应用双能源X线吸收法测定 营养不良病人机体组成

目的应用双能源X线吸收法(DEXA),检测营养不良病人的机体组成改变。　方法中等程度以上营养不良住院病人56例,其中男32例,女24例,年龄为39～66(平均51±14)岁作为研究对象。72例健康志愿者(男34例,女38例)为对照者,年龄为41～64(平均54±11)岁。机体组成测定应用HologicQDR—2000双能源X线测定仪。　结果营养不良病人实际平均体重是理想体重的72.5%,其体重指数、肱三头肌皮褶厚度、上臂肌围、白蛋白、转铁蛋白、前白蛋白及淋巴细胞总数均明显低于正常值,属中、重度营养不良范围。营养不良病人的体脂及瘦组织群含量明显低于健康志愿者,尤以体脂含量下降最为明显,差异极显著(P＜0.01)。两组矿物质含量无统计学差异(P＞0.05)。　结论营养不良时机体体脂和瘦组织群存在不同程度的消耗,其中以体脂的丢失尤为明显。DEXA是临床上测定机体组成的一种准确、可靠方法,可有效地检测营养不良病人的机体组成改变。     

肠内与肠外营养支持的临床对比研究

为比较肠内和肠外营养支持对营养不良病人的临床和代谢效应，本文用交叉自身对照实验设计方法（ｃｒｏｓｓｏｖｅｒｔｒｉａｌ）对１２例营养不良病人进行前瞻性研究。１２例病人随机分成两驵，一组６例先接受肠外营养（ｐａｒｅｎｔｅｒａｌｎｕｔｒｉｔｉｏｎ，ＰＮ）支...     

肠外营养支持对红细胞免疫功能的影响

本文对３０例胃癌根治术病人手术前后及肠外营养支持前后的红细胞免疫指标进行了观察。结果显示，胃癌根治术可促使红细胞免疫功能恢复。但胃癌根治术后实施ＴＰＮ较单纯胃癌根治术有更强的刺激红细胞免疫功能恢复的作用。肠外营养支持对红细胞免疫功能的影响@万焕真@陈顺...     

肠外营养支持在骨髓移植中的应用

６例白血病、１例恶性淋巴瘤病人，在进行自体（异体）骨髓移植过程中，出现严重的口腔溃疡、恶心、呕吐，导致食欲下降，进食困难，营养状况恶化。通过静脉输注１０％脂肪乳剂、安达美、水乐维他、１７种氨基酸及葡萄糖等肠外营养支持，有效地改善了骨髓移植病人的营养状况，顺利地渡过了骨髓空虚期，促进了骨髓移植的成功。     

肠外营养支持临床应用七年回顾

目的分析7年来肠外营养支持在我院临床应用的疗效。     

恶性肿瘤病人肠外营养支持的护理

肿瘤病人由于多种原因,在入院时即有不同程度的营养不良和体重减轻,后又因手术、化疗及放疗的影响,使病人的营养状况和体重进一步下降。肿瘤病人的预后与营养状况有密切关系。一部分肿瘤病人不是死于肿瘤本身,而是死于饥饿性营养不良〔１〕。我科开展了肿瘤病人围化疗...     

重型颅脑损伤病人的肠外营养支持

本文报告４６例重型颅脑损伤病人（格拉斯哥评分为３～８分）除了常规使用脱水降颅压和激素类药物、抗感染以及使用神经营养药物外，在伤后７２ｈ脑水肿消退期行肠外营养支持３～１８天。结果表明，肠外营养支持能够提高血浆蛋白的浓度，改善机体氮平衡，增加血淋巴细胞总...     

重度营养不良合理肠外营养支持探讨

目的探讨更合理的重度营养不良肠外营养支持(parenteral nut^tion,PN)的方案.方法1998年12月～2000年5月收集仁济及新华医院住院患者应用PN≥5天且体质指数(BMI)≤16患者的临床资料共40例;年龄22～105岁,平均年龄(62.8±17.2)岁;平均PN持续(25.1±22.7)天(5～120天).结果40例患者中复查体重14例,体重增加11例,不变1例,下降2例.PN后血红蛋白、白蛋白、前白蛋白、总蛋白均有不同程度的增高,具统计学意义.支持期间肝肾功能有一定程度的改善,发生PN相关并发症4例(占10%),其中肝功能损伤1例,胆汁淤积3例.结论营养不良由于其特殊性,营养支持方案应有别于一般疾病,过度的营养支持不但不能改善其体内营养素的缺乏,反而会加重脏器的负担,唯有合理的营养支持才能改善其营养状况,同时对维持正常代谢及内环境的稳定具有积极意义.     

