A sensible approach to the nutritional support of mechanically ventilated critically ill patients

Objectives The goal of this review is to educate physicians in the details of nutritional support of mechanically ventilated critically ill patients.Design The subtopics of this review include: introduction, goals of nutritional treatment, assessment of nutritional status, estimation of nutritional requirements, estimation of protein requirements, recommended approach to the initial nutritional regimen, routs of nutrition, and monitoring the response to nutrition.Setting The information is primarily germane to the medical management of patients with acute respiratory failure superimposed on chronic lung disease and malnutrition.Conclusion Malnutrition is prevalent in mechanically ventilated critically ill patients. Undernutrition is associated with respiratory muscle weakness and may contribute to ventilator dependency. Overnutrition may increase CO₂ production and increase ventilatory demands. This review advocates a titrated approach to nutritional management based on protein balance. Careful monitoring is necessary to ensure a regimen which maintains or improves body protein composition. Preliminary data exists which indicates that careful nutritional support may improve clinical outcome but more information is needed to recommend a universal approach.     

Multidisciplinary approach for circulatory support in patients with advanced heart failure

Despite the efficacy of heart-failure (HF) therapy, patients may still decompensate and require hospitalization. In addition to the gap between guidelines and clinical practice, this highlights the need for a multidisciplinary approach to the management of HF. The third European Mechanical Circulatory Support Summit presented the latest trials and trends in conservative therapy of end-stage HF (ESHF) and the alternative options over a ten-session program. The meeting covered topics such as epidemiological trends, different HF registries and guidelines for ESHF therapy. In addition to databases and HF trials, the presenters discussed the integration of multiple biomarkers in HF stratification, biological solution and embryonic stem cells for HF therapy, up-to-date myocardial recovery and the surgical aspects of ESHF treatment. Therapeutic options following short-term left ventricular support were discussed, such as: which patients should receive a ventricular assist device (VAD) and when; what the perfect window for implantation of a VAD is; bridge-to-bridge and device selection; VAD-weaning criteria; left ventricular unloading, patient–device matching (short-term device), cardiac transplantation following short-term support. There was a device update, presenting Circulite^®, Abiomed Impella^®, Levacor?, Levitronix^®, VentrAssist?, Heartmate ^®II, DuraHeart? and Heartware. Finally, the International VAD registry, European VAD registry and The International Society for Heart & Lung Transplantation Mechanical Circulatory Device database were also discussed. Herein, a commentary is givenon some of the interesting topics that indicate the importance of the community, the physician and the patient’s awareness of HF, the utilization of the updated guidelines and landmark studies and registries, as well as recent evidence-based modalities in the management of ESHF.     

胃癌根治术后早期营养支持及护理

总结胃癌根治术后营养支持的护理经验.回顾性分析103例胃癌根治术后患者实施营养支持的护理资料.应用全胃肠外营养(TPN)时应注意保护血管,做好血糖的监测,严格控制滴入速度.胃肠功能恢复后,做好口服饮食指导.103例患者全部营养状况均有不同程度改善,伤口均为Ⅰ期愈合,无发生并发症.80例治愈出院,23例好转出院,无1例死亡.做好营养支持的护理工作是改善胃癌根治术后患者预后的重要措施之一.

Abstract：

To summarize the nursing experience about gastric cancer patients'nutritional support after radical gastrectomy. A total of 103 cases were selected to analyze the patients'nursing document who were treated with nutritional support. When the total parenteral nutrition (TPN) was applied, we very paid attention to protecting blood vessels, monitoring blood glucose and controlling the infusing speed strictly. After gastrointestinal function recovered, the patients were conducted for dietary. All 103 patients'nutrition state were improved with different degree, the wound was primary healing and no complication occurred. 80 cases were cured, 23 cases were improved and discharged, no deaths case. Giving good care in nutrition support is one of the most important measures to improve the prognosis of radical gastrectomy patients with gastric cancer.     

Rethinking nutritional support for persons with cancer cachexia

Cancer cachexia is a poorly understood syndrome of anorexia, weight loss, and muscle wasting that negatively impacts quality of life and survival in cancer patients. Research has clearly implicated pro-inflammatory cytokines in the biology of cancer cachexia. More recent research implicates products of arachidonic acid and suggests that cachexia may be a chronic inflammatory condition rather than a nutritional aberration. To date, nutritional support to slow weight loss has focused primarily on increasing calorie intake. Alternatively, many foods contain factors that can modulate the synthesis or activity of pro-inflammatory mediators, especially the synthesis of prostaglandin E2 from arachidonic acid. These factors and foods are sometimes called nutraceuticals, and research is needed to evaluate their efficacy in combating cancer cachexia.     

