Prevention of catheter thrombosis increases survival,but does not modify lung injury in rats receiving long-term parenteral nutrition

It has previously been shown that rats receiving total parenteral nutrition (TPN) or each component of TPN die within 40 days of treatment. Central catheter thrombosis and lung injury were constant findings. The aim of the present study was to examine the impact of central thrombosis on lung injury and survival in rats receiving long-term parenteral nutrition. In the first part of the study TPN was infused via the jugular vein and incidence of central venous thrombosis and rate of survival were recorded. Addition of low molecular weight heparin (LMWH) reduced central thrombosis from 6 out of 7 animals to 2 out of 7 animals (p=0.027) and increased survival from 17.1±4.5 days to 32.4±4.9 days (p=0.04). In the second part of the study four infusion groups were established. Group 1 (controls) received saline 100?mL/kg/day via the jugular vein (n=6). Group 2 received Intralipid&;lt;formula&;gt;^®&;lt;/formula&;gt; 40?mL/kg/day via the jugular vein (n=7). Group 3 received Intralipid 40?mL/kg/day via the portal vein (n=7). Group 4 received Intralipid 40?mL/kg/day with added LMWH 70?U/kg/day (n=7). Lung injury and occurrence of central thrombosis were investigated. Lung injury was assessed by measuring pulmonary arterial pressure (Ppa), clearance of serotonin by the vascular endothelium and the capillary filtration coefficient (CFC). Either infusion via the portal vein or the addition of LMWH to the infusion via the jugular vein prevented central thrombus formation, but the lung injury was not modified by this method compared with infusing Intralipid via the jugular vein without LMWH. In conclusion, central thrombus formation contributes to death in rats receiving parenteral nutrition. The mechanism of the injurious effect of central thrombosis remains unknown, but central thrombus formation seems not to increase lung injury caused by Intralipid.     

Pulmonary function in rats dying from long-term parenteral nutrition

Infusion of Vamin or Intralipid causes death in a rat model of continuous parenteral nutrition. Morphological investigations have shown vascular injury and thrombus formation in the lungs. In this study, lung function in rats was examined before death due to parenteral nutrition. The rats were fed saline intravenously (group I); 100 mL kg(-1) day(-1) (controls); a 7% amino acid-glucose solution (Vamin-Glukos) (group II); 100 mL kg(-1) day(-1), or 20% fat emulsion (Intralipid) (group III); 40 mL kg(-1) day(-1). The infusion was stopped when the condition of the rats deteriorated. In a saline-perfused, isolated lung model, pulmonary arterial pressure (Ppa), transpulmonary pressure (Ptp), endothelial function, measured as inactivation of serotonin (bioassay), and the capillary filtration coefficient (CFC) were determined. Haematological parameters were also evaluated. Constant findings in group II and III were central thrombus formation, anaemia and thrombocytopenia. Ppa increased from 0.7 (0.04) kPa in group I to 1.4 (0.1) kPa and 1.7 (0.1) kPa in groups II and III, respectively (p<0.001). Inactivation of serotonin was reduced to 36% (2) in group II and 37% (2) in group III compared with 74% (5) in group I (p<0.002). CFC increased to 25 mg min(-1) (5) (group II) and 30 mg min(-1) (6) (group III) compared with 13 mg min(-1) (2) in controls (p=0.01). The study shows that major pulmonary hypertension and severe reduction of the endothelial function are present when rats deteriorate after infusion of parenteral nutrition substrates.     

Pulmonary function in rats dying from long‐term parenteral nutrition

Infusion of Vamin or Intralipid causes death in a rat model of continuous parenteral nutrition. Morphological investigations have shown vascular injury and thrombus formation in the lungs. In this study, lung function in rats was examined before death due to parenteral nutrition. The rats were fed saline intravenously (group I); 100?mL?kg^?1?day^?1 (controls); a 7% amino acid‐glucose solution (Vamin‐Glukos) (group II); 100?mL?kg^?1?day^?1, or 20% fat emulsion (Intralipid) (group III); 40?mL?kg^?1?day^?1. The infusion was stopped when the condition of the rats deteriorated. In a saline‐perfused, isolated lung model, pulmonary arterial pressure (Ppa), transpulmonary pressure (Ptp), endothelial function, measured as inactivation of serotonin (bioassay), and the capillary filtration coefficient (CFC) were determined. Haematological parameters were also evaluated. Constant findings in group II and III were central thrombus formation, anaemia and thrombocytopenia. Ppa increased from 0.7 (0.04)?kPa in group I to 1.4 (0.1)?kPa and 1.7 (0,1)?kPa in groups II and III, respectively (p<0.001). Inactivation of serotonin was reduced to 36% (2) in group II and 37% (2) in group III compared with 74% (5) in group I (p<0.002). CFC increased to 25?mg?min^?1 (5) (group II) and 30?mg?min^?1 (6) (group III) compared with 13?mg?min^?1 (2) in controls (p=0.01). The study shows that major pulmonary hypertension and severe reduction of the endothelial function are present when rats deteriorate after infusion of parenteral nutrition substrates.     

