要素膳与非要素膳及组件膳在危重患者中的应用

目的探讨要素膳与非要素膳及组件膳作为肠内营养液，早期联合或交替使用在危重患者肠内营养支持中的治疗效果。方法将笔者所在医院收任ICU的136例危重患者早期给予要素膳与非要素膳及组件膳联合或交替应用于肠内营养支持。结果肠内营养支持后患者的营养状况较营养支持前有明显的改善。结论利用要素膳与非要素膳及组件膳作为危重患者的肠内营养支持具有较好的治疗效果。     

胰十二指肠切除术后的营养支持

对胰十二指肠切除术后营养支持的方法进行探讨。胰十二指肠切除术后行肠外、肠内阶段性营养支持。术后先完全胃肠外营养 ,2～ 3天后开始经空肠造口管给予要素膳 ,后要素膳浓度和用量逐步增加 ,并相应减少胃肠外营养用量 ,于术后两周左右改为完全肠内营养 ,2 0天后过渡至经口进食。结果 :一周后前白蛋白及转铁蛋白均为正常值 ,总蛋白、白蛋白接近正常值 ,尿素氮、肌酐正常。病人营养支持期间 ,体重、上臂肌围和皮褶厚度变化不大。结论 :术中空肠造口置管 ,术后行肠外、肠内阶段性营养支持是一种较合理安全的营养支持方法 ,有利于预后和康复。…     

喉癌患者术后肠内营养疗效观察

目的 探讨喉癌术后肠内营养疗效。方法 将34例病理活检为喉部恶性肿瘤的住院患随机分为2组，均于术晨置鼻饲管。要素膳组氮热比例为lgN:698kJ；匀浆膳组氮热比例为lgN:793kJ。结果 两组患术后5天与3周后体格与生化指标平均水平及伤口修复情况差异均无显性（P＞0.05)。结论 喉癌术后适宜不仅有利于机体营养状况的好转，且对术后尚需放疗、化疗患的营养支持也十分重要。喉癌术后选择要素膳和匀浆膳营养支持效果是一致的。     

肠内营养支持在重症胰腺炎治疗中的地位

目的探讨肠内营养(EN)在急性重症胰腺炎治疗中的地位和介入时机。方法接受系统营养支持治疗的ASP病人11例，经肠外营养(PN)支持后改用经空肠造瘘管(或鼻空肠)EN。EN开始时机为血、尿淀粉酶正常，出现正常肠鸣音，有肛门排气或排便。制剂选择顺序为糖盐水(生理盐水)→化学定方膳→多聚膳→普通饮食。结果全组无死亡病例，后期并发症发生率低，血清白蛋白及转铁蛋白在EN后较EN前明显提高，而淋巴细胞计数改变不明显。结论ASP治疗应尽早从PN过渡到EN，由此不仅可以继续提供足够的营养支持，且能避免长时间PN带来的不利影响，减少并发症，降低死亡率。     

老年重症患者匀浆膳应用体会

营养学的新概念是能用普通膳食的尽量用普通膳食，能用匀浆膳的不用要素膳。近年来，我科应用匀浆膳对不能经口进食的危重症患进行营养支持，收到比较满意的临床效果。     

黄芪肠内营养对2型糖尿病合并缺血性卒中病人营养代谢的影响

目的:研究黄芪肠内营养对2型糖尿病合并缺血性卒中病人营养代谢的影响. 方法:将64例病人随机分为治疗组和对照组,每组32例.治疗组为黄芪水煎液(相当于生药60 g)加改良匀浆膳,对照组为改良匀浆膳,两组给予105 kJ/(kg·d)的营养支持,等氮、等热量供给,共30 d.两组肠内营养支持前后分别检测空腹血糖及餐后2 h血糖、血清胰岛素、血脂、清蛋白、转铁蛋白、血红蛋白、氮平衡等营养代谢指标. 结果:治疗组肠内营养支持后胰岛素抵抗改善,空腹及餐后血糖降低,与对照组比较差异有显著性意义(P＜0.05,P＜0.01).治疗组经营养支持后,负氮平衡转为正氮平衡,血清清蛋白升高,与对照组比较差异有显著性意义(P＜0.05). 结论:黄芪肠内营养支持可明显改善2型糖尿病合并缺血性卒中病人胰岛素抵抗、血糖及蛋白质营养代谢.     

