重症胰腺炎早期管饲肠内营养与全肠外营养的疗效比较

目的 比较重症急性胰腺炎经鼻空肠管肠内营养和全肠外营养治疗的临床效果.方法 回顾该院2015年1月-2016年6月收治的重症急性胰腺炎患者资料,共64例,根据采用的营养支持方式将其分为对照组(n=34)采用肠外营养,试验组(n=30)采用肠内营养,比较两组的治疗效果.结果 试验组血清白蛋白的增长优于对照组,差异有统计学意义(P<0.05);试验组血清淀粉酶恢复正常的时间、平均住院时间均短于对照组(P<0.05);胰腺感染发生率、导管相关感染发生率、多器官衰竭及肺部感染的发生率及病死率两组比较有差异,但差异无统计学意义(P>0.05),可能与鼻饲误吸的风险有关.结论采用经鼻空肠管对重症急性胰腺炎患者进行肠内营养支持,可以更好地改善患者的营养状况.     

早期营养支持治疗脑卒中营养风险的临床价值分析

目的探究早期营养支持治疗脑卒中营养风险的临床价值。方法选取2013年4月至2016年4月期间本院收治的80例脑卒中营养风险患者,采用随机分组方式,将其分为实验组与对照组,每组40例。对照组,实施常规营养支持治疗,实验组,实施早期肠内营养支持治疗,对比两组患者治疗效果。结果对比两组患者营养状况,实验组明显优于对照组,差异显著,具有统计学意义(P<0.05)。对比两组患者并发症发生率,实验组明显低于对照组,差异显著,具有统计学意义(P<0.05)。结论针对脑卒中营养风险患者,给予早期肠内营养支持治疗,效果显著,值得广泛推广。     

重症脑卒中患者早期动态营养评估及治疗策略的研究

目的分析和研究重症脑卒中患者早期肠内联合肠外营养支持的临床效果。方法选择2014年5月至2015年1月重症脑卒中患者60例作为研究对象,对其进行随机分组,对照组患者早期给予肠内营养支持,观察组患者早期给予肠内营养辅助以肠外营养支持,观察比较两组患者入院第21天后检测营养指标。结果两组患者各项营养指标比较发现,观察组明显优于对照组(P<0.05),具有统计学意义。结论在治疗重症脑卒中过程中加强改善患者的营养状况,肠内营养辅助以肠外营养支持能够有效改善患者的营养状况及预后。     

早期空肠输注肠内营养护理在外科老年患者胃肠部术后康复中的应用

目的:探讨早期空肠输注肠内营养护理对外科老年患者胃肠部术后康复的影响。方法:选取130例老年胃肠外科手术后患者,随机分为观察组与对照组,对照组患者予以临床常规的肠外营养支持护理治疗,观察组患者早期予以空肠输注肠内营养支持护理治疗(术后48 h内),观察与比较两组患者营养指标、胃肠功能恢复情况及并发症发生率等。结果:与对照组比较,术后治疗2周后观察组患者人血白蛋白水平有明显升高,与对照组比较差异具有统计学意义(P<0.05);观察组患者胃肠功能恢复情况显著优于对照组,其差异具有统计学意义(P<0.05);观察组患者相关并发症发生率显著低于对照组,其差异具有统计学意义(P<0.05)。结论:对老年胃肠外科手术后患者早期予以空肠输注肠内营养疗法,可显著改善患者营养状况,缩短胃肠功能恢复时间,降低术后并发症发生率,提高患者生活生存质量,促进患者术后的康复。     

早期肠内营养支持与肠外营养对ICU重型颅脑损伤患者营养状况及并发症的影响

目的探讨早期肠内营养支持与肠外营养对ICU重型颅脑损伤患者营养状况及并发症的影响。方法收集驻马店市第一人民医院2012年6月—2014年6月收治的120例ICU重型颅脑损伤患者,随机分为对照组和观察组,每组60例。对照组给予早期肠外营养支持,观察组给予早期肠内营养支持,比较两组患者的营养状况和并发症发生情况。结果入院1周后经血液检测发现观察组患者的总蛋白(TP)和白蛋白(ALB)水平分别为(37.69±6.28)g/L、(72.83±8.20)g/L,明显高于对照组,比较差异具有统计学意义(P<0.05)。观察组治疗期间的并发症发生率为15%,对照组为41.67%。差异具有统计学意义(P<0.05)。结论对ICU重型颅脑损伤患者提供早期肠内营养支持可有效改善其营养状况,降低并发症发生率,具有临床推广价值。     

