危重症病人胰岛素强化治疗时不同肠内营养制剂的影响

目的:观察危重症病人胰岛素强化治疗时对不同肠内营养(EN)制剂的影响。方法:选择机械通气的高血糖危重症病人40例,随机分为对照组和治疗组。对照组病人用EN制剂能全力,治疗组病人用EN制剂瑞代。第3～10天内给全量EN支持,达到完全EN[83.68 kJ(20 kcal)/(kg.d)],观察两组病人EN治疗后的胃肠道不良反应、第10天的24 h平均血糖、总热量、总胰岛素用量和血浆清蛋白(ALB)水平。结果:两组各有2例病人出现胃肠道潴留和腹泻而被剔除本研究,其余均能达到目标热量供给。两组病人EN治疗后第10天的平均血糖、总热量、血浆ALB均无显著性差异(P0.05)。治疗组病人EN治疗后第10天总胰岛素用量明显小于对照组(P0.05)。结论:危重症病人胰岛素强化治疗时不同EN制剂的选择对胰岛素的需要量有明显影响。     

营养干预对重度溃疡性结肠炎病人的治疗价值

目的:探讨营养干预对重度溃疡性结肠炎(UC)的治疗价值。方法:回顾性分析36例重度UC病人资料,其中20例病人进行了肠外营养(PN)或肠内营养(EN)治疗为观察组,其余16例为对照组。比较两组病人住院时间以及治疗前后的营养指标、血清内毒素、IL-4和外周血CD4+CD25+调节性T细胞(CD4+CD25+Treg)水平。结果:给予营养干预的观察组病人住院时间较对照组明显缩短(P0.05);治疗后的血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)水平较治疗前有明显增高,且改善程度显著高于对照组(P0.05);治疗后的血清内毒素水平亦较治疗前明显降低;IL-4及外周血CD4+CD25+Treg水平明显增加,与对照组比,差异有统计学意义(P0.05)。在营养支持中腹泻的发生率为20%,占所有不良反应的66.7%。结论:营养支持治疗可显著改善重度UC病人的临床病情及营养状况,对UC病人的免疫调节功能也有一定影响。     

重型颅脑损伤病人序贯性肠内营养治疗的研究

目的:探讨重型颅脑损伤病人序贯性肠内营养(EN)治疗的方案、可行性及临床效果。方法:将59例重型颅脑损伤病人随机分为研究组和对照组。研究组30例病人采用短肽型EN制剂过渡至整蛋白型EN制剂的序贯性EN治疗方案,对照组29例开始即采用整蛋白型EN制剂,根据操作流程实施。观察两组病人达到EN目标量的时间、需联合肠外营养(PN)治疗的比例、低清蛋白(ALB)血症率、喂养相关并发症、平均入住ICU天数等指标。结果:两组病人均能达到EN目标治疗,研究组开始EN治疗后达到EN目标量的时间早于对照组(P0.05),联合PN治疗的比例小于对照组(P0.05),ALB水平高于对照组(P0.05),腹胀发生率低于对照组(P0.05)。两组间其他喂养相关并发症和平均入住ICU时间无统计学差异。结论:对重型颅脑损伤后病人尤其是肠道吸收功能障碍者推荐采用序贯性EN支持治疗。     

富含缓释淀粉的肠内营养在颅脑损伤并发高血糖病人中的应用

目的:探讨富含缓释淀粉的EN制剂对颅脑损伤并发高血糖鼻饲病人营养状态、血糖水平和意识恢复情况的影响.方法:将64例颅脑损伤并发高血糖的鼻饲病人随机分为对照组和研究组,采用重力滴注法分别给予两种不同的EN制剂(瑞素和瑞代).比较两组病人的营养指标、血糖水平变化以及意识恢复情况等.结果:研究结束时,两组病人的各项营养指标(除Hb外)均显著高于营养支持前(P<0.05),两组间无显著性差异(P>0.05).研究组在营养支持第7天空腹血糖和餐后2 h血糖开始下降,到研究结束时,分别降至(7.36±1.99) mmol/L和(9.87±3.01) mmol/L,明显低于营养支持前和对照组(P<0.05).糖化血红蛋白(7.38±0.78)%,与营养支持前和对照组比无显著性差异(P>0.05).研究组病人意识恢复人数(18/28)明显多于对照组(P<0.05).结论:富含缓释淀粉的EN液,能有效地降低颅脑损伤并发高血糖病人的血糖水平,改善其营养状况及其预后.     