老年病人长期应用成品匀浆膳的营养评价

目的：观察长期管喂成品匀浆膳对高龄病人营养支持的效果。方法：应用自制的成品匀浆膳行营养，观察营养支持前及支持后4，8和12个月病人营养指标的变化。结果：营养支持12个月后血清白蛋白（Ab)，磷（P）和外周血淋巴细胞计数等有显著增高。血糖自4个月起减低，与支持前比较差异显著。结论：成品匀浆膳长期应用有助于维持老年病人自身的营养状态。     

肠内营养支持16年体会

对住院和门诊病人进行以肠内营养为主的临床营养支持,16年用要素饮食或匀浆饮食治疗各类病人2512例次.用要素饮食治疗104例住院病人,其中烧伤在伤后第15天恢复正氮平衡;癌症化疗或放疗前用要素饮食,可显著减轻化疗和放疗反应;22例喉癌全喉切除后,用鼻饲要素饮食或匀浆饮食,2～3周治疗后各项生化指标均优于对照组;4名中重度骨髓型急性放射病者采用多种形式进行营养支持,取得满意的效果;昏迷2100天的老年病人,一直用要素和匀浆饮食维持营养,没有发生营养不足.提示肠内营养是理想、简便、经济、安全的营养支持方法,值得推广和应用.     

黄芪匀浆膳对重型颅脑损伤患者免疫功能和营养代谢的影响

目的研究黄芪匀浆膳对重型颅脑损伤患者免疫功能及营养代谢的影响。方法将75例患者依不同营养措施综合考虑各非处理因素分为黄芪匀浆膳组、匀浆膳组和肠内营养多聚合剂组,每组25例。黄芪匀浆膳组尽早(48～72小时)给予改良匀浆膳加黄芪水煎液(相当于生药60g)治疗,匀浆膳组仅给予改良匀浆膳治疗,肠内营养多聚合剂组给予肠内营养多聚合剂治疗,早期肠内营养不足部分由肠外营养补充,共20天。各组肠内营养支持前后均采血测定IgA、IgG、IgM,T细胞亚群(CD4、CD8、CD4/CD8),同时监测空腹血糖、白蛋白、转铁蛋白、血红蛋白、氮平衡等营养代谢指标。结果黄芪匀浆膳组营养支持后IgG、CD4(%)、CD4/CD8升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.01);黄芪匀浆膳组和匀浆膳组营养支持后空腹血糖降低,与肠内营养多聚合剂组比较,差异具有显著性(P<0.01,P<0.05),黄芪匀浆膳组与匀浆膳组比较,差异亦有显著性(P<0.05);黄芪匀浆膳组营养支持后,负氮平衡转为正氮平衡,转铁蛋白与白蛋白升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.05,P<0.01)。结论黄芪匀浆膳可显著改善重型颅脑损伤患者免疫功能、血糖及蛋白质营养代谢。     

自制复合全营养膳对重症病人肠内营养支持的临床应用

目的:总结自制复合全营养膳对411例重症病人的肠内营养支持的临床应用情况. 方法:观察复合全营养膳对胸科术后和脑卒中病人的肠内营养支持效果和管饲肠内营养支持对胃肠并发症的影响,并对长期应用该制剂病人的血清三酰甘油(TG)、胆固醇(CH)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血尿素氮(BUN)、血肌酐(Cr)进行测定. 结果: ①复合全营养膳与常规肠外营养支持和常用商品肠内营养制剂相比较,实验组与对照组间的体重、血清总蛋白(TP)、血清清蛋白(Alb)、血红蛋白(Hb)、肱三头肌皮皱厚度(TSF)、臂肌围 (AMC)均无显著差异,都维持在较好水平.实验组营养治疗费用明显低于对照组; ②18例长期管饲肠内营养支持病人血清TG、CH、TP、Alb、K 、Na 以及有关肝、肾功能生化指标测定均无明显异常改变; ③246例管饲营养支持病人中,胃肠并发症发生率与腹泻发生率分别为21.1%和6.9%. 结论:自制复合全营养膳对重症病人肠内营养支持具有胃肠道并发症发生率低、长期应用对机体物质代谢、肝肾功能无明显影响以及营养治疗费用低等特点,效果理想.     

