炎症性肠病的肠内营养治疗与肠道菌群

在环境因素中,如饮食、地域、抗生素治疗、补充益生菌、肠内营养等对肠道菌群产生的影响与炎症性肠病的发生、发展密切相关。对于肠道菌群的作用机制的学说包罗万千,可以说是对宿主的各个方面都产生了影响。尽管益生菌的作用机制没有被破译,但是它们可以刺激黏液分泌,抑制致病菌定植,纠正菌群失衡,改善屏障功能,下调先天免疫系统受体的表达,平衡T细胞亚群之间的均衡,改变一些基因的表达。另外免疫调节还产生了短链脂肪酸和其他代谢产物,这些对炎症性肠病的发病都是非常重要的。     

糖尿病患者的肠内营养

营养治疗是Ⅱ型糖尿病综合治疗的基本组成部分，其理论和方法也在不断的进步和完善。本文对其有关内容进行了综述，包括：①糖尿病营养治疗理论的发展；②糖尿病患者营养素参考摄入量的最新建议；③糖尿病肠内营养制剂的不同种类、配方特点；④糖尿病患者进行肠内营养支持的原则；⑤不同营养支持方式的优缺点、适应症。     

Cognitive decline in patients with long-term domiciliary oxygen therapy

Cognitive and psycho-physiological condition in patients with long-term domiciliary oxygen therapy (DOT) remains uncertain. A cross sectional analysis was performed to investigate the age-related changes in cognitive and psycho-physiologic functions in patients with chronic respiratory failure receiving long-term DOT. Two expert practitioners visited the patient's home and examined them for analysis of cognitive function, emotional status, physical activity and degree of dyspneic sensation. One hundred and thirty-five patients completed the study. Control data from a cohort of 718 community dwellers were also included in this study. Male patients had significantly higher rates of chronic obstructive pulmonary disease (71% vs 47%, p = 0.001), lower values of forced expiratory volume in one second (FEV1.0) % (49.7 +/- 10.3 [standard deviation, S.D.] vs 66.0 +/- 7.5% predicted, p = 0.002) and higher Borg score, an indicator of dyspneic sensation, during daily exercise (3.2 +/- 0.8 [S.D.] vs 1.4 +/- 0.6, p = 0.01) compared with female patients. Linear regression analysis based on mean Mini-Mental State Examination scores, an indicator of cognitive function, showed that age-related cognitive decline was more pronounced in female patients than in female controls (-0.524/year, R2 = 0.426 vs -0.120/year, R2 = 0.027, p < 0.0001), while there was no significant difference between male patients and male controls (-0.156/year, R2 = 0.054, vs -0.077/year, R2 = 0.016, p = 0.231). These results demonstrate that age-related cognitive decline is more exaggerated in female patients receiving long-term DOT which should be taken into consideration in caring for patients with chronic respiratory failure.     

Caring for patients with COPD on long-term oxygen therapy

Long-term oxygen therapy (LTOT) is becoming a mainstay of treatment for people with severe chronic obstructive pulmonary disease (COPD) in the community. This article provides an overview of the fundamental aspects of the therapy, measurement of blood gases and the equipment used in LTOT.     

高压氧治疗脑卒中的剂量研究

观察２２例脑卒中患者在高压氧治疗不同时期体内自由基代谢物质含量的变化。每天用０．２ＭＰａ高压氧稳压治疗４０ｍｉｎ，连续治疗２０天。结果发现，经高压氧连续治疗１０天，患者血浆ＬＰＯ含量的增加和红细胞ＳＯＤ、ＧＳＨＰｘ活性的下降都不明显（Ｐ＞０．０５），仅红细胞明显降低（Ｐ＜０．０５）；连续治疗２０天后，患者血浆ＬＰＯ含量明显增高，红细胞ＳＯＤ和ＧＳＨＰｘ活性及ＧＳＨ含量显著下降（Ｐ＜０．０５）。建议     