短肽型肠内营养制剂适用于老年脑卒中病人的营养支持

目的:评价短肽型肠内营养(EN)制剂对老年脑卒中病人营养支持治疗的疗效. 方法:将60例出现吞咽障碍需营养支持治疗的老年脑卒中病人,随机分为试验组(n =30,入院48 h内鼻饲给予短肽型EN制剂)和对照组(n=30,入院48 h内鼻饲给予匀浆膳).观察两组病人营养支持前后营养指标和不良反应的发生情况.结果:经过30 d的营养支持,试验组病人较对照组能更好地维持前清蛋白、清蛋白和血红蛋白水平;对照组病人前清蛋白、清蛋白和血红蛋白水平比入院时有显著降低(P＜0.01).试验组病人不良反应(腹胀、腹泻、呕吐、胃潴留、误吸和吸入性肺炎)的发生率(36.67％)显著低于对照组(56.67％),差异有显著性统计学意义(P＜0.05). 结论:短肽型EN制剂对老年脑卒中病人营养支持治疗的疗效和安全性均优于匀浆膳.     

益生菌联合肠内营养对重度颅脑损伤病人的疗效观察

目的:探讨益生菌联合含有可溶性膳食纤维的肠内营养(EN)制剂对预防重度颅脑损伤病人并发肺部感染、腹泻和营养不良的疗效.方法:选择重度颅脑损伤病人132例,分为试验组(采用益生菌联合含有可溶性膳食纤维的EN支持)和对照组(采用单纯EN支持),两组病人均由鼻胃管连续滴注EN液.并观察病人的菌群失调、肺部感染率和腹泻的发生率...     

国产整蛋白型肠内营养对食管癌手术病人营养状况和胃肠道耐受性的影响

目的:研究国产整蛋白型肠内营养(EN)支持治疗对食管癌围手术期病人胃肠道耐受性和营养状况的影响。方法:本研究为双盲、随机对照,采用随机数表法将166例接受食管手术的病人分为研究组和对照组,每组83例。两组病人热量和营养供给根据Harris-Benedict公式测算基础能量消耗(BEE),再乘以校正系数1.1,氮量0.24 g/(kg·d)。研究组病人给予整蛋白型EN(力存),对照组给予标准配方整蛋白型EN(能全力),研究时间为10 d。于术前和术后第10天观察病人的体重(kg),体重指数(BMI),肝、肾和胃肠道功能等营养代谢指标。结果:两种整蛋白型EN均同等地改善食管癌围手术期病人营养不良,术后第10天,两组病人血清清蛋白(ALB)、前清蛋白(PA)高于术前。研究组和对照组病人腹泻发生率分别为36.0%、24.0%,差异有显著性意义(P0.05),而腹胀、恶心、呕吐、误吸、便秘等症状无显著性差异。两组病人在体重,BMI,营养风险评分、术后EN开始时间,血清肌酐(Cr)、尿素氮(BUN)、总胆固醇(TC)、三酰甘油(TG)各参数组间比较差异均无显著性意义。结论:力存能较好地改善食管癌围手术期病人的营养状况,胃肠道耐受性较好,是一种较安全的国产整蛋白型EN制剂。     

品管圈活动在降低肠内营养不良反应发生率中的作用

目的:探讨品管圈(QCC)活动在降低肠内营养(EN)不良反应的发生率,提高EN护理质量和病人耐受性中的作用. 方法:选择在我院肝胆外科因急性胰腺炎或胰十二指肠切除术行EN支持的病人,成立QCC小组,并开展关于降低EN不良反应的发生率,提高EN护理质量和病人耐受性的QCC活动,分析实施QCC活动前后EN不良反应发生率和护理满意度的变化等. 结果:开展QCC活动后,EN不良反应发生率明显降低(13.3％),护理满意度明显改善(95％). 结论:将QCC活动应用于EN的临床护理工作中,可减少EN支持不良反应的发生、提高病人对EN支持的耐受性,改善病人满意度.     