Predictors of Sustained Reduction in Energy and Fat Intake in the Diabetes Prevention Program Outcomes Study Intensive Lifestyle Intervention

BackgroundFew lifestyle intervention studies examine long-term sustainability of dietary changes.ObjectiveTo describe sustainability of dietary changes over 9 years in the Diabetes Prevention Program and its outcomes study, the Diabetes Prevention Program Outcomes Study, among participants receiving the intensive lifestyle intervention.DesignOne thousand seventy-nine participants were enrolled in the intensive lifestyle intervention arm of the Diabetes Prevention Program; 910 continued participation in the Diabetes Prevention Program Outcomes Study. Fat and energy intake derived from food frequency questionnaires at baseline and post-randomization Years 1 and 9 were examined. Parsimonious models determined whether baseline characteristics and intensive lifestyle intervention session participation predicted sustainability.ResultsSelf-reported energy intake was reduced from a median of 1,876 kcal/day (interquartile range [IQR]=1,452 to 2,549 kcal/day) at baseline to 1,520 kcal/day (IQR=1,192 to 1,986 kcal/day) at Year 1, and 1,560 kcal/day (IQR=1,223 to 2,026 kcal/day) at Year 9. Dietary fat was reduced from a median of 70.4 g (IQR=49.3 to 102.5 g) to 45 g (IQR=32.2 to 63.8 g) at Year 1 and increased to 61.0 g (IQR=44.6 to 82.7 g) at Year 9. Percent energy from fat was reduced from a median of 34.4% (IQR=29.6% to 38.5%) to 27.1% (IQR=23.1% to 31.5%) at Year 1 but increased to 35.3% (IQR=29.7% to 40.2%) at Year 9. Lower baseline energy intake and Year 1 dietary reduction predicted lower energy and fat gram intake at Year 9. Higher leisure physical activity predicted lower fat gram intake but not energy intake.ConclusionsIntensive lifestyle intervention can result in reductions in total energy intake for up to 9 years. Initial success in achieving reductions in fat and energy intake and success in attaining activity goals appear to predict long-term success at maintaining changes.     

Trends in food availability in Switzerland, 1961-2007

Trends in food availability in Switzerland were assessed using the Food and Agricultural Organization food balance sheets for the period 1961-2007. A relatively stable trend in the daily caloric supply was found: 3545?kcal/day in 1961 and 3465?kcal/day in 2007. Calories associated with carbohydrates decreased (slope±s.e.: -1.1±0.2?kcal/day/year), namely regarding cereals (-2.9±0.6?kcal/day/year) and fruit (-1.5±0.1?kcal/day/year), while the availability of sugars increased (1.2±0.5?kcal/day/year). In 1961, protein, fat, carbohydrates and alcohol represented 10.6, 33.5, 50.0 and 5.9% of total caloric supply, respectively; in 2007, the values were 10.8, 40.3, 43.7 and 5.2%. In 1961, palm, groundnut and sunflowerseed oil represented 3.4, 30.7 and 5.3% of total vegetable oils, respectively; in 2007, the values were 10.4, 3.7 and 31.6%. We conclude that between 1961 and 2007 total caloric availability remained relatively stable in Switzerland; the health effects of the increased and differing fat availability should be evaluated.     

Protein catabolism and requirements in severe illness

Reduced total body protein mass is a marker of protein-energy malnutrition and has been associated with numerous complications. Severe illness is characterized by a loss of total body protein mass, mainly from the skeletal muscle. Studies on protein turnover describe an increased protein breakdown and, to a lesser extent, an increased whole-body protein synthesis, as well as an increased flux of amino acids from the periphery to the liver. Appropriate nutrition could limit protein catabolism. Nutritional support limits but does not stop the loss of total body protein mass occurring in acute severe illness. Its impact on protein kinetics is so far controversial, probably due to the various methodologies and characteristics of nutritional support used in the studies. Maintaining calorie balance alone the days after an insult does not clearly lead to an improved clinical outcome. In contrast, protein intakes between 1.2 and 1.5 g/kg body weight/day with neutral energy balance minimize total body protein mass loss. Glutamine and possibly leucine may improve clinical outcome, but it is unclear whether these benefits occur through an impact on total body protein mass and its turnover, or through other mechanisms. Present recommendations suggest providing 20 - 25 kcal/kg/day over the first 72 - 96 hours and increasing energy intake to target thereafter. Simultaneously, protein intake should be between 1.2 and 1.5 g/kg/day. Enteral immunonutrition enriched with arginine, nucleotides, and omega-3 fatty acids is indicated in patients with trauma, acute respiratory distress syndrome (ARDS), and mild sepsis. Glutamine (0.2 - 0.4 g/kg/day of L-glutamine) should be added to enteral nutrition in burn and trauma patients (ESPEN guidelines 2006) and to parenteral nutrition, in the form of dipeptides, in intensive care unit (ICU) patients in general (ESPEN guidelines 2009).     