Elemental and intravenous total parenteral nutrition diet-induced gut barrier failure is intestinal site specific and can be prevented by feeding nonfermentable fiber

OBJECTIVE: Parenteral nutrition and elemental diets both cause bacterial translocation, immune dysfunction, and increased infection in laboratory animals, whereas elemental diets, with or without fiber, ameliorate some, but not all gut barrier failure. The purpose of this study is to investigate, in an Ussing chamber system, whether elemental vs. parenteral diets induce gut barrier failure in specific anatomical sites in the intestine and whether fiber can ameliorate this phenomenon. DESIGN: Controlled study in laboratory animals. SETTING: University laboratory. SUBJECTS: Male Sprague-Dawley rats. INTERVENTIONS: Nutritional support was provided to rats for 7 days by oral total parenteral nutrition (TPN; elemental diet) 307 kcal/kg/day, intravenous TPN (parenteral diet) 307 kcal/kg/day via jugular venous catheters, or rodent chow (controls). MEASUREMENTS AND MAIN RESULTS: Permeability to bacteria in intestinal segments of ileum, jejunum, and colon was evaluated in an Ussing chamber. Results were correlated with bacterial translocation to the mesenteric lymph nodes. Intravenous TPN caused greater bacterial translocation in all small intestinal segments and the cecum when compared with chow (p <.05). Oral TPN caused gut barrier failure only in the ileal segment, but not in the remainder of the small intestine (p <.001). Addition of cellulose provided a greater protection of the ileum to permeability than did pectin (p <.01). CONCLUSIONS: TPN causes global intestinal barrier failure, but elemental diet prevents barrier failure in parts of the small intestine other than the ileum. The addition of cellulose fiber to elemental diet can ameliorate further barrier failure in the ileum.     

食管及食管胃交界癌术后早期序贯肠内营养支持的应用

目的 探讨食管及食管胃交界癌术后早期序贯肠内营养支持的应用价值.方法 将63例食管、食管胃交界癌患者随机分序贯肠内营养支持(SEN)组32例和全肠外营养(TPN)组31例.TPN组术后第1天经中心静脉输注葡萄糖、脂肪乳、氨基酸、维生素和电解质混合液,热卡30CaL/kg,持续应用8d.SEN组术后20～24h经空肠管滴注5%葡萄糖氯化钠500ml,次日应用维沃(1Cal/ml)+肠外营养(PN),每日热卡同TPN,根据患者耐受情况,逐渐增加维沃用量,减少PN用量,待肠内营养达到目标热卡后PN停用,一般可于第4天达全量.观察术后并发症、肠内营养耐受情况、肛门排气时间.术前1d和术后第1、第8天分别测定血清白蛋白(ALB)、血清前白蛋白(PA),术前1d和术后第8天测量体重.结果 所有患者均治愈出院.两组患者均无吻合口瘘发生,SEN组6例患者行肠内营养时出现腹泻(3～5次/d),经加大维沃稀释浓度和使用肠道收敛剂后好转.肛门排气时间SEN组(50±5)h,早于TPN组的(70±6)h,差异有统计学意义(P<0.05).两组术后第8天体重均较术前下降,但TPN组更明显(P<0.05).两组术后第1天ALB及PA均降低,第8天SEN组已接近术前水平,而TPN组仍然较低(P<0.01).结论 早期序贯肠内营养支持有利于食管及食管胃交界癌患者术后胃肠功能的尽早恢复、营养状况的改善和体重的维持.     

