早期肠内营养支持治疗在危重病患者应用的临床研究

目的分析比较早期肠内营养（EEN）和肠外营养（PN）对危重病患者治疗及营养代谢状况的影响。方法以我院ICU收治的危重病患者为研究对象,随机分为实验组和对照组;实验组54例在入院24～48h内开始肠内营养,对照组48例则给予肠外营养。检测比较两组患者的各营养指标及感染发生率的变化。结果肠外营养组的氮平衡、血清白蛋白和臂肌围指标较肠内营养组明显降低（P〈0.05）。实验组的热量摄入、氮平衡优于对照组,感染发生率降低。结论危重病患者早期给予肠内营养可更好改善全身营养状况,提高代谢效应,从而改善预后。     

早期肠内营养支持治疗在危重病患者应用的临床研究

目的 分析比较早期肠内营养(FEN)和肠外营养(PN)对危重病患者治疗及营养代谢状况的影响.方法 以我院ICU收治的危重病患者为研究对象,随机分为实验组和对照组;实验组54例在入院24～48h内开始肠内营养,对照组48例则给予肠外营养.检测比较两组患者的各营养指标及感染发生率的变化.结果 肠外营养组的氮平衡、血清白蛋白和臂肌围指标较肠内营养组明显降低(P<0.05).实验组的热量摄入、氮平衡优于对照组,感染发生率降低.结论 危重病患者早期给予肠内营养可更好改善全身营养状况,提高代谢效应,从而改善预后.     

肝移植患者肠内免疫营养的临床观察

背景:免疫营养可通过提高机体细胞免疫功能,促进短半衰期蛋白质合成,调节局部及全身细胞因子的产生,维护肠道黏膜结构及功能的完整性,对术后的免疫抑制起正向调节作用。营养治疗能够明显加强肝移植围手术期机体免疫功能,但对肠内免疫营养在肝移植的应用效果至今少有报道。 目的：观察肝移植围手术期进行免疫肠内营养治疗的安全性和应用效果。 方法：将84例肝移植患者按营养治疗方式不同随机分为免疫肠内营养组和普通肠内营养组,监测移植前、移植后对肝功能、细胞免疫、体液免疫及排斥发生率,并比较两组患者的治疗效果。 结果与结论：免疫肠内营养组移植前1 d的血清前白蛋白和胆碱酯酶水平均显著高于营养治疗前。移植前1 d免疫肠内营养组CD3⁺CD4⁺显著高于普通肠内营养组 (P < 0.05),普通肠内营养组的细胞免疫功能恢复状态比免疫肠内营养组推迟1周,移植后1~  28 d免疫肠内营养组IgA均高于普通肠内营养组(P < 0.05),两组均未增加排斥反应发生率。结果证实,疫肠内营养治疗的患者肝细胞合成功能及免疫功能均显著优于普通肠内营养治疗,免疫肠内营养对肝移植围手术期患者的康复起重要作用。     

急性胰腺炎肠外营养和肠内营养治疗的探讨

目的观察肠外和肠内阶段性营养治疗急性胰腺炎的临床效果。方法急性胰腺炎患者60例,分为全胃肠外营养组和肠外加肠内阶段性营养组,全胃肠外营养组患者应用肠外营养持续至可以进食。肠外加肠内阶段性营养组患者在初期应用肠外营养,胃肠功能恢复后逐步减少肠外营养至全部用肠内营养替代,肠内营养持续至过渡饮食。观察两组临床指标及治疗效果。结果肠外加肠内阶段性营养组患者均能耐受早期肠内营养。早期适时由肠外过渡到肠内营养后一周患者的血清总蛋白、白蛋白、血钙水平,与营养支持前、营养支持后全胃肠外营养组相比均增高（P〈0.01）;对肝脏功能的损害减小（P〈0.01）。肠外加肠内阶段性营养组血糖平均水平趋于正常且波动度小,与全胃肠外营养组相比,差异有统计学意义（P〈0.05）。肠外加肠内阶段性营养组平均住院天数（29.93±9.30）d,短于全胃肠外营养组平均住院天数（25.47±7.50）d（P〈0.05）,且每日营养费用及住院总费用减少。结论肠内营养组患者的营养指标、对血糖的影响与全胃肠外营养组相比,效果更好。     