胃肠道肿瘤术后的肠外营养支持

２９例胃肠道恶性肿瘤病人，均作肿瘤切除术。根据术后不同的ＰＮ支持方法分为三组。Ａ组（９例）术后给予常规静脉补液（葡萄糖热能４１．８ｋＪ／ｋｇ·ｄ－１）；Ｂ组（１０例）连续５ｄ给予葡萄糖热能１２５．５ｋＪ／（ｋｇ·ｄ）和１４－氨基酸－８０００．１７ｇ氮...     

严重烧伤病人肠外营养支持的体会

本文总结近５年来我院救治的２００余例严重烧伤病人进行肠外营养治疗的心得体会。文章强调肠外营养对于严重烧伤病人支持治疗的重要性；根据烧伤病人创面存在的特点，认为营养支持的途径主要是外周静脉的穿刺或置管；提出经中心静脉途径进行肠外营养支持的主要问题是感染...     

营养支持途径对人体组成影响的随机对照研究

目的用随机对照方法比较肠内和肠外营养支持途径对术后患者人体组成的影响。方法60例符合入选标准的择期手术患者参加本研究,按入组序号和随机表分别进入研究组(肠内途径)或对照组(肠外途径)。在等氮(0.18g·kg-1·d-1)和等能量(25kcal·kg-1·d-1)穴1kcal=4.18kJ雪摄入条件下,于手术前1天及手术后第12天测定总体水穴TBW雪、总体脂肪穴TBF雪、非脂肪组织穴FFM雪、体重指数、三头肌皮褶厚度、上臂围、上臂肌围和握力。结果穴1雪TBF:研究组术后较术前降低(-0.91±1.50)kg,而对照组升高(1.54±1.84)kg,两组比较具有显著性差异(P=0.001);穴2雪TBW:术后研究组和对照组分别降低(-0.20±1.40)kg和(-2.40±2.34)kg,两组比较对照组降低更为显著(P=0.002);穴3雪FFM:术后研究组和对照组分别降低(-0.27±1.92)kg和(-3.28±3.19)kg,两组比较对照组降低更为显著(P=0.002)。结论与肠内营养组比较,肠外营养组术后总体脂肪显著增加,而非脂肪组织的减少更为明显。     

胰十二指肠切除术后患者临床营养的护理

目的总结胰十二指肠切除术后患者肠外营养（PN）和肠内营养（EN）的护理体会。方法回顾性分析了57例接受胰十二指肠切除术患者的临床资料，所有患者均于术前接受中心静脉置管，术中行空肠造瘘，术后给予PN和EN支持。结果PN中位时间为8天（5～24天），EN中位时间为21天（5～69天），平均术后肛门排气时间（72．5±19．8）小时，术后住院的中位时间为24天（17～74天）。57例患者中，1例于围手术期死亡，2例因严重腹胀、腹泻中止EN；41例出现腹胀，17例发生腹泻；中心静脉导管脱出和堵塞各2例，空肠造瘘未出现导管并发症；29例出现糖代谢严重异常，2例伤口裂开，19例次发生术后感染。结论胰十二指肠切除术后需要联合PN和EN，治疗中应坚持无菌配液、严格管路护理、注意血糖变化和加强心理治疗。     

Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes.     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月-2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组（观察组）19例和全肠外营养支持组（对照组）19例。观察组早期肠内营养（enteral nutrition,EN）和肠外营养（parenterl nutrition,PN）结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组（P〈0．05）,观察组并发症少于对照组。观察组10天后病死率为（15．79％）明显低于对照组（31．58％）。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月～2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组(观察组)19例和全肠外营养支持组(对照组)19例。观察组早期肠内营养(enteral nutrition,EN)和肠外营养(parenteral nutrition,PN)结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组(P<0.05),观察组并发症少于对照组。观察组10天后病死率为(15.79%)明显低于对照组(31.58%)。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。     

Survival of Patients with Multi-Level Malignant Bowel Obstruction on Total Parenteral Nutrition at Home

Home parenteral nutrition (HPN) may improve the survival in selected patients with malignant bowel obstruction. This retrospective, medical registry-based study aimed to identify clinical and laboratory markers predicting short survival, which would allow a more accurate selection of patients that would benefit from HPN in inoperative bowel obstruction. In a retrospective analysis of 114 patients receiving HPN, the median survival was 89 days after discharge home, and the three and six-month survival probability was 48% and 26%, respectively. Parenteral nutrition was provided during 98% of overall survival time and ended on a median of one day before the patient’s death. Discontinuing chemotherapy, anemia, severe hypoalbuminemia, and water retention appeared correlated with survival shorter than three months. In these cases, routine initiation of HPN should be discouraged, as it may not bring any benefits to the patient. The decision on the initiation of HPN should be made along with continuing or initiating chemotherapy.     