Pulmonary capillary pressure during acute lung injury in dogs

OBJECTIVES: To measure pulmonary capillary pressure and pulmonary artery occlusion pressures both during control conditions and during acute lung injury and to evaluate the effects of inotropic therapy and volume loading on these measurements after lung injury. DESIGN: Prospective, randomized, controlled laboratory trial. SETTING: University research laboratory. SUBJECTS: Eighteen heartworm-free mongrel dogs. INTERVENTIONS: Dogs were anesthetized (sodium pentobarbital, 30 mg/kg intravenously), intubated, and mechanically ventilated. A femoral artery and vein and the right external jugular vein were cannulated. After a median sternotomy, two pulmonary artery catheters were inserted via the jugular vein into the left and right lower lobar pulmonary arteries. Oleic acid (0.03 mL/kg) was administered to all dogs via the left pulmonary artery catheter, whereas the right lower lobe served as control. A baseline group of dogs received no further interventions, whereas two additional groups were given dobutamine (30-60 microg x kg(-1) x min(-1)intravenously) or saline boluses (1-2 L) before measurements were obtained after oleic acid lung injury. MEASUREMENTS AND MAIN RESULTS: Capillary pressure was estimated in both lower lung lobes by using the pulmonary artery occlusion method. Pulmonary capillary and pulmonary artery occlusion pressures were measured before and 2 hrs after oleic acid administration. Left lower lobar capillary pressure increased in all three groups, as did the difference between capillary pressure and pulmonary artery occlusion pressure. Capillary pressure in the control right lower lobe increased significantly only in the saline-loaded dogs, whereas the difference between the right-sided capillary and occlusion pressures increased only in the dogs given dobutamine. CONCLUSIONS: Oleic acid lung injury increases pulmonary capillary pressure independent of pulmonary artery occlusion pressure. The gradient between the two pressures was not significantly affected by volume loading or dobutamine infusion.     

THEOPHYLLINE PLASMA CLEARANCE IN CRITICALLY ILL GERIATRIC PATIENTS RECEIVING TOTAL PARENTERAL NUTRITION and IN CONTROL PATIENTS

Mean values and standard deviations are reported for theophylline plasma clearance in 45 hospitalized geriatric patients (age greater than 65 years), distributed into two groups: Group I (n = 24) included critically ill patients admitted to the ICU on total parenteral nutrition (TPN). Group II (n = 21) included patients admitted to the Internal Medicine Ward without TPN. All patients were treated with a constant intravenous infusion of aminophylline. Group I patients had a lower mean theophylline clearance of 0.42 +/- 0.23 ml/kg/min compared to Group II 0.64 +/- 0.24 ml/kg/min (P = 0.003).     

Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition

OBJECTIVE: To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. DESIGN: Prospective, randomized clinical trial. SETTING: Department of surgery in a university hospital. PATIENTS: Two hundred and fifty-seven patients with cancer of the stomach (n = 121), pancreas (n = 110), or esophagus (n = 26) were randomized to receive postoperative total parenteral nutrition (TPN group, n = 131) or early enteral nutrition (EEN group, n = 126). The nutritional goal was 25 kcal/kg/day. The two nutritional formulas were isocaloric and isonitrogenous, and they were continued until oral intake was at least 800 kcal/day. MEASUREMENTS: Morbidity, mortality, length of hospital stay, and treatment costs were evaluated in all patients. In 40 consecutive patients, selected nutritional, immunologic and inflammatory variables were studied. Moreover, intestinal oxygen tension was evaluated by micropolarographic implantable probes. MAIN RESULTS: The nutritional goal was reached in 100/126 (79.3%) patients in the EEN group and in 128/131 (97.7%) patients in the TPN group (p <.001). In the EEN group, hyperglycemia (serum glucose, >200 mg/dL) was observed in 4.7% of the patients vs. 9.1% in the TPN group (p = NS). Alteration of serum electrolyte levels was 3.9% in the EEN group vs. 13.7% in the TPN group (p <.01). No significant difference was found in nutritional, immunologic, and inflammatory variables between the two groups. The overall complication rate was similar (40.4% for TPN vs. 35.7%, for EEN; p =.52). No difference was detected for either infectious or noninfectious complications, length of hospital stay, and mortality. From postoperative day 5, intestinal oxygen tension recovered faster in the EEN group than in the TPN group (43 +/- 5 mm Hg vs. 31 +/- 4 mm Hg at day 7; p <.001). EEN was four-fold less expensive than TPN ($25 vs. $90.60/day, respectively). CONCLUSION: EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.     