The Importance of a Source of Sufficient Protein in Postoperative Hypocaloric Partial Parenteral Nutrition Support

A comparison of postoperative metabolic and nutritional responses to different hypocaloric parenteral nutrition supports was performed in 42 patients with various gastric lesions. Sixteen patients (group A) received 3000 mL of a 5% glucose in water or glucose in saline infusion per day after surgery (approximately 10 kcal/kg per day). Another 14 patients (group B) received 2000 mL of 5% glucose in water or saline plus 1000 mL of 5% amino acid solution per day (approximately 10 kcal/kg per day and 1 g of protein per kilogram per day). The other 12 patients (group C) received 2000 mL of 5% glucose in water or saline plus 500 mL of 5% amino acid solution and 500 mL of 10% fat emulsion (approximately 20 kcal/kg per day and 0.5 g of protein per kilogram per day). After 7 days of study, all three groups were found to have a decrease in body weight, mid-arm circumference, triceps skin-fold, and serum albumin level, and the differences among them were not significant. Groups B and C had significantly less negative mean nitrogen balance than group A (—5.54 ± 0.63 g/ d and -6.07 ± 0.49 g/d vs -9.20 ± 0.68 g/d). Group B also had a significantly greater increase of transferrin (from 175.5 ± 9.9 mg/dL to 185.4 ± 9.3 mg/dL) than group A and a significantly greater increase in total lymphocyte count (from 956 ± 113 cells/mm³ to 1196 ± 176 cells/mm³) than groups A and C. We concluded that postoperative hypocaloric nutrition support with a sufficient protein source, at least 1 g/kg per day, achieved better nitrogen balance, improved short half-life of visceral protein levels, and higher total lymphocyte count. (Journal of Parenteral and Enteral Nutrition 17: 254–256, 1993)     

青岛市居民膳食结构和营养状况调查

目的了解青岛市城乡居民的膳食结构和营养状况。方法利用青岛市首次居民营养与健康状况调查资料，对72个调查点2160户居民进行家庭膳食调查（城市720户，农村1440户），以个人72h膳食回顾结合家庭调味品称重获取膳食信息。结果青岛市居民平均每人日摄入能量9．6810，蛋白质68．3g，脂肪90．8g，维生素C摄入充足；硫胺素和核黄素偏低；钙530．2mg，占推荐膳食供给量（Recommended Dietary Allwance，RDA）的66．3％。膳食能量的47．3％来自谷类，蛋白质的43．5％来自谷类。脂肪提供总能量的35．3％，动物脂肪占膳食脂肪的35．0％。结论青岛市居民平均已摄入了足够的食物，改善居民的膳食模式应以调整不平衡膳食结构为主要目的。     

Lactation in the dog: milk composition and intake by puppies

The composition and intake of milk by mother-reared puppies was studied to compare protein and energy intakes of puppies with estimated requirements. Milk samples were obtained from five beagle bitches over the period of 7-37 days postpartum. Dog milk contained on average 22.7% dry matter, 9.47% fat, 7.53% protein, 3.81% sugar and 146 kcal gross energy per 100 g. Protein comprised 31% of milk energy. Nonprotein nitrogen averaged 0.054%, equivalent to 4.4% of total nitrogen. Milk intakes of puppies in the five litters were estimated from water kinetics following administration of deuterium oxide (D2O). D2O dilution indicated that body water comprised 72-73% of puppy body weight, and fractional turnover rate of body water averaged 0.15-0.17% per day in weeks 3 and 4 postpartum. Milk intakes were calculated as 160 +/- 5.4 g (mean +/- SEM) at 19 days and 175 +/- 5.3 g at 26 days, equivalent to 17.0 and 14.6% of body weight, respectively. Daily milk yields of the bitches averaged 964 g at 19 days and 1054 g at 26 days. Dry matter intakes of the puppies were equivalent to 3.9 and 3.3% of body weight at 19 and 26 days, respectively. Gross energy intakes averaged 223-224 kcal/ kg0 .75 per day, and protein intakes averaged 0.33-0.36 g per gram body weight gain at these ages. Estimates of the energy requirements of young puppies by the National Research Council appear to be too high.     