综合治疗加静脉营养支持治疗重症哮喘

目的观察静脉营养疗法治疗重症哮喘发作的临床效果。方法对46例重症哮喘急性发作患者在抗感染、平喘等综合治疗基础上，经静脉置管给予适当的全合一营养液，与对照组比较观察治疗1周后营养状况、免疫功能及肺功能的变化。结果静脉营养治疗组体重（WT）增加；血清总蛋白（TP）及动脉血氧分压（PaO2）明显升高；免疫功能及肺功能明显改善，与治疗前比较差异有显著意义（P〈0．05），与对照组治疗后比较差异也有显著意义（P〈0．05），且平均住院时间缩短。结论重症哮喘急性发作患者短期静脉营养疗法有助于患者的康复。     

Impact of an Intravenous Magnesium Shortage on Potassium Doses in Adult Surgical Patients Receiving Parenteral Nutrition

Background: Shortages of parenteral nutrition (PN) components have been common in recent years. Effects on patient management and outcomes have not been well documented. This study aimed to determine the effect of a parenteral magnesium shortage, and an institutional decision to omit magnesium from adult PN, on magnesium and potassium doses and serum concentrations. Materials and Methods: This was a retrospective cohort study of adult surgical patients during two 6‐month periods: prior to the magnesium shortage (2011) and during the shortage (2012). The relation between study period and electrolyte doses was evaluated by unadjusted and adjusted mixed models, while the relation between study period and hypokalemia and hypomagnesemia exposure was evaluated by Student's t tests and multiple linear regression. Results: During the shortage, patients received more supplemental magnesium (0.11–0.12 mEq/kg/d, P < .0001) but received less total daily magnesium (0.08–0.09 mEq/kg/d, P < .0001) and had greater exposure to hypomagnesemia (9.6–14.2 h·mcg/dL/h, P < .05 for all comparisons except multivariate analysis in a matched subpopulation). Patients received similar amounts of potassium in PN (0.06–0.08 mEq/kg/d less, P < .05 for full cohort but P > .05 for matched cohort), in supplemental doses (0.01–0.05 mEq/kg/d less, P > .05), and in total (0.07–0.14 mEq/kg/d less, P > .05), and they had similar exposure to hypokalemia. Conclusion: Daily magnesium doses were lower and hypomagnesemia exposure was greater during the shortage, but the differences were numerically small and their clinical significance was questionable. Potassium doses and hypokalemia exposure were not higher during the shortage. This supports the strategy of omitting magnesium from PN of select patients and supplementing as clinically necessary.     

Parenteral Nutrition Utilization After Implementation of Multidisciplinary Nutrition Support Team Oversight

Background: Multidisciplinary nutrition teams can help guide the use of parenteral nutrition (PN), thereby reducing infectious risk, morbidity, and associated costs. Starting in 2007 at Harborview Medical Center, weekly multidisciplinary meetings were established to review all patients receiving PN. This study reports on observed changes in utilization from 2005–2010. Materials and Methods: All patients who received PN from 2005–2010 were followed prospectively. Clinical data and PN utilization data were recorded. Patients were grouped into cohorts based on exposure to weekly multidisciplinary nutrition team meetings (from 2005–2007 and from 2008–2010). Patients were also stratified by location, primary service, and ultimate disposition. Results: In total, 794 patients were included. After initiation of multidisciplinary nutrition meetings, the rate of patients who started PN decreased by 27% (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63–0.84). A reduction in the number of patients receiving PN was observed in both the intensive care unit (ICU) and on the acute care floor (RR, 0.64; 95% CI, 0.53–0.77 and RR, 0.80; 95% CI, 0.64–0.99, respectively). The rate of patients with short‐duration PN use (PN duration of <5 days) declined by 30% in the ICU (RR, 0.70; 95% CI, 0.51–0.97) and by 27% on acute care floors (RR, 0.73; 95% CI, 0.51–1.03). Conclusions: Weekly multidisciplinary review of patients receiving PN was associated with reductions in the number of patients started on PN, total days that patients received PN, and number of patients who had short‐duration (<5 days) PN use.