重度颅脑损伤患者应用匀浆膳的临床观察

目的观察应用匀浆对重度颅脑损伤患者进行肠内营养支持的疗效。方法选取脑外科无肠内营养禁忌证的重度颅脑损伤患者40例,随机分为匀浆膳组和对照组,两组均为20例,对照组给予传统的一般流质食物,匀浆膳组给予我院自制的匀浆。分别于营养支持前及营养支持3w后测定三头肌皮皱、白蛋白及淋巴细胞总数,并观察两组发生并发症及预后情况。结果两组患者肠内营养支持前各指标均无显著性差异,匀浆膳组肠内营养支持3w后各项营养指标均高于对照组(p<0.05)。结论对于有正常或接近正常胃肠道功能的重度颅脑损伤患者,匀浆不失为肠内营养支持时一种理想选择,以利于患者的康复。     

鼻饲匀浆膳在老年重症病人营养支持中的应用

0引言 老年重症病人机体分解代谢亢进,营养不良发生率可达50%以上,同时由于多个重要脏器功能储备明显减少,内环境的稳定性也显著下降,故合理的膳食营养,对于各种原因不能经口进食的老年病人至关重要.为此,自1998年6月至2002年6月,我们对25例老年重症病人的营养状况进行了研究,并在治疗疾病的同时进行鼻饲匀浆膳作为辅助营养支持,取得一定疗效,既节省了医疗费用,又能延长老年病人生存时间.     

匀浆膳在重症卧床患者营养支持中的效果分析

目的:探讨匀浆膳在重症卧床患者营养支持中的应用效果.方法:随机抽取2016年10月-2017年10月本院收治的行肠内营养支持的重症卧床患者82例.按照随机均等原则分为研究组(匀浆膳,n=41)与对照组(营养液,n=41).对比两组治疗效果及安全性.结果:治疗2周后,研究组淋巴细胞总数、总蛋白均高于对照组(P<0.05),但两组血红蛋白、白蛋白无统计学意义(P>0.05);治疗2个月后,研究组血红蛋白、淋巴细胞总数、总蛋白、白蛋白水平均高于对照组(P<0.05);两组并发症无统计学意义(P>0.05).结论:重症卧床患者营养支持中匀浆膳的应用效果更为理想.     

脑昏迷患者匀浆膳治疗的病例观察

颅脑损伤意识障碍患者,由于不能正常进食,存在着一定程度的营养缺乏,需给予充分合理的营养支持治疗,现对本院神经内科及ICU病房中23例颅脑损伤后意识障碍患者,应用匀浆膳支持的临床体会报道如下.     

高热能匀浆膳用于危重患者的临床观察

肠内营养治疗是危重患者临床综合治疗中的重要部分。我科从1992年起即开始着手经肠营养制剂的研究并投入临床应用，旨在探讨危重患者经肠营养的实用配方。     

食管癌术后早期鼻-空肠鼻饲匀浆膳对比研究

目的 探讨食管癌术后早期自制匀浆膳肠内营养的可行性、安全性及临床效果.方法 食管癌病人216例随机分为两组,研究组术后肠内营养我科自制匀浆膳,对照组为病人家属自制流食,分别于术前和术后第十日进行人体测量、实验室检查和临床观察. 结果 研究组体重、三头肌皮褶厚度、血清白蛋白、血红蛋白较对照组显著提高(P＜0.01).肛门排气、下床活动时间明显提前(P＜0.01),并发症明显降低(P＜0.01).研究组胃肠道不良反应发生较少(15.7%). 结论 食管癌术后早期鼻饲自制匀浆膳能促进胃肠功能恢复、改善营养状况、降低并发症、安全、价廉,在基层医院具有推广应用价值.     

老年重症患者匀浆膳应用体会

营养学的新概念是能用普通膳食的尽量用普通膳食,能用匀浆膳的不用要素膳。近年来,我科应用匀浆膳对不能经口进食的危重症患进行营养支持,收到比较满意的临床效果。     

匀浆膳联合酸奶在危重症病人中的临床应用

目的: 探讨危重症病人应用匀浆膳联合酸奶行EN治疗的方法和效果. 方法: 将400例急诊手术、复苏抢救后的危重症病人随机分为两组.研究组给予匀浆膳联合酸奶治疗;对照组给予匀浆膳治疗.伤后48 h开始每天分别给予鼻饲额定热量的两种肠内营养治疗,不足部分辅以PN补充.根据有关监测指标、血常规、血气分析和肝肾功能检查,进行APACHE-Ⅱ评分,比较各营养指标、胃肠功能障碍指标以及预后. 结果: 研究组各营养指标均高于对照组,胃肠道并发症发生率低于对照组,预后优于对照组. 结论: 危重症病人给予匀浆膳联合酸奶行EN治疗,可有效地改善病人的营养状况,减少胃肠道并发症,提高生存率,有利于病人的康复.     