从代谢能和体成分变化确定人体热能需要量

<正> 利用气体代谢法计算人体热能消耗是研究热能需要量的常用方法,由于在某些特殊条件下应用该法有一定困难和该法在方法学上存在着某些缺点,因此,探索其它途径十分必要。本研究试图从代谢能和体成分变化确定卧床被试者的热能需要量,藉以探讨该方法的应用问题。     

Total daily energy expenditure in wasted chronic obstructive pulmonary disease patients

OBJECTIVES: To investigate total daily energy expenditure in chronic obstructive pulmonary disease (COPD) patients during a rehabilitation programme. DESIGN: Observational study involving a case and a control group. SUBJECTS: Ten COPD patients (six with body mass index (BMI) <18.5 kg/m(2) and four with BMI >18.5 kg/m(2)) were evaluated for their energy expenditure profile. Four additional healthy age-matched volunteers were also included for methodology evaluation. INTERVENTIONS: Measurements of total daily energy expenditure (TEE), resting energy expenditure (REE) and diet-induced thermogenesis (DIT) and energy intake were undertaken by indirect calorimetry and bicarbonate-urea methods and dietary records. RESULTS: REE in COPD patients was not significantly different from that predicted by the Harris-Benedict equation. Before the exercise day the mean TEE was 1508 kcal/day and physical activity level (PAL as calculated by TEE/REE) was 1.52. On the exercise day the TEE increased to 1568 kcal/day and PAL was 1.60, but neither of these changes were significant. The energy cost of increased physical activity during rehabilitation exercise was estimated to be 191 kcal/day. No significant change was found in DIT between the two patient groups. However, overall energy balances were found to be negative (-363 kcal/day). CONCLUSION: The rehabilitation programme did not cause a significant energy demand in COPD patients. TEE in COPD patients was not greater than in free-living healthy subjects. Patients, who were underweight, did not have a higher TEE than patients with normal weight. This suggested that malnutrition in COPD patients was not due to an increased energy expenditure. On the other hand, a significant negative energy balance due to insufficient energy intake was found in seven out of 10 patients.     

Energy balance in elderly patients after surgery for a femoral neck fracture

To study energy and protein balances in elderly patients after surgery, spontaneous energy and protein intake and resting energy expenditure (REE) were measured in 20 elderly female patients with a femoral neck fracture (mean age 81 +/- 4, SD, range 74-87 years; weight 53 +/- 8, range 42-68 kg) during a 5-6 day period following surgery. REE, measured over 20-40 min by indirect calorimetry using a ventilated canopy, averaged 0.98 +/- 0.15 kcal/min on day 3 and decreased to 0.93 +/- 0.15 kcal/min on day 8-9 postsurgery (p less than 0.02). REE was positively correlated with body weight (r = 0.69, p less than 0.005). Mean REE extrapolated to 24 hr (24-REE) was 1283 +/- 194 kcal/day. Mean daily food energy intake measured over the 5-day follow-up period was 1097 +/- 333 kcal/day and was positively correlated with 24-REE (r = 0.50, p less than 0.05). Daily energy balance was -235 +/- 351 kcal/day on day 3 (p less than 0.01 vs zero) and -13 +/- 392 kcal/day on day 8-9 postsurgery (NS vs zero) with a mean over the study period of -185 +/- 289 kcal/day (p less than 0.01 vs zero). When an extra 100 kcal/day was allowed for the energy cost of physical activity, mean daily energy balance over the 5-day study period was calculated to be -285 +/- 289 kcal/day (p less than 0.01 vs zero). Measurements of total 24-hr urinary nitrogen (N) excretion were obtained in a subgroup of 14 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

营养治疗慢性肾功能衰竭效果的初步观察

在非透析综合疗法中膳食治疗的原则,应是在限制低蛋白质摄入量的基础上设法提高必需氨基酸的摄入水平,以纠正体内氨基酸代谢紊乱。根据此原则我们为慢性肾功能衰竭患者制备了低蛋白麦淀粉膳食(蛋白质限制在20～40g/24hr,总热量2000～3000kcal/24hr),麦淀粉含蛋白质量甚低(0.4—0.6g％),故以其代替大米,面粉做为主食,既可减少植物蛋白质的进量,又可在低蛋白限量范围内适当增加含必需氨基酸丰富的食品,如蛋,奶、瘦肉等;并使优质蛋白质占膳食中总蛋白质量的50～70％。本组30例病人经治疗1—2个月后,除6例(2例无效,4例因故未坚持治疗)外,病人氮质血症均有减轻,临床症状得到改善,营养状况有所改进,延长了生命,根据6例氮平衡实验结果,提示慢性肾衰病人(Ccr5—10ml/min)的饮食在充足热量摄入的基础上,蛋白质摄入量至少0.5g/kg/24hr,(其中优质蛋白占50—70％),才可达到氮的平衡。