胃癌手术患者营养支持情况调查研究

目的：调查贵阳市胃癌手术患者营养支持现状，为营养支持的规范化提供指导依据。方法：选择我院172例胃癌手术患者为研究对象，评估其术前营养风险状况。检测患者入院和出院的相应营养指标，并调查营养支持、总住院天数、术后住院天数、总住院费用等情况。结果：172例患者中，营养不足的总发生率为18.02%，超重发生率为21.51%，肥胖发生率为5.23%。术前无营养风险者113例（占65.70%），给予营养支持者38例（占33.63%）；有营养风险者59例（占34.30%），给予营养支持者30例（占50.85%）。患者术后营养指标除血红蛋白外，其他营养指标较术前差异均有统计学意义（P＜0.05）。有营养风险患者中无营养支持者与有营养支持者的总住院天数、术后住院天数以及总住院费用差异均有统计学意义（P＜0.05）。结论：临床医生对患者的营养支持不够规范，对于患者的营养支持应基于证据进行规范化治疗。     

The provision of nutritional support for people with cancer

Nutritional support is one of the most fundamental aspects of nursing practice. Evidence suggests that many patients are malnourished when admitted to hospital and this is a particular problem for patients with cancer (Whitman, 2000).     

重症急性胰腺炎病人分阶段营养支持的研究

[目的 ]探讨分阶段营养支持对促进重症急性胰腺炎病人康复的作用。 [方法 ]将 62例确诊为重症急性胰腺炎的病人随机分为分阶段营养支持组 (A组 )和对照组 (B组 ) ,A组给予分阶段营养支持 ,B组给予肠外营养。 [结果 ]A组并发症发生率、平均住院日及住院费用均低于B组 (P <0 .0 5 )。 [结论 ]给予重症急性胰腺炎病人分阶段营养支持安全有效     

Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status

Goals of work  

The goals of the study were to determine the relationship of upper gastrointestinal symptoms with nutritional status and to assess their association with performance status in patients with advanced cancer.     

A practical approach to the management of patients with chronic renal failure

The number of patients with significant chronic renal failure is expanding rapidly in the United States. All physicians and medical-care providers will have an increasingly important role in the detection and management of renal failure in patients who are not undergoing dialysis. Patients with diabetes or hypertension should be carefully monitored for the development of renal insufficiency by using screening tools such as blood pressure measurement, determination of serum creatinine, urinalysis, and determination of 24-hour urinary microalbuminuria. In order to slow the progression of renal disease, attenuate uremic complications, and prepare patients with renal failure for renal replacement therapy, all medical-care providers should "take care of the BEANS." Blood pressure should be maintained in a target range lower than 130/85 mm Hg, and in many patients, angiotensin-converting enzyme inhibitors may be beneficial. Erythropoietin should be used to maintain the hemoglobin level at 10 to 12 g/dL. Access for long-term dialysis should be created when the serum creatinine value increases above 4.0 mg/dL or the glomerular filtration rate declines below 20 mL/min. Nutritional status must be closely monitored in order to avoid protein malnutrition and to initiate dialysis before the patient's nutritional status has deteriorated. Nutritional care also involves correction of acidosis, prevention and treatment of hyperphosphatemia, and administration of vitamin supplements to provide folic acid. Specialty referral to nephrology should occur when the creatinine level increases above 3.0 mg/dL or when the involvement of a nephrologist would be beneficial for ongoing management of the patient.     

住院肿瘤患者营养风险及营养支持状况的调查与分析

目的调查住院肿瘤患者营养风险及营养支持现状。方法对浙江省8家医院916例住院肿瘤患者行营养风险筛查,通过测评体质指数、检测血清白蛋白评定患者营养状况,了解有营养风险患者的营养支持现况。结果 916例患者的营养风险评分0～7分,有营养风险(≥3分)患者334例,其中营养不良167例,实施营养支持121例。结论住院肿瘤患者存在营养风险,需加强管理,规范营养支持。     

A practical approach to intersex

The realm of intersex presents a challenge to the family as well the health care provider. As the physical aspects of diagnosis and management have become better understood, it has become apparent that there are psychological and social aspects that we have only begun to understand. A general overview of intersex issues that may confront the urologic practitioner, and the current concepts of diagnosis and management, are provided.     

营养支持在ICU食管癌患者术后护理中的应用效果

目的探讨营养支持在ICU食管癌患者术后护理中的应用效果。方法将60例食管癌手术患者随机分为观察组和对照组,对照组采用传统营养支持,观察组在对照组基础上给予肠内营养支持,比较2组患者体质量和营养指标的变化、胃肠功能恢复情况、ICU停留时间、卡式功能状态。结果观察组术后10 d的体质量大于对照组,肠鸣音恢复时间、肛门排气时间、排便时间、ICU停留时间均短于对照组,Karnofsky评分高于对照组,差异均有统计学意义(P0.05)。观察组营养10 d后的前白蛋白、白蛋白、血红蛋白均高于对照组,差异有统计学意义(P0.05)。结论肠内营养联合肠外营养能够显著改善食管癌患者的术后营养状态,促进患者胃肠功能恢复,减少ICU停留时间。     

