肠内和肠外营养支持在危重病中的应用

目的:研究ICU危重病人肠内和肠外营养支持效果.方法:对ICU中56例危重病人的营养支持情况进行对比分析,其中肠内营养支持组32例,肠外营养支持组24例.结果:本组病人52例康复,4例死于原发病.经肠内营养支持后,血清前清蛋白明显升高(P＜0.01),血清清蛋白和血红蛋白亦有升高(P＜0.05);而肠外营养支持后,各指标差异无显著性意义.两组对比,肠内营养支持组病人血清前清蛋白和清蛋白均高于肠外营养支持组(P＜0.05),上臂肌围和肱三头肌皮皱厚度无显著差异.结论:ICU危重病人救治中,应根据疾病的不同情况,选择合适的营养支持方式,肠内营养有更好的代谢效应及营养效果.     

危重病人早期肠内营养的临床应用分析

目的:分析早期肠内营养在危重病人中的临床应用状况. 方法:回顾3年半中住ICU>10天的278例病人资料,分析各类病种及各种途径早期肠内营养的实施情况,观察开始时间、达到营养目标点时间、并发症等. 结果:87.1%的危重病人可早期给予肠内营养,早期肠内营养开始时间、达到营养目标点时间与营养途径有关. 结论:早期肠内营养在危重病人中可以实施,并可能有助于降低病死率.     

危重病人肠内营养的应用分析

随着营养支持的发展,肠内营养的应用也日趋增多,对危重病人而言,肠内营养支持至关重要。如何应用危重病人肠内营养是肠内营养护理关注的焦点,因此,研究危重病人肠内营养的应用具有十分重要的现实意义。本文以危重病人肠内营养的应用为切入点,在阐述肠内营养的内涵的基础上,对危重病人肠内营养液的选择进行了分析,并探讨了危重病人肠内营养的护理方法,旨在说明危重病人肠内营养应用的重要性,以期为危重病人肠内营养的应用提供参考。     

52例ICU危重病人肠内营养支持临床观察

目的探讨对ICU内危重病人行肠内营养支持的效果。方法筛选2012年4-9月入住我科并进行肠内营养危重病人52例,分析比对肠内营养支持前后患者血红蛋白,白蛋白,血糖水平变化以及不耐受情况,评估肠内营养效果。结果所有患者在行肠内营养支持后,白蛋白及总蛋白水平较之前明显升高,差异有统计学意义(P<0.05),而血红蛋白水平及血糖水平差异无统计学意义(P﹥0.05),部分病人发生在早期发生腹胀,腹泻等不耐受情况,但经干预均成功接受肠内营养支持。结论肠内营养支持有助提高危重病人白蛋白水平,而且耐受性好。     

重危病人的营养支持治疗

0 引言 危重病人机体的高代谢反应,可迅速导致营养不良的发生,使免疫功能下降及出现多器官功能障碍.因此,及早给予营养支持是非常重要的.近2年来,我科应用肠外营养(PN)和肠内营养(EN)支持治疗41例危重病人,现总结报道如下.     

危重病人达到肠内营养支持营养目标的短期疗效

目的对1998年以来临床28例危重病人,实施达到营养目标的肠内营养支持,并做了短期疗效观察。     

肠外联合肠内序贯营养降低重症卒中病人肺部感染及上消化道出血风险

目的 :通过对缺血性卒中危重病人急性期采取不同营养支持方案的对照研究,探讨卒中危重病人急性期合理的营养支持策略。方法 :采用前瞻性研究方法,将50例急性卒中病人按照随机单盲原则分为入院发病24 h内给与单纯肠内营养组及肠内营养联合肠外营养组。比较两组间肺部感染、胃潴留、上消化道出血、低血糖及高血糖的发生率。以20 d转出ICU为终点事件,Kaplan-Meier法比较分析两组之间差异。结果 :肠外营养联合肠内营养(PN+EN)组和肠内营养(EN)组在高血糖和低血糖发生率上无差异(P0.05),EN组胃潴留及上消化道出血、腹泻及肺炎发生率明显高于PN+EN组(P0.01)。结论 :危重卒中病人急性期采取肠外联合肠内序贯营养可降低肺部感染、胃潴留及上消化道出血等并发症,可能缩短ICU住院时程。     

重症病人肠内营养支持的几点实践体会

0引言 为适应临床医疗需要和提高营养治疗水平,我院营养科自1998年以来,逐步开展了重症病人肠内营养支持,积累了丰富的经验,形成了一定的特色,并由此促进了科室工作的全面发展.本文作者仅就我科近年来在开展重症病人肠内营养支持时早期对胃肠功能适应性调理的重要性,针对不同疾病特点采用个体化、功能化肠内营养配方的必要性,评价营养支持效果应考虑整体效应性及开展重症病人肠内营养支持体对营养科学科发展的影响的几点实践体会,作以下简要介绍.     

危重病人营养与代谢支持策略的演变

已认识到全肠外营养在危重病人营养支持中的不足,主要是感染和肝功能的并发症较难克服。与全肠外营养相比,肠内营养具有并发症少,费用低等优点。但由于外科病人通过肠道进行营养支持有一定限制。为避免能量与蛋白质供给不足,可采用肠内 肠外的营养支持模式。过多供给能量与蛋白质,不仅不能改善病人的营养状态,反而对机体有害,危重病人的合理营养支持最好是按实际测量的能量消耗供给营养底物,要想进一步改善重危病人营养支持的效果。必须注重辅助疗法的应用。如谷氨酰胺、精氨酸、亚油酸、短链脂肪酸以及微生态营养。     

营养支持治疗在神经外科危重病人中的合理应用

目的 :探讨神经外科危重病人营养支持的方法。　方法 :对 2 8例神经外科危重病人早期 (发病后 4 8～ 72h)即开始实施肠内营养 ,并逐渐加量 ,不足部分以肠外营养补充 ;应激期 (发病后 7天内 )注意适当减少葡萄糖的供给。　结果 :本组治愈 2 3例 ,死亡 5例 ;治疗过程中未出现明显的糖、脂代谢异常和肝酶谱变化的代谢性并发症。肠内营养期间无严重腹泻、腹胀等并发症。使用呼吸机支持者均一次脱机成功 ,　结论 :早期即行肠内营养 ,逐渐过渡到完全肠内营养 ;应激期适当减少葡萄糖的供给 ,可提高脑外科危重病人的救治成功率 ,降低并发症和病死率     

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.