食管癌患者术后肠内营养临床效果分析

目的观察肠内营养(EN)与肠外营养(PN)对食管癌患者术后临床效果的影响,评价食管癌术后早期肠内营养支持的临床意义。方法肠外营养组(PN组)术后每日行完全肠外营养支持直到经口进食;肠内营养组(EN组)术后第1日以静脉支持为主,第2日开始经鼻肠营养管滴入肠内营养制剂瑞素,并逐步增大剂量,减少静脉支持。在术后各个不同时间点分别进行各项指标及营养免疫功能指标的测定。结果 EN组术后排气、排便时间和术后平均住院时间均短于PN组。术后EN组营养和免疫功能指标均优于PN组。结论食管癌术后早期肠内营养可促进小肠运动功能恢复,可有效改善食管癌患者术后营养状况和免疫功能。     

老年胃癌合并糖尿病患者术后早期肠内与肠外营养对比研究

目的探讨老年胃癌合并糖尿病患者术后早期肠内营养的合理性和安全性。方法将60例老年胃癌合并糖尿病患者随机分为早期肠内营养组（EEN,30例）和肠外营养组（PN,30例）。检测手术前和手术后第4、10天营养指标和肝功能等变化,详细记录血糖变化,观察临床恢复情况。结果术后肠内营养组血糖水平波动较肠外营养组平稳（P〈0.01）。术后第4天EEN组患者的各项营养指标和肝功能指标恢复明显高于PN组患者（P〈0.01）。并发症发生率EEN组少于PN组,差异有统计学意义（P〈0.01）。结论胃肠肿瘤手术后早期应用肠内营养对老年糖尿病患者是一个较好的方法,方便血糖调控,同时可促进机体康复,减少并发症。     

腹部外科病人术后行完全胃肠外营养的临床观察

目的 观察完全胃肠外营养支持治疗对腹部外科术后病人的临床疗效，方法 ６１例腹部外科病人分成两组。胃肠外营养组接受肠外营养，普通对照组接受以葡萄糖供能为主的治疗。术后一周观察病人的氮平衡，体重血浆，白蛋白等的变化。结果 胃肠外营养组血浆白 白蛋白等的氮平衡，体重比对照组明显增加，治疗后两组间差异有统计学意义。     

胰十二指肠切除术后早期营养支持的临床研究

目的研究胰十二指肠切除术后早期营养支持的疗效及肠内营养的优缺点.方法将28例拟行胰十二指肠切除的病人随机分为肠内营养(enteralnutritionEN)和肠外营养(parenteralnutritionPN)两组,每组14例.每例病人于术后2～3天开始给予营养支持,均为10天.结果两组病人的营养状况明显改善,与术前相比有较显著性意义(p<0.01),但两组间比较无显著性差异(p>0.05);EN与PN均能纠正水电解质平衡,对血糖的影响无明显差异;胃肠功能的早期恢复EN早于PN,无并发症和副作用,并且费用较低,住院时间缩短.结论胰十二指肠切除术后早期营养的疗效明显,而EN具有早期促进胃肠功能恢复,并安全、有效、简便、易护理、费用低并可减少住院日等优点.     

肠内与肠外营养联合支持对重症患者营养状况的影响

目的:探讨肠内与肠外营养联合支持对重症患者血清白蛋白(Albumin,ALB)和总蛋白(Total protein,TP)的影响.方法:入选2016年9月至2019年9月入院的急危重症患者95例,随机分为对照组47例与实验组48例,对照组给予肠外营养支持,实验组首日给予肠外营养支持,待病情稳定48小时后给予肠内肠外营养联合支持.测量两组患者治疗前后血清营养、免疫功能指标以及胃肠功能恢复情况,统计并发症发生率.结果:治疗后,实验组血清ALB、TP水平和体脂量、肱三头肌皮肌褶皱厚度(Triceps skinfold,TSF)、上臂肌围(Mid-arm muscle circumference,MAMC)均高于对照组(P<0.05),实验组并发症发生率比对照组较少(P<0.05)死亡率两组数据接近.结论:肠内营养与肠外营养联合支持相比于单一肠外营养治疗更有利于改善重症患者营养状况,提高ALB、TP水平,减少并发症,改善临床预后.     

胰十二指肠切除术后早期营养支持的临床研究

目的研究胰十二指肠切除术后早期营养支持的疗效及肠内营养的优缺点.方法将28例拟行胰十二指肠切除的病人随机分为肠内营养(enteral nutrition EN)和肠外营养(parenteral nutrition PN)两组,每组14例.每例病人于术后2～3天开始给予营养支持,均为10天.结果两组病人的营养状况明显改善,与术前相比有较显著性意义(p<0.01),但两组间比较无显著性差异(p>0.05);EN与PN均能纠正水电解质平衡,对血糖的影响无明显差异;胃肠功能的早期恢复EN早于PN,无并发症和副作用,并且费用较低,住院时间缩短.结论胰十二指肠切除术后早期营养的疗效明显,而EN具有早期促进胃肠功能恢复,并安全、有效、简便、易护理、费用低并可减少住院日等优点.     