匀浆膳营养支持护理在提高ICU患者营养和免疫状态中的应用效果

目的:研究匀浆膳营养支持护理在提高ICU患者营养和免疫状态中的效果.方法:将在本院诊治的110例ICU患者均分为对照组和观察组,各组均为55例患者,在进入ICU的24小时内,对照组主要采用胃管灌注器分次给患者灌注食物(分次推注营养支持护理法);观察组患者采取匀浆膳营养支持,对比两组患者病情康复情况以及ICU停留天数变化...     

肉苁蓉匀浆膳配方和加工工艺的研究

目的:制备适用于危重症并发吞咽功能障碍而胃肠功能良好病人的肉苁蓉匀浆膳. 方法:参照中国居民膳食指南、平衡膳食宝塔、各类食材营养素含量并结合危重症急性期病理生理特点和本地区国人饮食习惯,将肉苁蓉与匀浆膳合理搭配,确定各种食材配比,加工工艺及质量标准. 结果:制备成功普通型和低糖型肉苁蓉匀浆膳,经专业机构检测,各营养成分、肉苁蓉含量和物料加工细度等均达到预期标准. 结论:该肉苁蓉匀浆膳食材搭配合理、营养成分全面、加工质量稳定,符合中国膳食营养指南及危重症病人的营养需求.     

Postoperative Diet with an Oligomeric Hyperproteic Normocaloric Supplement versus a Supplement with Immunonutrients in Colorectal Cancer Surgery: Results of a Multicenter,Double-Blind,Randomized Clinical Trial

(1) Background: For normo-nourished colorectal cancer patients, the need for immunonutrients after elective surgery is not known. (2) Methods: Multicenter, randomized, double-blind, phase III clinical trial comparing the postoperative diet with 200 mL oligomeric hyperproteic normocaloric (OHN; experimental arm) supplement vs. 200 mL immunonutritional (IN) (active comparator) supplement twice a day for five days in 151 normo-nourished adult colorectal-resection patients following the multimodal rehabilitation ERAS protocol. The proportions of patients with complications (primary outcome) and those who were readmitted, hospitalized for <7 days, had surgical site infections, or died due to surgical complications (secondary outcome) were compared between the two groups until postoperative day 30. Tolerance to both types of supplement and blood parameters was also assessed until day 5. (3) Results: Mean age was 69.2 and 84 (58.7%) were men. Complications were reported in 41 (28.7%) patients and the incidence did not differ between groups (18 (25%) vs. 23 (32.4%) patients with OHN and IN supplement, respectively; p = 0.328). No significant differences were found for the rest of the variables. (4) Conclusions: IN supplement may not be necessary for the postoperative recovery of colorectal cancer patients under the ERAS regimen and with normal nutritional status at the time of surgery.     

运动护理指导和个体化饮食在妊娠期糖尿病患者中的应用研究

目的探讨运动护理指导和个体化饮食在妊娠糖尿病患者中的应用效果。方法将我院2010年5月至2012年9月收治的80例妊娠糖尿病病人作为观察组,对照组选择我院既往接受治疗的80例妊娠糖尿病病人。观察组实施个体化饮食并给予运动护理指导;对照组提供常规饮食,并按照病人自身习惯开展随意的自我活动。观察并记录两组病人出院时的血糖水平改变幅度、孕产妇及新生儿并发症的发生率。结果观察组空腹血糖与对照组相比无明显差异(P>0.05),但餐后2 h血糖明显低于对照组(P<0.05)。观察组在妊高征、羊水过多、羊水过少、酮症酸中毒、早产及感染等方面的发生率显著低于对照组(P均<0.05);对照组在新生儿低血糖、巨大儿、新生儿窒息以及呼吸窘迫综合征等方面发生率显著高于观察组(P均<0.05)。结论个体化的饮食指导及运动护理指导能够有效调节孕产妇的血糖水平处于合理范围,可明显降低孕产妇以及新生儿各种并发症的发生率。     