重型颅脑损伤应激高血糖病人应用低糖类肠内营养制剂的临床研究

目的:观察重型颅脑损伤应激高血糖病人应用低糖类肠内营养(EN)制剂的临床效果。方法:将60例病人随机分为试验组和对照组。试验组病人使用低糖类EN制剂(瑞代),对照组病人使用匀浆膳,均经鼻胃管滴入。观察两组病人治疗前后血糖,血清清蛋白(ALB),血清钾、钠、氯和血脂的变化。结果:EN支持后,试验组病人的血糖水平明显低于对照组(P0.05);两组病人的ALB水平均明显升高,而血脂无明显变化。治疗14 d后,试验组病人需加用胰岛素的例数明显少于对照组(P0.05)。结论:重型颅脑损伤高血糖病人选用合适的EN配方,能较好地控制血糖,提高治疗效果。     

脑卒中合并吞咽功能障碍的老年病人序贯肠内营养支持治疗的研究

目的:探讨序贯肠内营养(EN)支持治疗在脑卒中合并吞咽功能障碍老年病人治疗中的应用和临床效果. 方法:将62例急性缺血性脑卒中合并吞咽功能障碍的老年病人随机分为研究组和对照组.研究组(n=32)病人给予短肽型EN制剂,逐步过渡至整蛋白型EN制剂的序贯EN治疗方案.对照组(n=30)病人直接给予整蛋白型EN制剂.观察两组病人人组第1和第14天的营养指标、免疫功能指标和神经功能缺损评分(NIHSS)的变化以及并发症的发生情况. 结果:入组第14天,两组病人的营养指标、免疫功能指标和NIHSS评分均较第1天明显下降(P＜0.05).研究组与对照组比,营养指标和免疫功能指标下降的程度均较轻(P＜0.05),NIHSS评分下降程度无显著性差异(P＞0.05).研究组病人总并发症的发生率少于对照组(P＜0.05). 结论:序贯EN支持治疗能减轻脑卒中合并吞咽功能障碍的老年病人营养不良发展程度和免疫功能下降程度,促进神经功能恢复,降低并发症发生的风险.     

炎症性肠病营养风险和营养治疗方案选择的回顾性分析

目的 :了解IBD病人的营养风险发生情况、相关因素以及营养治疗的选择。方法 :以2006年1月至2015年12月在北京大学第一医院治疗并随访的IBD病人为研究对象。根据病历记录采用营养风险筛查2002进行营养风险评估。根据病人的体重指数(BMI)分为正常组(BMI在18.5~23.9之间)、降低组(BMI18.5)和增高组(BMI≥24)。了解IBD整体和UC、CD病人的营养风险发生情况,分析营养风险的相关因素,比较营养治疗方案的选用。结果 :388例IBD病人纳入研究,UC 306例,CD 82例,营养风险总发生率为49.5%。尽管UC和CD入院时的BMI分布无差异,但CD的营养风险为64.6%,UC为45.4%,(P=0.002),CD较UC更易发生营养风险。BMI降低者的营养风险发生率高达95.7%。营养风险的发生在年龄、性别、IBD家族史上无差异。UC复发频繁、重度活动、广泛受累者营养风险比例较高。CD穿透型、既往有手术史和重症活动者营养风险比例较高。选择充足热卡营养治疗的病人CD为77.4%,明显高于UC的46.8%,(P0.001)。本组IBD病人肠内营养治疗遵循,重症UC病人不能一味强调肠内营养途径,CD病人应先处理好禁忌征再开展肠内营养的原则。结论:IBD病人的营养风险高,CD较UC更明显,尤其应重视低BMI值的IBD病人。UC和CD病人的营养风险发生各有其相关因素。把握好适应征和禁忌征的前提下给予IBD病人肠内营养治疗是安全的。     

Nutrition entérale dans le SIDA compliqué d'atteinte digestive

The tolerance and efficacy of enteral nutrition in patients with AIDS and digestive tract complications were assessed retrospectively in a serie of 17 patients aged 28–57 year. The digestive complications included cryptosporidiosis, CMV colitis and nutrient malabsorption. All the patients were severely malnourished, with a weight loss ranging from 13 to 38 per cent. Enteral nutrition was poorly tolerated in eight patients (47%) because of digestive discomfort (diarrhea) or psychological disturbances. Eleven patients received more than two weeks of enteral nutrition: mean intake 43.2 9.6 keal/kg/day, for 14 to 28 days. There was no significant improvement in most nutritional parameters. Global nutritional status improved in three patients, remained unchanged in six patients, and deteriorated in two patients. In patients with AIDS and digestive involvement, the tolerance and nutritional efficacy of enteral nutrition are poor.     