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia, and mucositis, which negatively impact oral intake, leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN versus PN provided during admission to children aged ≤ 18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of post-transplantation parameters. Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted, and gray literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN versus PN in children aged ≤ 18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. Because included studies were observational, risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. Because only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form. Conflicting results in favor of either method of nutrition support or no difference between methods were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission, and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGVHD) and platelet engraftment. A paucity of studies was found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions, and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs, and participant selection. Some studies were more than 15 years old. Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGVHD and faster platelet engraftment.     

Parenteral nutrition support: Beyond gut feeling? Quality control study of parenteral nutrition practices in a Tertiary Care Hospital

Background:Enteral nutrition (EN) is preferred over parenteral nutrition (PN) in hospitalized patients based on International consensus guidelines. Practice patterns of PN in developing countries have not been documented.Objectives:To assess practice pattern and quality of PN support in a tertiary hospital setting in Chennai, India.Methods:Retrospective record review of patients admitted between February 2010 and February 2012.Results:About 351,008 patients were admitted to the hospital in the study period of whom 29,484 (8.4%) required nutritional support. About 70 patients (0.24%) received PN, of whom 54 (0.18%) received PN for at least three days. Common indications for PN were major gastrointestinal surgery (55.6%), intolerance to EN (25.9%), pancreatitis (5.6%), and gastrointestinal obstruction (3.7%).Conclusions:The proportion of patients receiving PN was very low. Quality issues were identified relating to appropriateness of indication and calories and proteins delivered. This study helps to introspect and improve the quality of nutrition support.     

Effect of glutamine on apoptosis of intestinal epithelial cells of severe acute pancreatitis rats receiving nutritional support in different ways

Objective: To investigate the effect of glutamine (Gln) on pro-inflammatory cytokines (TNF-α, IL-2 and IL-10) and the balance between pro-inflammatory cytokines and anti-inflammatory cytokines in severe acute pancreatitis (SAP) rats receiving nutritional support in different ways. Methods: Male SD rats (n=80) were randomly assigned into 5 groups: sham group, SAP+ parenteral nutrition (PN) group, SAP+ enteral nutrition (EN) group, SAP+EN+Gln group and SAP+PN+Gln group. At the same time, rats in 5 groups were sacrificed at 4 and 7 days after nutritional support. ELISA was employed to detect the pro-inflammatory cytokines including TNF-α, IL-2 and IL-10. Results: The serum TNF-α in the EN+Gln group after 7-day treatment was significantly lower than that in the EN, PN and PN+Gln groups at corresponding time point (P<0.05). The serum IL-2 in the EN+Gln group after 7-day treatment was markedly higher than that in the EN, PN and PN+Gln groups at corresponding time point (P<0.01). After 7-day treatment, the serum IL-2 in the EN+Gln and EN groups were markedly higher than that after 4-day treatment (P<0.01), but the serum IL-2 in the PN group was significantly lower than that after 4-day treatment (P<0.01). The serum IL-10 after 7-day treatment was markedly lower than that after 4-day treatment in all groups (P<0.01), and PN group had the lowest serum IL-10. Serum IL-10 in the EN+Gln group was significantly higher than that in the PN and PN+Gln groups at both time points (P<0.01). The serum IL-10 in the EN group was significantly higher than that in the PN group after 4-day treatment (P<0.01), but the serum IL-10 in the EN group was comparable to that in the PN group after 7-day treatment. The serum IL-10/TNF-α in the EN+Gln group was only slightly higher than that in the control group at both time points. The serum IL-10/TNF-α in the EN group was significantly lower than that in the EN+Gln group at both time points (P<0.05). The serum IL-10/TNF-α in the PN group was markedly lower than that in the EN group and EN+Gln group (P<0.05 and P<0.01, respectively).Conclusion: EN in combination with Gln are superior to EN alone, PN alone and PN in combination with Gln in regulating inflammation in SAP rats, and the EN has more potent capability to regulate the balance between pro-inflammation and anti-inflammation than PN.     