Immediate application of positive-end expiratory pressure is more effective than delayed positive-end expiratory pressure to reduce extravascular lung water

OBJECTIVE: To determine by the measurement of extravascular lung water (EVLW) whether the timing of positive-end expiratory pressure (PEEP) application influences the intensity of lung injury. DESIGN: Animal experimental study. SETTING: Animal experimental laboratory. SUBJECTS: Mixed-breed pigs (n = 18), aged 4 to 5 mos, weighing 25 to 30 kg. INTERVENTIONS: The animals were anesthetized and tracheotomized, after which a permeability pulmonary edema was instigated by infusing oleic acid (0.1/kg) into the central vein. All animals were then randomly divided into three groups. In group 1 (n = 5), 10 cm H2O of PEEP was applied immediately after the oleic acid infusion and maintained throughout the 6 hrs of the experiment. Group 2 (n = 7) received the same level of PEEP 120 mins after the insult for 4 hrs. Group 3 (n = 6), the control group, was ventilated without PEEP for the six hrs of the experiment. MEASUREMENTS AND MAIN RESULTS: At the end of the experiment, EVLW was calculated by gravimetric method. EVLW in group 1 (11.46+/-2.00 mL/kg) was significantly less than in group 2 (19.12+/-2.62 mL/kg) and group 3 (25.81+/-1.57 mL/kg), (p<.0001). Oxygenation also showed important differences by the end of the experiment when the Pao2/Fio2 ratio was significantly better in group 1 (467+/-73) than in group 2 (180+/-82) and group 3 (39+/-9), (p<.0001). CONCLUSIONS: The application of 10 cm H2O of PEEP reduces EVLW in a time-dependent manner and maximum protective effect is achieved if it is applied immediately after lung injury production.     

Evolution of energy expenditure and nitrogen excretion in severe head-injured patients

OBJECTIVE: The aim of the study was to estimate the influence of therapeutic changes on the level of energy expenditure (EE) and N excretion in a homogeneous group of patients usually considered hypermetabolic. DESIGN: EE and N excretion of head-injured patients were measured simultaneously at phases 1 and 2 (patients treated 4 +/- 3 and 18 +/- 8 days after injury, respectively). SETTING: Acute care hospital. PATIENTS: Eight severe head-injured patients, mean weight 63.1 +/- 6.1 (SD) kg, mean age 21 +/- 3.8 (SD) yr. INTERVENTIONS: At phase 1, all patients were sedated with fentanyl (6.7 +/- 1.9 micrograms/kg.hr) plus flunitrazepam (9.1 +/- 4.8 micrograms/kg.hr) and were mechanically ventilated. All patients received continuous total parenteral nutrition. The nonprotein caloric intake averaged 1092 +/- 200 kcal/day, including 77% glucose and 23% fat (Intralipid 20%). The total N intake averaged 7 +/- 5 g/day, consisting of crystalline amino acids. At phase 2, no patient received any sedative and all were breathing spontaneously via tracheostomy. All patients received parenteral and/or enteral nutrition. The nonprotein caloric intake averaged 1929 +/- 200 kcal/day consisting of 65% carbohydrates and 35% fat. The total N intake averaged 13 +/- 2 g/day. MEASUREMENTS AND MAIN RESULTS: The EE was significantly higher at phase 2 than at phase 1 (2121 vs. 1737 kcal), but the interindividual variability was low at both phases. N excretion was high at the two periods of the study and not correlated to the level of EE. The RQ was 0.75 at both periods, indicating predominant fat oxidation. CONCLUSIONS: We could not demonstrate any parallelism in the evolution of EE and protein catabolism in head-injured patients. The therapeutics (mechanical ventilation, sedation, and nutrition) have a major effect on EE but little on N excretion.     

丙氨酰谷氨酰胺双肽对胃癌患者术后免疫功能的影响

目的观察添加丙氨酰谷氨酰胺双肽的全肠外营养(TPN)对胃癌术后患者免疫功能的影响。方法进展期胃癌根治性切除患者50例,随机分为对照组和试验组,对照组采用常规TPN,试验组在常规TPN基础上加用丙氨酰谷氨酰胺双肽注射液。术后第1天开始对两组患者行肠外营养支持,时间1周。于术前及术后第1天、第8天分别抽取外周血测定IgG、IgA、IgM和T淋巴细胞亚群CD3、CD4、CD8,及CD4/CD8比值。结果术后第1天,两组患者的各项免疫指标均有所下降;术后第8天,试验组的各项免疫指标均有所恢复,其中IgG、IgM、IgA、CD3、CD4和CD4/CD8比值与对照组有显著性差异(P<0.05)。两组患者在观察期间均无严重并发症。结论含丙氨酰谷氨酰胺双肽的全肠外营养能有效改善和增强胃癌患者术后机体的免疫功能。     