A practical approach to hypercalcemia

Hypercalcemia is a disorder commonly encountered by primary care physicians. The diagnosis often is made incidentally in asymptomatic patients. Clinical manifestations affect the neuromuscular, gastrointestinal, renal, skeletal, and cardiovascular systems. The most common causes of hypercalcemia are primary hyperparathyroidism and malignancy. Some other important causes of hypercalcemia are medications and familial hypocalciuric hypercalcemia. An initial diagnostic work-up should include measurement of intact parathyroid hormone, and any medications that are likely to be causative should be discontinued. Parathyroid hormone is suppressed in malignancy-associated hypercalcemia and elevated in primary hyperparathyroidism. It is essential to exclude other causes before considering parathyroid surgery, and patients should be referred for parathyroidectomy only if they meet certain criteria. Many patients with primary hyperparathyroidism have a benign course and do not need surgery. Hypercalcemic crisis is a life-threatening emergency. Aggressive intravenous rehydration is the mainstay of management in severe hypercalcemia, and antiresorptive agents, such as calcitonin and bisphosphonates, frequently can alleviate the clinical manifestations of hypercalcemic disorders.     

晚期肿瘤患者疼痛护理措施

目的通过对晚期肿瘤患者疼痛护理,解除或减轻患者的痛苦,以提高患者的生活质量。方法护士正确掌握三阶梯给药原则及药物不良反应与处理,对患者的疼痛进行正确评估,予以心理支持及疼痛护理。结果按三阶梯给药原则,结合有效的心理护理,50例患者疼痛有效控制率达到96%。结论护理人员通过细致入微的临床护理,给予必要的药物治疗和心理支持,减轻了晚期肿瘤患者的痛苦,改善了患者的生活质量。     

重症慢阻肺患者短期营养支持下血清氨基酸水平的变化

通过对25例重症慢阻肺(COPD)伴营养不良住院患者进行营养评价,并对其中12例患者进行短期静脉营养支持治疗(PN组),13例对照组患者仅给予抗感染、平喘、止咳等处理。以观察短期营养支持的效果及血清氨基酸水平的变化。结果显示:静脉营养支持可明显提高血清中某些氯基酸的水平及血清蛋白水平(P<0.05,P<0.01),改善患者的营养状况。但PN组治疗后尿素氮、尿肌酐及尿3-甲基组氨酸(3-MH)的排出并不比对照组下降明显,表明对此类患者进行静脉营养支持虽可促进机体蛋白质的合成,但并不能明显降低其蛋白质分解代谢率。     

序贯肠内营养支持对食道癌患者术后营养状况的影响

目的观察不同营养支持方式对食道癌患者术后营养状况的影响。方法选择食道癌患者42例,随机分为序贯肠内营养支持组及整蛋白肠内营养支持组,分别于术前、术后第1天、第10天测定营养及胃肠道相关指标并进行对比分析。结果术后第1天2组患者营养指标均较术前下降(P<0.05),但同期2组间比较无统计学意义。术后第10天,2组患者血清前白蛋白、转铁蛋白、外周血淋巴细胞计数均有上升,相对整蛋白肠内营养支持组,序贯肠内营养支持组升高更为显著,腹泻、腹胀发生率更低。结论序贯肠内营养支持较整蛋白肠内营养支持能更有效地提升食道癌术后患者的营养状况,并减少胃肠道不适,是更有效的营养支持方案。     

It's tough to swallow: a practical approach to nutritional care of dysphagia

Have you ever swallowed a food or liquid only to have it "go down the wrong way"? If you have, then you have an idea of what it might be like to have a swallowing problem. Now multiply that experience times the more than 600 times a day that we normally swallow! Imagine how difficult it would be to deal with that on a daily basis. Approximately 6-15 million Americans are affected by dysplagia (chewing and swallowing problems). About 53-74% of nursing home residents, 14% of hospital patients and 33% of rehabilitation center patients have some form of dysphagia, which can have a dramatic impact on nutritional status.     

对症支持护理在晚期卵巢癌患者中的应用效果

目的研究对症支持护理在晚期卵巢癌患者中的应用效果。方法选择2016年2月至2018年2月我院收治的120例晚期卵巢癌患者作为研究对象,以随机数字表法将其分为对照组和观察组,各60例。对照组在化疗期间给予常规性的护理,观察组在对照组的基础上进行对症支持护理。观察并记录两组患者的护理效果。结果观察组患者的焦虑和抑郁发生率均低于对照组(P<0.05)。护理后,两组患者的生活质量评分均升高,且观察组患者的生活质量评分高于对照组,差异具有统计学意义(P<0.05)。护理后,观察组患者的不良反应总发生率显著低于对照组(P<0.05)。护理干预后,观察组的护理满意度显著高于对照组(P<0.05)。结论将对症支持护理用于晚期卵巢癌患者,可以有效地缓解患者的焦虑以及抑郁情绪,提高其生活质量,降低不良反应发生率,提高患者的护理满意度,值得推广运用。