6 PUFAs have a tumor enhancing effect, predominantly during the post-initiation phase. n-3 PUFAs may protect against colorectal carcinogenesis during both the initiation and post-initiation phase. Population-based human studies show little or no associations between n-6 or n-3 PUFA intake and colorectal cancer. Short-term biomarker studies in humans suggest though that fish oil (FO) supplementation with high amounts of n-3 PUFAs may protect against colorectal carcinogenesis and that n-6 PUFA supplementation may increase the risk.     

Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients

Background

Anemia is a common complication among hemodialysis (HD) patients. Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment, about 10% of HD patients show suboptimal response to these agents. Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness. Considering the anti-inflammatory properties of omega-3 fatty acids, this study aimed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients.

Methods

In this randomized, placebo-controlled trial, 54 adult patients with HD duration of at least 3 months were randomized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months. Anemia parameters including blood hemoglobin, serum iron, transferrin saturation (TSAT), erythropoietin resistance index, and required dose of intravenous iron and erythropoietin, and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, C-reactive protein (CRP), hepcidin, ferritin, intact parathyroid hormone (iPTH), and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention.

Results

45 subjects (25 in the omega-3 and 20 in the placebo group) completed the study. No significant changes were observed in blood hemoglobin, serum iron, TSAT, and required dose of intravenous iron in either within or between group comparisons. Additionally, erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group. Although a relative alleviation in inflammatory state appeared in the omega-3 group, the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment (P <0.001 and P = 0.003, respectively).

Conclusion

Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia. However, future well-designed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia.     

全肠道外营养液稳定性影响因素分析

目的：考查电解质和pH值对全肠道外营养液（TPN）稳定性的影响。方法：自行设计4组不同电解质浓度的TPN液标准处方,配制后放置于室温中,并于0、4、8、12、16、20和24h时分别取样,测定溶液pH值,用电光显微镜测定溶液脂肪乳微粒大小并肉眼观察其外观变化。结果：在0～24h,4组TPN液的pH值均保持在5.80～6.00,组一与组二无显著性差异（P〉0.05）,而组一与组三和组四均有显著性差异（P〈0.05）。随着时间的推移,脂肪乳微粒粒径有变大的趋势且随电解质的加入而明显,二价电解质对溶液pH的影响明显高于一价电解质;经过24h的放置,TPN液在外观上无明显变化。结论：一价电解质的常用量对TPN液中脂肪乳微粒影响较二价电解质小;但粒径的改变均在正常范围,因此室温下放置24h,TPN稳定。     

超低出生体重早产儿早期应用全静脉营养的安全性评估

目的评价超低出生体重早产儿(出生<1000g),生后1小时内给予全静脉营养的安全性。方法将相对健康的34例超低出生体重早产儿,随机分为治疗组及对照组,前者于生后1小时内给予全静脉营养,后者于生后72小时起给予静脉营养。观察患儿需机械通气时间,机械通气的例数,鼻塞CPAP时间(nCPAP)、平均吸氧时间、黄疸持续时间、诊断感染次数。结果两组需机械通气时间、例数,鼻塞CPAP时间(nCPAP)、平均吸氧时间、黄疸持续时间、诊断感染次数等指标上均未见有统计意义的不同。结论超低出生体重早产儿在早期(生后1小时内)应用全静脉营养是安全的。