全胃肠外营养加谷氨酰胺对多器官功能障碍综合征患者血浆二胺氧化酶及D-乳酸的影响

目的探讨添加谷氨酰胺的全胃肠外营养(TPN)对多器官功能障碍综合征(M ODS)患者血浆二胺氧化酶(DAO)、D乳酸的影响。方法将2003年9月—2005年6月收入山东省聊城市人民医院ICU的40例M ODS患者,按随机、对照研究方法分为常规TPN组(A组,20例)和谷氨酰胺+TPN治疗组(B组,20例)。两组患者均接受等氮、等热量的肠外营养(PN)治疗。A组按常规给予TPN;B组在给予TPN基础上加用谷氨酰胺0.27 g.k-g 1.-d 1(相当于力肽0.4 g.k-g 1.-d 1),共7 d。TPN治疗前及治疗后1、3和7 d分别抽血检测血浆DAO和D乳酸浓度,并统计两组PN治疗时间和病死率。同时选20名健康献血员作为正常对照(C组)。所有数据均用SPSS 10.0统计软件进行统计学处理。结果TPN治疗前A、B两组患者血浆DAO、D乳酸水平均显著高于C组(P均<0.01),A、B两组间差异无显著性(P>0.05);B组患者经谷氨酰胺+TPN治疗后,血浆DAO、D乳酸均显著低于A组(P均<0.01)。A组TPN治疗时间为(15.8±2.3)d,B组为(12.5±2.4)d,A组显著高于B组(P<0.05)。A组病死率为25%,B组为10%,两组比较差异无显著性(P>0.05)。结论经静脉补充谷氨酰胺(力肽)有助于增加M ODS患者肠黏膜上皮细胞能量供给,显著降低血浆DAO和D乳酸浓度,缩短TPN治疗时间。     

Intimatan prevents arterial and venous thrombosis in a canine model of deep vessel wall injury

Resistance of fibrin-bound thrombin to inactivation by the heparin/antithrombin III complex is considered a limitation in the use of heparin as an antithrombotic agent. Intimatan (dermatan 4,6-di-O-sulfate) is a heparin cofactor II agonist that inhibits both free and bound forms of thrombin. The present study examines the hypothesis that Intimatan prevents thrombotic occlusion in response to vascular wall injury in a canine model of carotid artery/jugular vein thrombosis. The left carotid artery and right jugular vein served as vehicle-treated control vessels, whereas the right carotid artery and left jugular vein were subjected to electrolytic injury after administration of Intimatan (9 mg/kg bolus + 300 microg/kg/min infusion, i.v.) or dalteparin (Fragmin) (400 IU/kg, s.c.). Intimatan significantly increased time to carotid artery (226.0 +/- 14.0 min) and jugular vein (240.0 +/- 0.0 min) thrombosis, compared with control vessels (carotid artery, 87.1 +/- 7.9 min; jugular vein, 60.6 +/- 7.4 min). Vessel patency was maintained in eight of eight jugular veins and seven of eight carotid arteries during treatment with Intimatan. Dalteparin significantly increased time to carotid artery thrombosis (122.1 +/- 17.5 min) compared with control (64.3 +/- 8.2 min), but did not change the time to thrombosis in the jugular vein. Only one carotid artery remained patent at the end of the dalteparin protocol. The two drugs produced minimal increases in bleeding times, and Intimatan increased the activated partial thromboplastin time above that observed with dalteparin. The results demonstrate that Intimatan is effective in preventing occlusive arterial and venous thrombosis in an experimental model of deep vascular wall injury.     

Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients

A comparative nutritional study in brain-injured patients (BIP) was performed to assess the influence of a combined enteral-parenteral nutrition (CN) and a total parenteral nutrition (TPN) on protein catabolism in the early posttraumatic period. 20 male BIP (Glasgow coma scale 5–7) were randomized to one of the two feeding regimes. Nutritional support was based on 150–175% basic energy expenditure. Amino acid intake was 1.4 g/kg/day in the TPN and 2.4 g/kg/day in the CN group. Negative nitrogen balance (NNB) averaged x (SEM=3.06 g/m²/day) in the TPN group and x (SEM=2.33 g/m²/day) in the CN group. Between both feeding regimes not statistically significant differences could be observed concerning mortality, N-balance, creatinine and 3-methylhistidine excretions. Protein concentration of the regurgitated gastric fluid was significantly higher in the CN than in the TPN study group. Data imply that both alimentary regimes are of similar value, but BIP with imparired gastric function, such as high tube reflux, are better treated by TPN.     