肠内营养支持治疗对胰腺炎患者预后的影响

目的 探讨和研究肠内营养支持治疗对于胰腺炎患者预后的影响。方法 100例胰腺炎患者,根据患者的病情需求进行非手术或手术治疗,根据治疗后营养支持方案的不同分为观察组和对照组,各50例,对照组采用肠外营养支持,观察组通过鼻饲管进行肠内营养支持,对两组患者的并发症发生率、住院时间、治疗费用以及各项营养指标进行统计对比。结果 观察组患者的并发症发生率为12.0%(6/50),显著低于对照组的48.0%(24/50),差异具有统计学意义(P<0.05),且观察组患者的住院时间及治疗费用均显著低于对照组(P<0.05);从两组营养情况来看,治疗前两组对比差异无统计学意义(P>0.05),治疗后观察组患者的血清白蛋白及Hb含量均显著高于对照组,差异具有统计学意义(P<0.05)。结论 肠内营养支持治疗能够有效的改善胰腺炎患者的几天营养状况,能够加速患者恢复正常饮食,促进恢复,减少并发症发生率,值得在临床上推广应用。     

胃肠手术后早期肠内营养支持的临床研究

目的 探讨胃肠手术后早期肠内营养的可行性、安全性和临床效果.方法 选择胃肠道手术后患者46例,随机分为肠内营养组(EN组,22例)和全肠外营养组(TPN组,24例).肠内营养组在术后24 h即输注氨基酸,随后应用蛋白;肠外营养组采用标准的肠外营养.对比分析两组在营养支持前后体重、肝肾功能、电解质、血浆蛋白和血红蛋白等指标,及胃肠道功能恢复情况、各种不良反应及营养费用.结果 两组患者血浆白蛋白、前白蛋白和转铁蛋白水平在营养支持后明显升高,EN组高于TPN组,有统计学差异(P<0.05).EN组肛门排气时间较TPN明显缩短(P<0.05),具有统计学意义.结论 胃肠术后早期肠内营养支持可以改善患者机体的营养状况,促进肠功能的恢复.安全、可行,是有效的营养补给方式.     

肠内营养在晚期癌症患者中的应用研究

目的探讨肠内营养(EN)在癌症晚期治疗中的应用价值。方法采用营养风险筛查量表评估我院2014年3月~2015年3月期间收治的晚期癌症患者机体营养状况,将筛选出存在机体营养不良风险的84例晚期癌症患者按照肠内营养治疗和肠外营养治疗分为研究组和对照组各42例。结果两组实施营养治疗前机体营养状况、日常生活功能康复指标状况比较差异均无统计学意义(P>0.05),实施营养治疗后2周研究组机体营养指标状况、日常生活功能康复指标状况均优于对照组,并发症发生率为7.2%低于对照组23.9%(P<0.05)。结论肠内营养在癌症晚期患者营养治疗中的应用,能够有效改善患者机体营养状况,促进患者功能康复,且营养治疗过程中的并发症发生率低,安全性高,值得临床推广应用。     

重型颅脑损伤术后早期不同营养支持的合理性研究

目的 评价重型颅脑损伤术后早期不同营养支持的合理性及临床意义.方法 将重度颅脑损伤术后的患者(GCS<8分)随机分为A组(早期肠外营养组PN)、B组(早期肠内营养组EN)、C组(肠外肠内序贯营养支持),每组34例.术后36～72h给予相同营养支持,观察各组营养状态的变化及并发症的发生率和预后死亡率.结果 ①营养评价A、C组比B组好,C组、B组差异显著(P<0.05).C组并发症少于B组(P<0.05).②C组的预后优于其它两组,C组的病死率最低(P<0.05).结论 重度颅脑损伤术后患者早期全肠道外营养1周后过渡到肠内营养是比较合理的,这对预后差异有显著性意义.     

肠内营养干预对肠瘘患者预后及并发症的影响

目的 探讨肠内营养干预对肠瘘患者预后及并发症的影响.方法 2013年6月至2015年6月选取本院胃肠外科收治的128例肠瘘患者,根据抽签法将患者分为观察组及对照组,各64例.对照组给予肠外营养支持,观察组应用肠内营养支持,两组患者营养状况及并发症的影响比较分析.结果 观察组干预后7d血红蛋白、白蛋白、前蛋白及转铁蛋白水平显著高于对照组,差异均有统计学意义(t=12.986、14.563、12.036、16.234,均P＜0.05).观察组感染率、肠造口率低于对照组,差异均有统计学意义(x2=13.076、12.507,均P＜ 0.05),7d营养达标率显著高于对照组,差异有统计学意义(x2=23.801,P＜0.05),平均住院时间低于对照组,差异有统计学意义(t=5.123,P＜0.05).结论 肠内营养支持较肠外营养支持更能有效提高肠瘘患者营养水平,降低患者感染率,缩短患者住院时间,促进患者术后康复.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.