COPD机械通气患者营养支持研究进展

慢性阻塞性肺疾病(COPD)的患者由于疾病本身的影响造成营养素的摄入不足、吸收不良及消耗量增加等,易导致机体的营养不良。良好的营养状态对COPD患者的预后有着积极的作用,而合理的营养支持有助于改善患者的营养不良状态。在营养支持过程中,营养支持方式及时机的选择、营养配方的选择以及一些特殊营养物质的添加都会直接影响营养治疗的效果。同时,在进行营养治疗过程中,易出现腹胀、腹泻、胃潴留、返流、吸入性肺炎等常见并发症,这些并发症如何处理也会影响患者的预后。营养支持的监测可以为营养治疗方案的调整提供依据,因此应该如何通过相关生化指标的监测来评估营养支持的效果也是一个重要的问题。作者对这些相关问题作一讨论。     

高位肠瘘中TPN的护理

全肠胃外营养(简称TPN)是一种支持疗法,是近20年来发展的一种能起到“人工肠胃”作用的重要治疗措施。近年来,它广泛应用于肝肾疾病、肠道疾病、肿瘤、手术前后等,取得良好效果。用于肠外瘘的治疗,使其死亡率明显下降,治愈率有所提高。现就高位肠瘘应用于TPN治疗而取得瘘口自愈的护理体会总结如下:1护理要点1.1TPN输液的配制在整个治疗护理过程中是一个关键环节,除做好一般常规护理外,还必须做到以下几点:(1)严格无菌操作技术。(2)TPN治疗的营养物质的输入配方:氮∶热比为1∶120;钾钠钙镁磷等离子根据电解质平衡情况而调整。少量输血以…     

对鼻空肠营养管堵管原因及护理对策的相关研究

临床上对肠内营养(EN)供给时,经常会采用经鼻空肠给药的途径输注营养液,然后营养液再经过肠道的吸收来补充人体内所需要的营养物质.尤其对于一些重症医学患者来说,采取鼻空肠置管输送营养液的方式能够有效纠正患者的营养状态,大大降低了误吸的发生机率,提高了临床治疗效果.本文通过分析鼻空肠输送营养液,发生堵管、脱管现象的原因,提出了一些具体的护理对策.     

过多食用粗粮也对健康不利

粗粮的品种多样，所含的营养物质也各不相同，所以最好的食用方式是粗粮和细粮搭配食用，这样可以起到营养均衡的效果，口感还比较美味。     

个体化和标准化肠外营养配方及其实施形式

胃肠外营养(PN)是指通过胃肠道以外的途径,即静脉输入人体代谢所需的营养物质的一种方法.作为20世纪外科学基础治疗手段的重大进步,PN已被广泛地应用于与营养相关的各科病人的综合治疗中,也成为危重症医学中的一项重要治疗手段[1].根据美国肠内肠外营养学会(ASPEN)统计,全美每年有60万人接受PN治疗,约有7 000例病人居家接受PN,即家庭肠外营养(HPN).在国内,PN的应用面也越来越广.     

肉质的营养调控

肉质受到许多遗传和环境因素的影响,合理的营养有助于改善肉品品质。本文综述了饲料中营养物质的种类和水平对肉质的影响,并提出了通过营养调控改善和提高肉品质量的有效措施。     

硒:术后康复也“给力”

每个人都会生病,生病后就需要药物治疗,有时,还需要手术治疗。而手术,无论是大手术还是小手术,对人体都是一种严重损伤。研究亦表明,外科手术造成的创伤会直接引起机体内分泌及代谢过程的改变,这些改变会导致体内营养物质的大量消耗。而手术后的伤口愈合及组织再生则需要更多的营养物质。所以,手术后的营养补充非常重要,关系到手术伤口的愈合和病人体质的恢复。     

肝移植围手术期肠内免疫营养治疗的观察

目的: 研究ω-3脂肪酸、精氨酸、膳食纤维等营养物质强化的肠内免疫营养(EIN)治疗,在肝移植围手术期营养支持中的安全性和治疗效果. 方法: 将39例肝移植病人随机分为两组,分别给予EIN和普通EN.通过肝功能、细胞免疫、体液免疫、排斥发生率的检测,比较两组病人的治疗效果. 结果: EIN组病人的肝细胞合成功能和免疫功能等都好于EN组;两组病人的排斥反应发生率均未增加. 结论: EIN治疗能明显减轻肝移植病人围手术期机体免疫抑制状态,改善细胞免疫和体液免疫功能,且未增加术后排斥反应的发生率.     