高龄患者卒中相关性肺炎的营养治疗疗效观察

目的研究高龄患者卒中相关性肺炎肠内外营养治疗的效果。方法将50例高龄患者卒中相关性肺炎随机分为肠内营养（EN）组和肠外营养（PN）组,每组25例。EN组采用鼻饲肠内营养液,PN组为静脉注入营养液,在摄入同等热量和氮量的条件下比较营养支持后两组NIHSS评分、血红蛋白、帆清总蛋白、白蛋白含量。结果治疗21d后,EN组血红蛋白（111±10．9）g／L、血清总蛋白（67．3±7．0）g/L、白蛋白（36．3±3．2）g/L,明显高于PN组（P〈0．05）,EN组NIHSS评分（9．3±1．4）明显低于PN组（11．3±1．4）（P〈0．05）,且并发症明显低于PN组。结论高龄患者卒中相关性肺炎早期给予肠内营养,可明显改善患者营养状态,促进神经功能的恢复,并且并发症少。     

Leczenie żywieniowe pacjentów poddawanych przeszczepieniu macierzystych komórek krwiotwórczych

Hematopoietic stem cell transplantation (HSCT) – the highly aggressive therapeutic process – is connected with high risk of side effects and complications, which influence nutritional management.Moreover, limitation of possibility of nutrients delivery is accompanied by simultaneous increase in requirement for nutritional elements. Thus, implementation of nutritional support as an element of supportive treatment is advisable or necessary in many of these patients.Unfortunately, there is a lack of uniform clinical nutrition guidelines for HSCT patients. Currently, special attention is paid to: suitable qualification for different form of nutritional support, consideration of routine implementation of nutritional support after myeloablative conditioning (especially with total body irradiation), avoidance of unjustified arrest of oral/enteral nutrition (probably higher risk of Graft-vs-Host disease – GvHD) and likely clinical advantages of the use of glutamine and/or omega-3 fatty acids in nutritional mixtures.Moreover, in the context of clinical nutrition, patients with severe gastro-intestinal toxicity and persons with GvHD grade > II with intestinal failure require special attention. For these patients, primary nutritional support is parenteral nutrition (PN).The indications of PN implementation include: impossible, ineffective (e.g. nutrients absorption <50% daily requirements) or contraindicated oral/enteral feeding and progressive undernutrition. In case of use of myeloablative conditioning with total body irradiation and high-dose chemotherapy, the routine PN initiation should be taken into consideration according to preemptive strategy.Composition of intravenous nutritional mixtures is also very important. Based on scientific references and own study, the addition of glutamine and omega-3 fatty acids seems to be advisable (e.g. positive influence of mucous membrane regeneration and hematopoietic recovery, less complications). However, not all clinical studies confirmed above mentioned advantages. Moreover, optimal daily dose of these substrates is currently unknown.     

肠道营养支持对烧伤大鼠肠粘膜屏障功能的保护作用及其机理

观察不同营养支持途径地严重烧伤所致肠粘膜屏障功能损害的影响并探讨其机制。采用30％体表面积Ⅲ度烧伤大鼠模型,随机分成正常对照（Control),静脉营养（PN）及肠道营养（EN）组,观察了烧伤后肠粘膜屏障功能的变化及PN和EN对其的影响,结果显示,烧伤后肠粘膜通透性,血浆二胺氧化酶（DAO）活性明显高于对照组（P＜0．01）,而肠上皮细胞增殖指数,肠三叶因子（ITF）含量,肠粘液层厚度及己糖和唾液酸的含量则明显降低（P＜0．05）,同PN相比,EN对上述指标均有一定的逆转作用,提示EN较PN更有利于减轻肠粘膜受损程度,促进肠粘膜修复。     

肠内和肠外营养对上消化道肿瘤术后肠瘘患者的临床应用研究

目的提高上消化道肿瘤术后并发肠瘘患者的营养支持效率.方法 28例患者随机分为肠内和肠外营养支持两组,前者用市售普通营养制剂由空肠营养管持续滴入,进行管饲调节喂养.瘘口封闭后改由口服.后者采用深静脉置管,进行静脉营养支持.两组在热卡,糖、蛋白质、脂肪的组成比例及电介质、微量元素的含量等均相似.营养支持开始后第7、14、21、28、35天清晨空腹采血.检测血浆丙二醛（MDA）及超氧化物歧化酶（SOD）活力变化.测定血浆前白蛋白及转铁蛋白、血浆内毒素.结果肠内营养组的MDA及内毒素水平明显低于肠外营养支持组.结论肠内营养支持可保护肠道功能,减轻肠道缺血再灌注损伤,降低循环内毒素水平,明显改善患者的营养状态.