肠内肠外营养在胃癌病人术后临床价值的分析

目的:探讨胃癌病人术后给予肠内营养(EN)与肠外营养(PN)在临床应用价值方面的差异. 方法:回顾性分析200例胃癌病人术后经EN和PN支持治疗的效果.将胃癌术后病人根据营养支持治疗方式的不同分为EN组(130例)和PN组(70例).比较两组病人营养支持前、后血红蛋白、红细胞计数、淋巴细胞计数、血清总蛋白、清蛋白、血肌酐、总胆固醇、三酰甘油、血钙、IgA、IgG、IgM水平的变化以及各种并发症发生率、营养支持时间、营养支持平均每天费用及平均住院时间的差异. 结果:术后第7天,EN组病人的血红蛋白和红细胞计数明显升高,与PN组比差异有统计学意义(P＜0.05).血清总蛋白、清蛋白和IgA、IgG、IgM水平升高显著,差异有统计学意义(P＜0.05);与PN相比,EN组在经7d营养支持后,白细胞计数、肌酐、总胆固醇、三酰甘油、血钙水平比较均无显著性差异(P ＞0.05);EN组术后切口感染和肠梗阻发生率均低于PN组,肛门排气时间和术后平均住院时间,平均住院费用均少于PN组. 结论:与PN支持比,EN可有效地改善胃癌术后病人的营养状态,提高机体免疫功能.     

不同营养支持方法在胃癌病人术后的应用

目的:探讨不同营养支持方法在胃癌术后病人中的应用价?方法:将60例胃癌根治术后病人随机分为三组,分别进行肠外营养支持(PN组)、肠内营养支持(EN组)和肠外联合肠内营养支持(PN-EN组).观察在治疗过程中三组病人并发症的发生率、术后肠功能恢复时间、术后平均住院天数、肝功能、血糖及营养评定等各项指标,进行对比分析.结果:三组病人术后并发症的发生率、平均住院天数、肝功能、血糖无明显差异;EN组病人术后胃肠道功能恢复时间明显早于PN组和PN-EN组(P＜0.05).各组术后血清清蛋白、前清蛋白和转铁蛋白在营养支持后均明显升高(P＜0.05),负氮平衡均得到有效纠正.结论:三种营养支持方法均能明显改善胃癌术后病人机体营养状况,肠外联合肠内营养尤其适用于不能耐受术后早期肠内营养的病人.     

危重症病人肠内与肠外营养支持的对比观察

目的:对比研究危重症病人EN与PN支持的效果.方法:将48例危重症病人随机分为EN组和PN组,对比观察营养支持后两组病人的Hb、PA、血清总蛋白(TP)、ALB等营养指标以及腹泻、腹胀、胃肠道出血、肝功能损害、高血糖等并发症的发生率.结果:经EN支持后,病人的Hb、TP和PA明显升高(P<0.05);而PN组与营养支持前比较,病人各指标无显著性差异.PN组并发症的发生率高于EN组.结论:EN支持可较好地改善病人的营养状况,并发症少,是危重症病人较好的营养支持方式.     

不同营养途径对危重症病人营养和免疫功能的影响

目的:观察比较不同营养支持途径对危重症病人的治疗效果.方法:选择ICU危重症病人45例,分为A组(PN支持) 、B组(EN支持)和C组(PN+EN支持),每组各15例.分别于营养支持前和连续营养支持治疗8 d后测体质指数(BMI)、血清总蛋白(TP)、ALB、Hb、淋巴细胞总数(TLC)、IgA、IgG和 IgM、 T细胞亚群(CD3、CD4、CD8)百分比,并进行临床营养指标和免疫指标的分析对比.结果:给予营养支持8 d后,42例(93.3%)病人康复,3例(6.7%)死于原发病.三组病人的Hb均明显升高,EN组和PN+EN组的TP、ALB较PN组有显著升高,EN组TCL和IgM、PN+EN组IgG和IgM均较PN组升高.结论:三种途径营养支持均可改善危重症病人的营养状况和免疫功能,EN或联合EN的效果更加明显.在危重症病人的治疗中,可根据病人的不同情况,合理地选择营养支持方式.     