人体必需营养素及其功能(一)

人类为了维持生存、繁衍和进行生产劳动 ,必须每天从膳食中获取各种各样的营养物质。不同的个体由于其年龄、性别和生理状况不同 ,对各种营养素的需要也不相同。人体是一个复杂而精密的系统 ,其每一项生理活动或生命过程的完成都需要多种营养物质的共同参与。生命中所需要的这些营养素都需要从每天的饮食中获得 ,饮食是健康的基础 ,均衡饮食的意义不但在于各类食物的多样化 ,还包括营养素充足和合理比例 ,这些基础概念和学说是健康教育的根据。食物和人体必需营养素食物是生物为了生存和繁衍所必须摄入的物质 ,人类经过多年的筛选认识并留传…     

关于结肠癌肠梗阻患者应用腹腔镜手术的效果及炎症指标的研究

目的:临床针对结肠癌肠梗阻患者进行治疗时,具有很多种治疗措施,为了对患者的治疗效果进行促进,本文分析使用腹腔镜手术的方式对患者进行治疗干预,对其产生的临床效果,同时还需针对患者的炎症指标进行探讨.方法:此次研究选择的对象,都属于结肠癌患者,并在这些患者选择出现肠梗阻的136例展开研究,这些患者在我院接受治疗的时间为20...     

Nutrition and metabolic support in the 21st century

New approaches to nutritional support are necessary to test therapies that may potentially enhance outcomes. Such approaches include the move to rely on the enteral route for nutrient delivery, the ability to reduce exogenous calories in our nutritional support systems, the need to utilize nutrients for their pharmacological effects, the ability to use growth factors to enhance nutrient efficacy, and the ability to institute nutritional supplementation before elective operations, thus practicing preventative nutrition. Testing these approaches in the years to come should allow us to identify modalities that will permit us to move away from nutritional therapy as a supportive modality and use it as a primary or secondary method of patient care.     

Nutritional Niches of Cancer Therapy-Induced Senescent Cells

Therapy-induced senescence (TIS) is a state of stable proliferative arrest of both normal and neoplastic cells that is triggered by exposure to anticancer treatments. TIS cells acquire a senescence-associated secretory phenotype (SASP), which is pro-inflammatory and actively promotes tumor relapse and adverse side-effects in patients. Here, we hypothesized that TIS cells adapt their scavenging and catabolic ability to overcome the nutritional constraints in their microenvironmental niches. We used a panel of mechanistically-diverse TIS triggers (i.e., bleomycin, doxorubicin, alisertib, and palbociclib) and Biolog Phenotype MicroArrays to identify (among 190 different carbon and nitrogen sources) candidate metabolites that support the survival of TIS cells in limiting nutrient conditions. We provide evidence of distinguishable TIS-associated nutrient consumption profiles involving a core set of shared (e.g., glutamine) and unique (e.g., glucose-1-phosphate, inosine, and uridine) nutritional sources after diverse senescence-inducing interventions. We also observed a trend for an inverse correlation between the intensity of the pro-inflammatory SASP provoked by different TIS agents and diversity of compensatory nutritional niches utilizable by senescent cells. These findings support the detailed exploration of the nutritional niche as a new metabolic dimension to understand and target TIS in cancer.     

Nutritional challenges and countermeasures for space travel

There has been a reinvigoration of public interest in space exploration in what has been deemed the new space race, which aims to eventually take humans to Mars in the 2030s. This type of Earth‐independent deep space mission presents a multitude of challenges for providing astronauts with adequate nutrition, which are not currently posed by our presence in low earth orbit. For example, there are technical challenges associated with providing enough food with sufficient nutrient content, bioavailability and increased shelf life. Environmental stressors may also impact physiology and in turn affect nutritional status. Increased exposure of radiation, for example, causes changes in the gut and liver that might facilitate nutrient deficiency. Current or potential countermeasures for these challenges are explored including the use of bio‐regenerative systems such as growing crops or biomass, or inducing torpor to reduce nutritional needs. Additionally, the beneficial role of nutrients has also been explored for alleviating the harmful effects of spaceflight exposure. It is clear that such countermeasures will be necessary to maintain astronaut health during long‐duration missions to potentially counteract physiological stresses and to allow us to continue pushing the boundaries of space exploration.     