Antithrombotic efficacy of thrombin inhibitor L-374,087: intravenous activity in a primate model of venous thrombus extension and oral activity in a canine model of primary venous and coronary artery thrombosis

The small molecule direct thrombin inhibitor L-374,087 was characterized across species in an in vitro activated partial thromboplastin clotting time (aPTT) assay and in vivo in rhesus monkey and dog thrombosis models. In vitro in rhesus, dog, and human plasma, L-374,087 concentrations eliciting 2-fold increases in aPTT were 0.25, 1.9, and 0.28 microM, respectively. In anesthetized rhesus monkeys, 300 microgram/kg bolus plus 12 microgram/kg/min and 300 microgram/kg bolus plus 30 microgram/kg/min L-374,087 i.v. infusions significantly reduced jugular vein thrombus extension, with both regimens limiting venous thrombus extension to 2-fold that of baseline thrombus mass compared with a 5-fold extension observed in the vehicle control group. Antithrombotic efficacy in the rhesus with the lower-dose regimen was achieved with 2.3- to 2.4-fold increases in aPTT and prothrombin time. In a conscious instrumented dog model of electrolytic vessel injury, the oral administration of two 10 mg/kg L-374,087 doses 12 h apart significantly reduced jugular vein thrombus mass, reduced the incidence of and delayed time to occlusive coronary artery thrombosis, and significantly reduced coronary artery thrombus mass and ensuing posterolateral myocardial infarct size. Antithrombotic efficacy in the dog was achieved with 1.6- to 2.0-fold increases in aPTT at 1 to 6 h after oral dosing with L-374,087. These results indicate significant antithrombotic efficacy against both venous and coronary arterial thrombosis with L-374,087 with only moderate elevations in aPTT or prothrombin time. The oral efficacy of L-374,087 characterizes this compound as a prototype for the further development of orally active direct thrombin inhibitors.     

急性重症胰腺炎患者营养支持的临床研究

目的 探讨急性重症胰腺炎营养支持的治疗效果.方法 将96例患有急性重症胰腺炎的患者随机分成对照组和治疗组.对照组给予全肠外营养,通过中心静脉注入;而治疗组在不同阶段给予肠外营养与肠内营养治疗.监测营养状况、急性阶段反应、胰腺损害、肠黏膜穿孔和免疫功能等指标.结果 与对照组相比治疗组患者体质量和前白蛋白都有所增加(P＜0.05),但是白蛋白没有显著的增加.急性生理和慢性健康状态(APACHEⅡ)评分在治疗7天后下降,然而对照组APACHEⅡ评分在第11天下降.肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和血清C反应蛋白的浓度下降时间在治疗组(第4天下降)要早于对照组(第7天下降).在对照组和治疗组均没有发现胰腺器质性改变.内毒素浓度和尿乳果糖(L)∶甘露醇(M)比例在治疗组没有改变,但是这两个指标在对照组有明显的升高.与治疗组相比,对照组的CD4:CD8 T细胞比例和IgG浓度明显下降(P＜0.05).结论 与全肠外营养相比,肠外营养与肠内营养混合治疗能改善患者营养状况,缓解急性期反应.与对照组相比,治疗组的肠黏膜完整性和免疫功能都能受到有效的保护.肠内营养不会刺激胰腺分泌并且避免了胰腺炎症的扩大.适当的给予肠内与肠外营养对于治疗急性重症胰腺炎有一定效果.     

