肠内营养对重型破伤风患者营养支持的探讨

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.     

肠内营养对重型破伤风患者营养支持的探讨

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.     

Effect of enteral feeding ELENTAL on nutritional status of burned patients

To investigate the maitainance effect of enteral feeding ELENTAL on inteatine,liver and nutritional status of bumed patients.METHODS:30 cases of burned patients were randomly devided into ELENTAL feeding group(Egroup) and intravenous nutrition group(control,D).The whole calorie in group E were supplied by feeding elemental dist ELENTAL and those in group D were supplied by intravenous nutrition from the third day after burning.the supplemented calorie and nitrogen were equal in two groups.Before the ezperiment and on the 5th day and 10th day,blood were drawn to examine the levels of and serum transferring.RESULTS:There were no significant diference of serum lipid and serum transferring levels on the 7th day and 10th day in burned patients.CONCLUSION:ELENTAL diet can protect intestine effectively and improve nutritius status of the burned patients.     

要素营养制剂ELENTAL对烧伤患者营养状况的维护效应

AIM: To investigate the maitainance effect of entered feeding ELENTAL on intestine, liver and nutritional status of burned patients. METHODS: 30 cases of burned patients were randomly devided into ELENTAL feeding group(E group) and intravenous nutrition group(control, D). The whole calorie in group E were supplied by feeding elemental diet ELENTAL and those in group D were supplied by intravenous nutrition from the third day after burning, the supplemented calorie and nitrogen were equal in two groups. Before the experiment and on the 5th day and 10th day, blood were drawn to examine the levels of and serum transferring. RESULTS: There were no significant difference of serum lipid and serum transferring levels on the 7th day and 10th day in burned patients. CONCLUSION: ELENTAL diet can protect intestine effectively and improve nutritious status of the burned patients.     

黄芪注射液对严重脓毒症患者的疗效观察

Objective To observe the effects of Radix Astragali injection on severe septic patients. Method This was a prospective study. Fifty severe septic patients admitted in ICU from 2006 to 2008 were col-lected, malignent disease like carcinoma, pregnant ones were excluded. They were randomly divided into two groups: Radix Astragali injection treatment group (n = 30) and control one (n = 20). The data of the two groups were comparable. With the same basic therapy, the experimental group treated with additional Radix Astragali in-jection. Then, APACHE Ⅱ scores were calculated on day 0(before therapy), day 7 and day 14 after treatment with Radix Astragali injection, and the 28th day mortality was also calculated for both groups. Blood CD4, CD8, CD4/CD8, NK-cell expression level was measured by direct immunofluorescence, IL-1β, IL-6, TNF-α level was tested by ELASA. SPSS 11.5 software, was used for statistic. Results The APACHE Ⅱ scores in Radix Astragali treatment group were 20.73±5.06, while in control groups were 35.00±3.70 after treatment for 14 days, and mortality in the 28th day was 25.3% and 41.6% respectively, there were significant deferences between the two groups (P < 0.05). At 14 days after treatment, the level of CD4, CD4/CD8 and NK-cell in the Radix Astragali treatment group was significantly increased, with (34.11±14.09) %, (2.05±0.98) %, (28.83±8.08) %, re-spectively, and compared with control group, there were significant differences (P < 0.01). Though, the level of CD8, IL-6 and TNF-α was showed (20.84±9.84) %,(710.87±313.52) pg/mL,(14.63±30.38) pg/mL respectively, significantly decreased after treatment with Radix Astragali injection, there were also significant dif-ferences between the two groups (P < 0.01). Conclusions Radix Astragali injection can improve the immunity disorder of severe septic patients, it will be a hopeful therapy for severe sepsis.     

强直性脊柱炎铁蛋白的变化及相关性研究

Objective To observe the ankylosing spondylitis (ankylosing spondyiltis, AS) in patients with ferritin and its relationship with disease activity indicators of relevance. Methods 40 cases of active AS patients with ferritin, the activity indexs(ESR, CRP) and immunoglobulins (IgA, IgG, IgM), a separate control group of 30 patients and to detect those targets; analysis of 40 cases of active stage AS in patients with ferritin and its relationship with disease activity indicators of relevance. Results ① Compared with normal control group,with active AS patients with ferritin, ESR, CRP, IgG, IgA was significantly higher (P<0.05 or P<0.01),while IgM was not statistically significant (P ＞ 0.05). ② Ferritin and ESR, CRP was positively correlated (P<0.05 or P<0.01),and IgA,IgG,IgM was no significant correlation (P ＞ 0.05). Conclusion AS patients with active stage of the ferritin, IgA, IgG increased, the elevated ferritin and with ESR, CRP are relevant, IgA,IgG elevated in active AS patients have prompted the immune disorder, suggesting that ferritin AS disease activity can serve as a reaction of an objective index, mechanism of the increase may be due to the release of inflammatory factors cause the immune disorder.     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.     