伴有夜间低氧的慢阻肺患者家庭氧疗的疗效研究

目的：对于伴有睡眠呼吸紊乱而无日间低氧血症的COPD患者进行系统的研究,并探讨早期介入家庭氧疗对保护肺功能,改善COPD患者生活质量的作用。方法：选择无日间低氧的COPD患者进行肺功能及整夜多导睡眠检测（PSG）,选取睡眠呼吸暂停低通气指数（AHI）为5~30的患者为研究对象,随机分为实验组及对照组,两组患者均接受常规治疗。实验组接受家庭氧疗,每日吸氧时间〉15h。对两组患者根据病情每1~3个月门诊随诊1次,两年后所有患者复查肺功能、血气分析、睡眠监测及血液生化检查。结果：两年后实验组患者FEV1与对照组比较有明显提高,差异有显著意义（P〈0.05）;而实验组FVC与对照组相比无明显变化（P〉0.05）。两年后实验组的PaO2、SaO2均有改善,与对照组比较差异均有显著性（P〈0.05）。同时复查PSG发现,实验组患者的AHI较对照组相比虽无明显差异,但对照组患者AHI已呈上升趋势,实验组患者的浅睡眠时间较对照组相比缩短,差异有显著性（P〈0.05）。结论：提早进行家庭氧疗对于无日间低氧的COPD患者可以改善其睡眠紊乱情况,延缓肺功能的下降。     

加温湿化吸氧法在气管切开患者中的应用

目的 探讨加温湿化吸氧法在气管切开患者中的应用价值.方法 选择41例气管切开患者作为研究对象,采用随机数字法将患者分为治疗组21例与对照组20例.治疗组采用加温湿化吸氧法进行呼吸道护理,对照组采用常规呼吸道湿化法进行呼吸道护理,对2组患者呼吸道湿化效果进行判定,并比较2组的痰液黏稠度、痰痂的形成、呼吸道刺激性症状、呼吸道黏膜出血,呼吸道阻力、肺部感染情况及平均ICU入住天数.结果 治疗组湿化效果优于对照组,痰液黏稠度、痰痂的形成、呼吸道刺激性症状、呼吸道黏膜出血,呼吸道阻力、肺部感染及平均ICU入住天数等各项指标也优于对照组.结论 加温湿化吸氧法比常规呼吸道湿化法更适合于气管切开患者的呼吸道护理.     

Caring for patients receiving oxygen therapy

Although respiratory disease can occur at any age, older people are more likely to suffer both acute and chronic respiratory disease. Without sufficient oxygen, cells fail and die, and extensive cell death causes body systems to fail. This article considers the principles of short-term oxygen therapy and offers guidance to nurses who may be required to administer such treatment in their work with older people.     

局部氧疗在尿道下裂术后的应用

目的观察局部氧疗对减少尿道下裂术后切口愈合、切口感染及尿道瘘等并发症的影响。方法将98例尿道下裂术后的病人根据分型及手术方式随机分为治疗组和对照组,对照组给予常规治疗及伤口护理,治疗组在常规治疗及伤口护理的基础上加用局部氧疗,每天2次,连续14 d。结果治疗组病人阴茎阴囊伤口愈合好,阴茎无水肿,切口感染及尿道瘘的发生率显著低于对照组(P<0.05)。结论局部氧疗应用于尿道下裂术后病人,可有效减少尿道下裂术后并发症,疗效满意,操作简便、经济、安全。     

高压氧治疗中老年患者的心理状况及护理

目的:探讨老年患者高压氧治疗过程的心理状态和护理。方法:选择我院高压氧治疗的老年患者120例,治疗前后采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行心理调查,比较治疗前后患者的SAS,SDS评分。结果:治疗后患者SAS,SDS评分低于治疗前(P<0.05)。结论:高压氧治疗前老年患者可能出现焦虑或抑郁状态,适当的护理干预能缓解患者的心理障碍。     