The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

Background: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. Aim: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. Method: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. Results: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). Conclusion: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.     

Nutrition in inflammatory bowel disease

The diet of industrialized nations may contribute to the pathogenesis of both ulcerative colitis (UC) and Crohn disease (CD). Malnutrition is relatively unusual in UC, but in CD, which often affects the small intestine, it is frequent and may be severe. Nutrition support is therefore frequently indicated. First principles of artificial nutrition can be applied effectively using the gut whenever possible. Parenteral nutrition is generally required only in those with short bowel syndrome. An increasing literature (especially in pediatrics) favors the use of defined exclusive enteral nutrition (EN) in the primary treatment of active CD. Controlled trials are, however, lacking, and recommendations are accordingly not of the highest rank. It appears that in this context, simple polymeric regimens are usually sufficient, and there is currently insufficient evidence to make a strong recommendation for disease-specific feeds. In the maintenance of remission in CD, controlled data demonstrate that defined EN reduces the risk of relapse requiring steroid treatment. There are no data in support of primary nutrition therapy in UC either in management of the acute flare or in maintenance. In conclusion, nutrition therapy in adults with inflammatory bowel disease is probably both undervalued and underused, but the evidence base needs to be strengthened to confirm its efficacy, determine better those patients most likely to benefit, and optimize the regimens to be employed.     

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.     

手术后经空肠造口管早期肠内营养病人的耐受性分析

目的:分析影响腹部手术后病人经空肠造口管EEN耐受性的相关因素.方法:对63例腹部术后病人经空肠造口管行EEN支持,观察其耐受性,并用Logistic多因素回归分析,探讨影响病人对EEN耐受性的相关因素.结果:63例病人中有45例(71.4%)能耐受EEN支持,18例(28.6%)不能耐受EEN支持.Logistic多因素回归分析显示:APACHE-Ⅱ评分、术后血清ALB、术中失血量和输血量,是影响病人术后EEN耐受性的因素(P<0.05).结论:腹部手术后病人经空肠造口管EEN耐受性良好.EEN支持的耐受性除与喂养方式有关外,还与疾病状态及其严重程度、血清ALB水平、术中失血量和输血量等因素相关.     

Nutrition given to critically ill patients during high level/complex care (on Italian ICUs)

BACKGROUND & AIMS: Within a prospective study on costs in 45 Italian intensive units we reviewed nutrition support practice given during critical illness. METHODS: From June to October 1999, patients with an ICU stay longer than 47 h were studied. Nutrition (i.e. fasting, parenteral, enteral and mixed) and calorie supply by the enteral route were monitored during the first consecutive days (up to seven) of invasive support of organ failure (high-care). RESULTS: 388 patients received high-care for at least 1 day, 200 patients had seven consecutive high-care-days. Some form of nutrition was given in 90.7% of patients, 9.3% were never fed (25.8% of the cardiac patients). Parenteral nutrition was given in 13.9% of patients (78.9% of the abdominal surgery patients), 39.7% received only enteral nutrition, and 36.4% received mixed nutrition. Finally, 77.1% of the patients received nutrient by gut. Nutrition was given in 78.5% of 2115 collected days, 44.1% of the first high-care-days and 93.5% of the 7th days were positive for nutrition. Enteral calorie load on the first day was similar for enteral and mixed nutrition (range 8-14 kcal/kg), it was higher for exclusive enteral nutrition between the 4th and the 7th day (15-19 vs. 11-14 kcal/kg). It differed according to diagnosis group. CONCLUSIONS: In Italian ICUs, in complex critically ill patients, nutrition is consistently given in critical illness, gut is widely used except in abdominal surgery patients.     