Nutritional support in oncologic patients: where we are and where we are going

The use of nutritional support in cancer patients has evolved since its introduction in the clinical practice 40 years ago. Both parenteral and enteral nutrition are now increasingly integrated within the main oncologic strategy with the aim of making surgery, chemotherapy and radiation therapy more safe and effective. This requires a better awareness of the inherent risk of starvation and undernutrition by the surgeons, medical oncologists and radiologists, the ability to implement a policy of nutritional screening of cancer patients and to propose them the nutritional support in a single bundle together with the oncologic drugs. Four different areas of nutritional intervention are now recognized which parallel the evolutionary trajectory of patients with tumour: the perioperative nutrition in surgical patients, the permissive nutrition in patients receiving chemotherapy and/or radiation therapy and the home parenteral nutrition which may be total (in aphagic-obstructed-incurable patients) or supplemental (in advanced weight-losing anorectic patients). Since cancer is a common disease and the continuous progress in medical therapy is changing its natural history, with more and more patients entering in a chronic and finally incurable phase where nutrition is determinant for survival, we can expect an increased demand for nutritional support in the next future.     

机械通气患者营养支持及护理进展

本文结合近年来一些国内外文献以及研究成果，较详细介绍了机械通气患者营养支持的适应证、营养管的置入途径、营养的时机、给与方式、营养品的选择；阐明早期给营养支持对危重病人的重要意义及对现存问题的护理干预；强调合理的营养支持可以提高患者的免疫力、减少并发症的发生，有利于患者平稳脱机。高质量的护理可保证营养支持发挥其最大效应。     

胃癌术后肠内营养与肠外营养的护理分析

目的：探讨胃癌术后肠内营养与肠外营养的护理。方法：研究我院2014年3月至2015年12月期间随机抽取的胃癌术后患者80例,分为对照组与观察组各40例,其中对照组运用肠外营养支持护理,观察组运用肠内营养支持护理,分析两组患者营养支持护理效果差异。结果：在护理前后各蛋白指数上,观察组改善幅度高于对照组,p<0.05;在术后感染率显著并发症发生率上,观察组低于对照组,p<0.05;在肛门排气与住院时长上,观察组短于对照组,p<0.05。结论：胃癌术后通过肠内营养支持护理可以有效的提升患者恢复效果,加快术后恢复,减少术后并发症。     

Nutritional approaches in the risk reduction and management of Alzheimer's disease

Alzheimer's disease (AD) is a heterogeneous and devastating neurodegenerative disease with increasing socioeconomic burden for society. In the past 30 y, notwithstanding advances in the understanding of the pathogenesis of the disease and consequent development of therapeutic approaches to novel pathogenic targets, no cure has so far emerged.This contribution focuses on recent nutritional approaches in the risk reduction and management of AD with emphasis on factors providing a rationale for nutritional approaches in AD, including compromised nutritional status, altered nutrient uptake and metabolism, and nutrient requirements for synapse formation. Collectively these factors are believed to result in specific nutritional requirement in AD. The chapter also emphasizes investigated nutritional interventions in patients with AD, including studies with single nutrients and with the specific nutrient combination Fortasyn Connect and discusses the current shift of paradigm to intervene in earlier stages of AD, which offers opportunities for investigating nutritional strategies to reduce the risk for disease progression.Fortasyn Connect was designed to enhance synapse formation and function in AD by addressing the putative specific nutritional requirements and contains docosahexaenoic acid, eicosapentaenoic acid, uridine-5'-mono-phosphate, choline, phospholipids, antioxidants, and B vitamins. Two randomized controlled trials (RCTs) with the medical food Souvenaid, containing Fortasyn Connect, showed that this intervention improved memory performance in mild, drug-naïve patients with AD. Electroencephalography outcome in one of these clinical studies suggests that Souvenaid has an effect on brain functional connectivity, which is a derivative of changed synaptic activity. Thus, these studies suggest that nutritional requirements in AD can be successfully addressed and result in improvements in behavioral and neuro-physiological alterations that are characteristic to AD.The recent advance of methodologies and techniques for early diagnosis of AD facilitates the investigation of strategies to reduce the risk for AD progression in the earliest stages of the disease. Nutrition-based approaches deserve further investigation as an integral part of such strategies due to their low risk for side effects and their potential to affect pathological processes of very early AD.     

The Role of Nutritional Support for Cancer Patients in Palliative Care

The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.     

Plant Biotechnology Can Enhance Food Security and Nutrition in the Developing World Part 1

The world’s demand for food production will increase markedly in the coming years. Meeting this demand will require that we employ all manner of approaches, including the use of biotechnology, to produce results that cannot be achieved using traditional methods. This 2-part article reviews ongoing experiences in developing countries where crop biotechnology is being used to enhance the availability and/or nutritional value of local crops. In part 1, the authors describe strategies that seek to enhance yields of staples and to improve the yields of indigenous nutritious foods. In Part 2 of this article, the authors describe strategies that seek to enhance the nutrient density of foods that can increase net income to resource-poor farmers in developing countries.