营养支持对重型颅脑损伤病人营养指标和肺部感染的影响

目的:探讨肠内营养(EN)与肠外营养(PN)支持对重型颅脑损伤病人营养指标和肺部感染的影响。方法:将62例重型颅脑损伤病人分为PN组(n=30)和EN组(n=32)。比较两组病人在营养支持后第1和第2周的营养指标及肺部感染的发生率。结果:EN组病人的血清清蛋白和前清蛋白较PN组有明显改善,而PN组病人的谷丙转氨酶较EN组有明显升高。EN组病人肺部感染发生率明显低于PN组。结论:EN支持可改善重型颅脑损伤病人的营养指标,减少肺部感染的发生率,有利于病人康复。     

肠内营养对术后病人营养支持疗效的前瞻、随机、对照临床研究

目的 :观察肠内营养 (EN)、肠外营养 (PN)支持对维持或改善手术创伤后病人营养状态及肠粘膜屏障功能的影响。　方法 :选择腹部手术后需行营养支持的 6 0例成年病人随机进入EN组及PN组。两组营养支持均等热量、等氮量。分别于营养支持前、中、后检测营养状态指标及肠道粘膜通透性。营养支持期间每天测定氮平衡 ,并计算累计氮平衡。　结果 :①EN组体重、白蛋白、转铁蛋白高于PN组 ,但无显著差异。EN组前白蛋白、纤维连接蛋白在术后第 7、12天显著高于PN组 ;②EN组累计氮平衡为正氮平衡 ,而PN组为负氮平衡 ,二者之间差异非常显著 ;③研究期间EN组肠道通透性显著低于PN组。　结论 :与PN支持相比 ,EN可有效地改善术后病人的营养状态 ,促进肠粘膜屏障功能的恢复。     

胰十二指肠切除术后不同营养支持方式的疗效比较

目的:比较胰十二指肠切除术(PD)后病人肠内营养(EN)和肠外营养(PN)支持的临床疗效.方法:将71例在我院接受PD的病人随机分为EN组(n=36)和PN组(n=35).比较两组病人手术前后血肝功能相关指标、营养指标以及术后并发症的发生率、肛门排气时间、住院时间和营养支持费用的差异. 结果:两组病人术后血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)等均较术前明显降低(P＜0.05),术后第12天降低更加明显(P＜0.01).而在术后第8和12天,EN组病人ALT、AST、TBil、DBil较PN组明显降低(P＜0.05),总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)均升高(P＜0.05);术后第12天EN组的血淋巴细胞计数(LY)明显高于PN组(P＜0.05).EN组病人较PN组术后平均住院时间缩短、肛门排气时间早、并发症发生率低、营养支持费用少(P＜0.05). 结论:PD术后EN支持能明显改善病人的营养状态,促进术后恢复,降低住院费用.     

食管癌术后病人两种营养支持治疗的比较

目的:观察食管癌术后病人两种营养支持疗法的效果。方法:将80例食管癌术后病人随机分为肠外营养(PN)组和肠内营养(EN)组,所有病人在手术前1 d和术后第8天检测血红蛋白(Hb)、血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)、体质指数(BMI)以及肛门排气时间、住院时间和营养费用等指标。结果:两组病人术后血清ALB,住院时间、BMI、Hb比较无显著性差异(P>0.05)。EN组病人血清PA,TF明显高于PN组(P<0.05),术后肛门排气时间明显早于PN组(P<0.05),所用营养费用低于PN组。结论:两种营养支持治疗均可改善食管癌病人的营养状况,但EN与PN比,更具有符合生理、安全、价廉的优点。     

营养支持治疗在老年危重患者救治中的应用

目的探讨不同营养支持方式在老年危重患者救治中的作用。方法选择老年危重患者98例,根据不同营养支持方式分为肠外营养(PN)组30例,肠内营养(EN)组32例,PN+EN组36例。摄入同等总热量和同等氮量,营养支持治疗时间14 d。治疗0 d和连续营养支持治疗14 d后,检测血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞总数(TLC)、免疫球蛋白(IgA、IgG、IgM)值并进行回顾性对比分析。结果 3组患者Hb均较治疗前增高。EN+PN组患者Alb、PA较PN组及EN组治疗后增高。营养支持治疗后,3组患者TLC明显增高。EN组IgA、IgM,EN+PN组IgA、IgG、IgM均较PN组增高。PN+EN组并发症低于PN组及EN组。结论老年危重患者救治中应根据老年人特点及疾病不同情况合理选择营养支持方式,PN+EN联合应用更有利于改善老年危重患者营养状况及免疫功能,减少并发症发生,促进疾病的康复。     

肠外与肠内营养对胰腺外分泌和急性重症胰腺炎的影响

肠外营养(PN)不能改变胰腺炎自然病程,能降低并发症和病死率,但导管感染和肠源性并发症增加。近年来,肠内营养（EN）应用受到重视,但在急性重症胰腺炎（SAP）中的应用仍有争议。从EN对胰腺外分泌和SAP自然病程的影响分析,提出经空肠喂养不会刺激胰腺分泌,也不会加重SAP的病情。在临床实际应用中,应结合SAP的分期和临床状况,采用PN和EN联合应用来达到营养支持的目的。     