Risk factors for ulcerative colitis associated colorectal cancers in a Hungarian cohort of ulcerative colitis patients

BACKGROUND: There is an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC). The prevalence of UC associated CRC is different in various geographical regions. The risk depends primarily on the duration and extent of disease. AIM: The aim of the study was to identify risk factors for and epidemiology of CRC in UC patients in Veszprem province. PATIENTS AND METHODS: From our thirty-year IBD database we retrospectively studied the relevant epidemiological and clinical data of all UC patients in Veszprem province. The data of 723 UC patients (m/f: 380/343) were evaluated. The rate of familial disease was 5.2%, the rate of non-CRC related colectomies was 3.7% in our UC patients. RESULTS: CRC was diagnosed in 13 patients (m/f: 6/7, 13/8564 person year duration) during follow-up. The onset of UC in the 13 patients with UC-CRC was 34.5 (13-61) years, 4.1 years younger compared to UC patients without CRC. Mean age of UC-CRC patients at diagnosis of CRC was 50.9 (27-70) years (duration of UC: 16.5 +/- 8.2 years), almost 15 years younger than the average in sporadic CRC population in Hungary. Eight patients are still alive (survival: 67.9 (10-163) months), four patients died because of CRC (survival: 8.0 months), one died due to unrelated cause after 10 years of the diagnosis of CRC. Longer disease duration, chronic continuous disease, more extensive colitis, the presence of iron deficiency or chronic anaemia, primary sclerosing cholangitis (PSC) and dysplasia in the biopsy were identified as risk factors for developing CRC. In a logistic regression model longer disease duration, extensive colitis, PSC and dysplasia were still associated with increased risk. The cumulative risk for developing CRC after a disease duration of 10 years was 0.6% (95% CI: 0.2-1.0%), at 20 years 5.4 % (95% CI: 3.7-7.1%) and at 32 years 12.6% (95% CI: 7.0-18.2%). CRC diagnosed at surveillance colonoscopy was associated with longer survival (p = 0.04). CONCLUSION: The cumulative risk of CRC was high in our UC patients, however it was lower compared to that reported in Western European and North American studies. CRC developed approximately fifteen years earlier compared to the sporadic CRC cases. Long disease duration, extensive colitis, the presence of iron deficiency or chronic anaemia, dysplasia and primary sclerosing cholangitis (PSC) seem to be important risk factor for developing CRC in UC patients.     

肠外瘘病人肠内营养支持临床应用研究

目的：观察肠内营养在肠外瘘病人应用的时机、条件、途径及肠内营养制品的选择,研究肠内营养在肠外瘘病人中的作用。方法：收集１７０例肠外瘘病人诊断、住院总天数及全肠外营养（ＴＰＮ）、全肠内营养（ＴＥＮ）、肠内＋肠外营养（ＰＮ＋ＥＮ）、经口饮食的天数,计算不同营养支持方法期间,非蛋白质热量、蛋白质的供给量和并发症的发生率。收集ＴＰＮ、ＴＥＮ支持前和支持后满１５天病人的血清白蛋白浓度。另对４０例肠外瘘病人进行为期１５天的前瞻性观察,了解肠内营养对白蛋白、前白蛋白、转铁蛋白、纤维连结蛋白、总蛋白、球蛋白和肝酶谱的影响。结果：１７０例病人的总住院天数为１３５５３天,其中１６４人曾使用ＴＰＮ６０４０天（４４．６％）;１２９人使用ＴＥＮ３６７６天（２７．１％）;８３人使用肠内＋肠外营养４８９天（３．６％）;１２８人经口饮食２３３     

双歧杆菌强化的肠内营养支持在胃癌术后早期的应用

目的:研究双歧杆菌强化的肠内营养在胃癌术后的早期应用. 方法:选择60例进展期胃癌病人,随机分为两组,即强化肠内营养组和对照组,每组各30例.强化肠内营养组于手术后第1天开始应用能全力加双歧杆菌活菌制剂,共7天;对照组单用能全力.两组病人分别于手术前1天和手术后第7天测定粪便中分泌型IgA,并比较两组感染并发症的发生率. 结果:术后第7天,强化肠内营养组粪便中分泌型IgA量较对照组明显升高,感染等并发症下降,差异有显著意义性意义(P <0.05) . 结论:胃癌术后早期应用双歧杆菌强化的肠内营养可改善肠黏膜屏障功能,减少感染性并发症的发生率.