乌司他丁对百草枯中毒大鼠肺脏病理变化的影响

目的 探讨乌司他丁对百草枯中毒大鼠肺脏病理变化的影响.方法 SD大鼠60只随机(随机数字法)分为正常对照组(A组)、百草枯染毒组(B组)和乌司他丁治疗组(C组),各20只.A组给予生理盐水1 mL一次性灌胃;B组给予PQ液40 mg/kg(稀释至1 mL)灌胃染毒,并每日给予1 mL生理盐水腹腔注射;C组给予PQ液40mg/kg(稀释至1 mL)灌胃染毒,给予UTI 2万U/kg,2次/d腹腔注射.在给药后7,14,21,28 d处死大鼠,用苏木素-伊红(HE)、Masson染色评价肺组织病理学变化的表达.数据采用SPSS 10.0统计软件处理,等级资料采用秩和检验,有统计学意义后进行两两比较(Bonferroni法).结果 百草枯染毒后大鼠肺泡炎、肺纤维化程度积分明显增高,乌司他丁治疗组肺组织水肿、出血、炎性细胞浸润及纤维聚集程度减轻.结论 乌司他丁能明显抑制百草枯中毒大鼠肺炎症及纤维化程度.     

持续皮下胰岛素输注在伴有糖尿病的腹部大手术后危重患者肠外营养期间的应用

目的 探讨持续皮下胰岛素输注在伴有糖尿病的腹部大手术后危重患者完全胃肠外营养期间的应用价值。方法 选择腹部大手术后行完全胃肠外营养（TPN）治疗1周（或以上）的伴有糖尿病的危重患者40例，随机分成两组：胰岛素泵持续皮下胰岛素输注（CSII）组和胰岛素盐水微量输液泵静脉持续输入组，分别监测血糖水平、低血糖发生以及切口感染和愈舍情况。结果 CSII组和对照组胰岛素应用后血糖均明显下降；治疗后第1天、第2天CSII组血糖控制情况明显优于对照组；治疗后第3—7天两组血糖比较无统计学意义；CSII组低血糖发生率、切口感染率、伤口愈合障碍率均低于对照组。结论 CSII控制腹部大手术后TPN支持期间伴有糖尿病危重患者的血糖，与传统静脉胰岛素滴注相比，血糖控制平稳，发生低血糖情况少，且可减少术后切口感染及愈合障碍等并发症，临床应用前景良好。     

规范化序贯肠内肠外营养支持疗法与肠外营养支持对于胃肠道手术后患者的疗效对照研究

目的对照研究规范化序贯早期肠内肠外营养支持疗法(EEN+PN)与肠外营养支持(TPN)对胃肠道手术后患者的临床疗效。方法 136例拟行开腹胃肠道手术的患者随机分为EEN+PN组(n=72)和TPN组(n=64),分别于术前、术后第3、7天监测并比较代表性营养相关指标、生化相关指标以及免疫及炎症指标,记录并比较2组患者术后恢复、营养支持疗法费用以及住院时间。结果 EEN+PN组在术后第7天的白蛋白明显高于TPN组,EEN+PN组在术后第3、7天的前白蛋白明显高于TPN组,EEN+PN组术后第7天淋巴细胞计数显著高于TPN组,EEN+PN组首次排气时间、住院时间均明显短于TPN组,营养支持相关费用明显低于TPN组。结论胃肠道手术后规范化序贯早期肠内肠外营养支持疗法可以改善机体营养状态及免疫功能,有利于患者的术后恢复,有效保护胃肠道功能,降低营养支持疗法相关费用,缩短住院时间。     

丙氨酰-谷氨酰胺对多器官功能障碍综合征患者的肠黏膜保护作用

目的探讨添加丙氨酰-谷氨酰胺的全肠外营养(TPN)对多器官功能障碍综合征(MODS)患者的肠黏膜屏障功能的影响。方法将入住本院ICU的MODS患者56例,均分为丙氨酰-谷氨酰胺双肽组(治疗组)和常规TPN组(对照组)。2组患者均接受等氮、等热量的肠外营养治疗。对照组按常规TPN,治疗组在给予TPN基础上加用L-丙氨酰-I-谷氨酰胺0.4 g/(kg.d),共7 d。所有患者均于TPN治疗前及治疗后第1、3、7天检测血浆二胺氧化酶(DAO)、D-乳酸、内毒素(LPS)浓度,观察分析营养指标,测血浆DAO、D-乳酸和LPS浓度。结果治疗组治疗后血浆DAO、D-乳酸和LPS浓度各项指标显著低于对照组;治疗组营养指标明显高于治疗前和对照组,对照组仅转铁蛋白较治疗前增高。结论应用丙氨酰-谷氨酰胺的肠外营养能够明显纠正MODS患者的营养代谢障碍,增加患者肠黏膜上皮细胞能量供给,保护肠黏膜上皮细胞功能。