肠内免疫营养对多发伤患者免疫功能的影响

目的 观察肠内免疫营养对多发伤患者免疫功能的影响.方法 上海长征医院综合性ICU 2007年3月至2008年5月收治32例多发伤患者,随机(随机数字法)分为肠内免疫营养组(EIN组,n=16)和普通配方肠内营养组(EN组,n=16).两组患者于伤后第3天开始分别接受EIN和普通配方EN支持至少14 d.于入组当天、营养支持第7天和第14天分别检测外周血淋巴细胞计数(TLC),免疫球蛋白(IgC,IgM,IgA)和T淋巴细胞亚群(CD3,CD4,CD8,CD4/CD8).结果 EIN组第7天和第14天TLC,IgG,IgM,IgA,CD4及CD4/CD8比值均明显高于入组当天(P＜0.05),且随EIN时间延长而持续增高;EN组所有免疫指标在第7天较入组当天无明显改变,第14天TLC,IgG,IgM,IgA,CD4及CD4/CD8比值均明显高于入组当天(P＜0.05),但均明显低于EIN组第14天测定值(P＜0.05).结论 与普通配方EN相比,多发伤后早期EIN更有利于机体体液和细胞免疫功能的恢复和提高.     

脓毒症患者血清可溶性髓系细胞表达的触发受体-1水平及与预后的关系

Objective To approach the relationship between the contents of soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1) and prognosis in patients with sepsis. Methods Using prospective, control study design, a total of 50 patients with sepsis who were admitted in intensive care unit (ICU) of the Second Hospital of Tianjin Medical University from March to December in the year of 2009 were enrolled. Firstly, the patients were divided into sepsis (n=28) and severe sepsis (n=22) groups according to the patients' condition. Then the patients were divided into survival group (n = 34) and death group (n = 16)according to the clinical outcome at 28 days after onset of sepsis. Clinical and laboratory data including blood routine tests, blood chemistry, blood gas analysis, C-reactive protein (CRP) and procalcitonin (PCT) were collected on the 1st, 3rd and 7th day after onset. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ ) score was determined. sTREM-1 levels were determined using enzyme linked immunosorbent assay (ELISA) method. Correlation analysis of the sTREM-1, APACHE I score, white blood cell count (WBC) and CRP, using Logistic regression analysis. A total of 30 healthy persons were enrolled into the control group. Results The sTREM-1 levels (ng/L) in 50 septic patients on the 1st day were higher than those of the healthy persons (52. 80±9. 30 vs. 23. 29±6. 22, P＜0. 01). The sTREM-1 levels (ng/L) in severe sepsis group on the 1st, 3rd and 7th day (58. 25±10. 59, 65. 75±13. 57, 50.18±21. 73) were higher than those of the sepsis group (48.55±5.20, 42.85±8.54, 34.02±12.86, P＜0.05 or P＜0.01). The sTREM-1 levels (ng/L) of the survival group on the 1st, 3rd and 7th day (53. 07± 10. 47, 45. 04±9. 89,32. 84 ±8. 42) were decreased with the progression of the ailment. The sTREM-1 levels did not differ significantly between the control group and survival group on the 7th day (P＞0. 05). The sTREM-1 levels (ng/L) in the death group on the 1st, 3rd and 7th day were increased with the progression of the ailment (52.27±6.42, 69.67±12.83, 75. 70± 10. 55), and the level was significantly higher than that in survival group on the 3rd and 7th day (both P＜0. 01). The contents of sTREM-1 were positive correlated with APACHE Ⅱ score (r= 0.657, P＜0. 01), but not correlated with WBC (r= 0.023, P＞0. 05), whilesomewhat correlated with CRP (r=0. 150, P＜0.10). Logistic regression analysis showed that sTREM-1 [odds ratio (OR) = 0. 893,P = 0. 000] and APACHE I score (OR = 0.771, P = 0.000) might be potential prognostic factors for septic patients. The area under the receiver operator characteristic curve was 0. 868 and 0.930. The sensitivity of prognostic evaluation was 81.1% and specificity was 74.5% with sTREM-1 50 ng/L, and the sensitivity was 83. 8% and specificity was 86. 3% with APACHE Ⅱ score 20 to estimate the outcome. Conclusion The serum sTREM-1 are elevated at early stage in sepsis patients. It can reflect the severity of the condition. The sTREM-1 level, which might be considered as a potential prognostic factor for septic patients, is significantly correlated with APACHE Ⅱ score.     

肠内营养对重型破伤风患者营养支持的探讨

目的 探讨重型破伤风患者应用肠内营养(EN)支持对患者营养状况的影响.方法 将60例重型破伤风患者随机分为EN组和对照组,每组各30例,EN组在常规治疗的基础上给予肠内营养,对照组在常规治疗基础上给予部分静脉营养,于营养支持前一天及营养治疗后第11天检测两组患者的BMI、TSF、MAMC,TP、PA、ALB及Hb等指标,并且全程观察不良反应及疗效.结果 营养支持10天后两组患者的BMI、TSF、MAMC下降不明显,EN组的TP、PA、ALB及Hb均高于同期对照组(P＜0.05).EN组并发症发生率(16.7%)低于对照组(36.7%),两组比较有统计学意义(P＜0.05).结论 早期EN可改善重型破伤风患者蛋白质代谢和患者营养状况,提高了机体免疫功能,减少并发症.

Abstract：

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.