自制加湿三通吸氧接头用于人工气道病人吸氧

随着人工鼻、一次性简易吸氧喷雾瓶等在临床的使用,传统的人工气道病人吸氧管侵入式放置吸氧的传统方法将逐渐被取代,人工气道的管理将上一新的台阶,人工气道痰痂的发生率、肺部感染率将逐步降低。但人工气道病人气道情况各不相同,即使同一病人不同时间的人工气道条件也不相同,如:人工鼻不适宜气道分泌物多而稀薄,且咳嗽反射强烈的病人,因其气道阻力增加,对小儿、严重肺功能不全等不能耐受通路中阻力增加者     

Humidification for oxygen therapy in non-ventilated patients

Oxygen therapy is a necessary treatment for some patients in hospital; however, as with any treatment there are side effects. These include drying and cooling of the respiratory tract. This can lead to unpleasant side effects discouraging patients from continuing with their treatment. To overcome this there are a variety of humidification devices, both heated and cold, which can help people tolerate their treatment. This article will discuss the AQUAPAK system which humidifies dry oxygen making it more comfortable for the patient to breathe and preventing dehydration of the respiratory system.     

198例患者高压氧治疗心理状态及护理

目的：了解患者在接受高压氧治疗时的心理状态，并及时施以心理疏导，使患者顺利完成治疗。方法：通过发放调查表，调查2007年2—12月接受高压氧治疗的198例患者入氧舱前的心理状态，根据患者心理状态类型施以心理疏导。结果：恐惧型、抑郁型和焦虑型患者经疏导后症状明显改善（P〈0．05），狂燥型患者较疏导前无显著性差异（P〉0．05）。结论：了解患者行高压氧治疗时心理变化，及时并施以心理护理是顺利完成高压氧治疗的保证。     

氧疗湿化液温度对呼吸系统疾病病人氧疗舒适度和效果影响

[目的]探讨使用接近人体鼻腔温度(30 ℃～35 ℃)的湿化液进行加温湿化氧疗对呼吸系统疾病病人氧疗舒适度和氧疗效果的影响.[方法]将84例呼吸系统疾病病人随机分为试验组和对照组,对照组病人接受室温湿化氧疗,试验组病人接受加温湿化氧疗,比较两组病人的氧疗舒适度和氧疗效果.[结果]两组病人在氧气温度、湿度、鼻咽部感觉、咳嗽程度、咳痰难度、痰量、痰液性状方面的差异有统计学意义(P<0.05).[结论]对呼吸系统疾病病人,采用加温湿化氧疗较室温湿化氧疗更利于提高病人的氧疗舒适度和氧疗效果.     

Long term oxygen therapy and mechanical ventilation for patients with COPD

Non-drug treatments such as long term oxygen therapy (LTOT) and non-invasive positive pressure ventilation (NPPV) are thought important for patients with chronic obstructive pulmonary disease (COPD). It is reported that LTOT can improve the prognosis of patients with COPD, particularly who have severe respiratory failure. NPPV attracted attention to avoid endotracheal intubation and high efficacy in patients with acute exacerbation of COPD. In chronic phase of COPD, NPPV may improve the quality of life in patients with hypercapnia, selected carefully.     

静舒氧治疗喘息型支气管炎的临床观察

静舒氧又称静脉体液给氧。它是用医用自动输氧器代替原静脉输液器的进气口 ,使氧气能够部分溶解在静脉输注的液体中 ,提高了液体中物理溶解氧的含量 ,从而达到快速向组织供氧的目的。我科自 2 0 0 2年 8月— 2 0 0 4年 5月利用VFSY -1加拿大蓝孚生物医学工程技术有限公司生产的静舒氧 ,进行治疗喘息型支气管炎 ,效果显著。现总结如下。1　资料与方法1.1　对象　选择我科 60例喘息型支气管炎住院病人 ,进行氧分压、氧饱和度和二氧化碳分压 ,咳嗽、咳痰、呼吸、痰量的比较。其中男 3 0例 ,女 3 0例 ;年龄 3 5岁～ 70岁 ,平均 5 1岁 ;发病均…