匀浆膳联合酸奶在重型颅脑损伤患者中的临床应用

目的探讨重型颅脑损伤患者应用匀浆膳联合酸奶行肠内营养治疗的临床效果。方法ICU重型颅脑损伤患者200例急症手术后随机分为两组：研究组给予匀浆膳联合酸奶治疗；对照组给予匀浆膳治疗。伤后48小时开始分别给予鼻饲额定热卡的两种肠内营养治疗，每日消耗不足部分辅以肠外营养补充。比较各营养指标、胃肠功能障碍指标、意识恢复程度及预后。结果研究组各营养指标均高于对照组，各种胃肠道并发症的发生均少于对照组，预后优于对照组。结论重型颅脑损伤患者给予匀浆膳联合酸奶行肠内营养治疗可有效地改善患者的营养状况，减少胃肠道并发症，提高生存率，有利于患者的康复。     

液体膳对手术病人营养治疗效果观察

液体膳对手术病人营养治疗效果观察窦若兰，刘树德，胡若梅，顾景范（天津天和医院，天津３０００５０）关键词液体膳营养支持，氮平衡ＴｈｅＥｆｆｅｃｔｏｆＬｉｑｕｉｄＤｉｅｔｏｎｔｈｅＮｕｔｒｉｔｉｏｎａｌＳｔａｔｕｓｏｆＰａｔｉｅｎｔｓａｆｔｅｒＯｐｅｒａ...     

Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations

The Mediterranean diet has emerged as a comprehensive lifestyle, including specific foods and meal composition and a set of behavioural and social features. Adherence to the Mediterranean diet has been shown to promote health and reduce the prevalence of chronic diseases. The actual implementation of the Mediterranean diet is affected by several sociocultural factors as well as geographical components. Indeed, the geographical location, such as a specific country or different areas in a country and specific latitude and climate, appears to be an important factor that may strongly affect the implementation of the Mediterranean diet or some of its principles as well as the adherence to it. Another dynamic component affecting personal nutritional choices, also regarding adherence to the Mediterranean diet and its principles, is the individual life-long trajectory of food preference and nutrition habits and awareness. In this review, we discuss the current evidence on the impact of geographical location on adherence to the Mediterranean diet.     

膳食结构的变化对脂肪肝患者疗效观察

目的 通过营养干预改变脂肪肝患的膳食结构和生活方式，并观察其疗效。方法 营养干预措施采用询问法登记摄入食物的种类和数量，制订膳食原则及编制食谱。健康教育进行营养知识讲座及咨询活动。结果 通过营养干预脂肪肝患改变了原有的膳食结构及饮食习惯，能量摄入和消耗处于动态平衡；增加粗粮、蔬菜和鱼禽类等食品的摄入量，动物性脂肪摄入减少；53．1％脂肪肝患有好转，46．2％超重或肥胖的人体重恢复到标准体重范围内。结论 普及营养知识，养成良好的饮食和生活习惯，防止食源性疾病的发生。     

The Relationship between Low Serum Vitamin D Levels and Altered Intestinal Barrier Function in Patients with IBS Diarrhoea Undergoing a Long-Term Low-FODMAP Diet: Novel Observations from a Clinical Trial

Decreased serum vitamin D (VD) levels have been associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS). VD can also modulate the intestinal barrier. Given the link between the GI barrier’s alterations and diet, attention has aroused the positive effects of the Low FODMAP Diet (LFD) on IBS patients’ symptom profile. We evaluated the GI symptoms and the urinary and circulating markers of GI barrier function, the markers of inflammation and intestinal dysbiosis in 36 IBS patients with predominant diarrhea (IBS-D) (5 men and 31 women, 43.1 ± 1.7 years) categorized for their circulating VD levels in low (L-VD) and normal (N-VD) (cutoff = 20 ng/mL). Evaluations were performed before and after 12 weeks of LFD. At the baseline, L-VD patients showed a significantly worse symptom profile and altered small intestinal permeability (s-IP) than N-VD. After LFD, a significant increase in the circulating VD levels in both the subgroups and a significant improvement of s-IP in L-VD patients occurred. Finally, VD levels negatively correlated with the symptom score and fecal zonulin. These data highlight the close relationship between VD and the intestinal barrier and support their involvement in IBS-D pathophysiology. Moreover, the potentially positive role of LFD in the management of IBS-D was confirmed.     

Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion

Introduction: Otitis media with effusion (OME) is common in pediatric primary care consultations. Its etiology is multifactorial, although it has been proven that inflammation factors mediate and that immunity is in a phase of relative immaturity. The objective of this study was to assess the effects of the Traditional Mediterranean Diet (TMD) modulating inflammation and immunity in patients diagnosed with OME. Materials and Methods: A analysis as a single-group pre-test/post-test was conducted on 40 girls and 40 boys between 18 months and 5 years old. Tympanometry normalization was the main test to control the benefit of diet. Clinical and therapeutic variables were studied through evaluation questionnaires, a quality test of the diet, as well as various anthropometric parameters. Results: At the end of one year, tympanometry had normalized in 85% of patients. The remaining 15% had normal audiometry and/or associated symptoms had decreased. Likewise, episodes of recurrent colds decreased from 5.96 ± 1.41 to 2.55 ± 0.37; bacterial complications of 3.09 ± 0.75 to 0.61 ± 0.06 and persistent nasal obstruction of 1.92 ± 0.27 to 0.26 ± 0.05. The degree of satisfaction of the families with the program was very high. Conclusions: The application of the Traditional Mediterranean Diet could have promising effects in the prevention and treatment of otitis media with effusion.     

Effectiveness of Personalized Low Salicylate Diet in the Management of Salicylates Hypersensitive Patients: Interventional Study

Salicylic acid and its derivatives (including acetylsalicylic acid/aspirin) are popular in medicine. They also occur naturally in many food products. The aim of the study was to investigate the effect of the personalized low salicylate diet (PLSD) on the reduction of asthma, rhinosinusitis and urticaria symptoms in patients with hypersensitivity to aspirin (ASA) or nonsteroidal anti-inflammatory drugs (NSAIDs). To achieve the research goal, a prospective, nonrandomized, baseline-controlled intervention study was conducted. Thirty patients diagnosed with NSAIDs hypersensitivity, who despite pharmacotherapy had symptoms of hypersensitivity, were included in the study. The PLSD was recommended for all participants for a period of two to four weeks. The intensity of subjectively declared symptoms of asthma, rhinosinusitis and urticaria were measured before and after dietary intervention, using, respectively, the asthma control test (ACT), the sino-nasal outcome test (SNOT-22) and the four-item itch questionnaire (FIIQ). Diet adherence and salicylate intake were measured by a 3-day food record. The severity of symptoms improved significantly after the intervention. The median of the ACT score was 24 scores before and 25 after the dietary intervention (p < 0.002), the median of the SNOT-22 score was 25 before and 13 after a dietary intervention (p < 0.0002) and the median of the FIIQ score was 5 before and 0 after a dietary intervention (p < 0.0002). The intake of salicylates decreased from 0.79 mg/day (before intervention) to 0.15 mg/day (p < 0.001) (during intervention). Although the usefulness of a low salicylate diet in the treatment of salicylate hypersensitivity is controversial, the results of our study indicate that the PLSD may have a positive effect in reducing symptoms of salicylate hypersensitivity and could be an additional tool supporting the therapy of these patients.     

膳食结构与2型糖尿病患者胰岛素抵抗的相关性研究

目的 对2型糖尿病（T2DM）患者的膳食结构进行分析,探讨膳食中三大营养物质的摄入量及其所占能量供给比例与胰岛素抵抗之间的关系.方法 160例T2DM患者,根据膳食情况调查分为高碳水化合物组（高CHO组）、高蛋白高脂肪组和正常比例膳食对照组,检测葡萄糖代谢指标、血脂谱和胰岛素水平,计算胰岛素抵抗指数（HOMA-IR）.结果 T2DM组每日CHO、脂肪和蛋白质摄入量、每日摄入食物所产生的总热量及蛋白质热量/总热量均显著高于非糖尿病组（P＜0.01）;相关性分析表明,HOMA-IR与空腹血糖（FPG）、日摄入CHO量等呈正相关（P＜0.01）;多因素回归分析表明,日摄入CHO量、膳食中脂肪提供热量所占比例等是HOMA-IR的影响因素.结论 高脂肪高蛋白饮食对2型糖尿病患者糖、脂代谢的影响尤为明显,日摄入CHO总量及膳食中脂肪所占能量供给比例等与胰岛素抵抗密切相关.