营养环境与人群营养素摄入水平的相关性

完善了营养环境的概念及指标，提出可以用线性规划建立的数学模型计算营养环境的指标，即由该模型得出的营养素的理论达标率和营养素的边际成本。用天津１９８９年的营养素的理论达标率和１９８８年天津人群的营养素实际达标率进行线性回归分析，得出回归方程：实际达标率（％）Ｙ＝１５．１５（％）＋０．７８８Ｘ（Ｘ为理论达标率，％），其相关性显著（Ｒ＝０．９８６，Ｐ＜０．００１）；还发现天津营养环境中脂肪、动物性蛋白质的边际成本大于零。讨论了上述方程的意义，营养环境与营养干预的关系。认为，改善食物的营养素含量、降低价格、增加营养素含量丰富的食物品种的营养干预措施，效果较好。     

The enteral vs parenteral nutrition debate revisited

Many trials and several meta-analyses have been devoted to comparing enteral with parenteral nutrition support. In this review, these studies are subjected to critical analysis with particular emphasis on their methodology and clinical relevance. Evidence is produced to suggest that the heterogeneous patient populations of the studies and the rigid approach taken to comparing different nutrition therapies inter alia render their conclusions highly questionable and of very doubtful clinical significance. An alternative approach to nutrition research is suggested in which strategies of nutrition support rather than fixed menus are compared. It is suggested that objective measures of intestinal function be evaluated more fully in patients requiring nonvolitional nutrition support, and these are briefly reviewed. In addition, a more scientific approach to evaluating the physiological effects of nutrition support, including chemical tagging and evaluation of muscle function, is recommended.     

Ceramide in Lipid Emulsions Used in Parenteral Nutrition

Parenteral nutrition-associated liver disease is a prevalent and severe complication of long term parenteral nutrition. We present here for the first time data on the presence of ceramide, a bioactive compound involved in a variety of metabolic processes, in different lipid emulsions used in parenteral nutrition. Further research is needed to determine whether this potential harmful bioactive compound is involved in parenteral nutrition-associated liver disease.     

Nutrition knowledge and attitudes of New Zealand registered midwives

Aim: The importance of nutrition for a healthy pregnancy is well established. In New Zealand, the majority of women choose midwives as their maternity provider. Therefore, it is important that midwives have an understanding of nutrition issues related to pregnancy. The purpose of the present study was to determine the nutrition knowledge of New Zealand midwives, and to assess the importance they place on nutrition during pregnancy. Methods: An 18‐question postal survey was sent to all members of the New Zealand College of Midwives (n = 1340). Results: A total of 370 questionnaires were returned (response rate of 27.6%). Less than 40% of midwives reported that they had formal nutrition education; however, nearly 75% of respondents indicated that they had received nutrition information through their midwifery education. Most midwives indicated that nutrition was important or very important during pregnancy (98.4%), and that they had a significant or very significant role in educating pregnant women (94.9%) about nutrition. Midwives generally reported a high level of confidence in dealing with nutrition‐related issues. Midwives answered most of the nutrition knowledge questions correctly. However, 64.6% of midwives (n = 369) incorrectly identified spirulina as a good source of iron for vegetarians, 28.1% (n = 104) incorrectly answered that maternal intake of cabbage and beans are often responsible for colic in breastfed infants, and 40.0% (n = 128) incorrectly answered that to reduce food allergies all lactating women should avoid peanuts and shellfish. Conclusion: Overall, midwives were knowledgeable on nutrition issues related to pregnancy and reported a high level of confidence on educating women about nutrition.     

Practice Analysis of Nutrition Support Professionals

Background: The National Board of Nutrition Support Certification (NBNSC) is an independent credentialing board responsible for administering the multidisciplinary certification examination in nutrition support. For an exam to be legally and practically defensible, it must represent practice. Validation is by practice audit, the highest level of supporting evidence. Objectives: To define the role of the nutrition support professional (NSP) and the current elements (knowledge and functions) required for competent NSP practice. Methods: A survey instrument was constructed using a content validation strategy to establish the link between job tasks and the content of the examination. Internet‐based surveys were made available to 5100 NSPs. NSP duties performed and knowledge required for patient safety and welfare were analyzed for the group as a whole and for each profession separately. Results: A total of 765 surveys were completed (return rate of 15%). The results of the practice audit demonstrate a common core of practice across the nutrition support disciplines as well as a universal core of elements believed to be important for competent nutrition support practice. Conclusion: The results of this survey continue to support a common core of practice across nutrition support disciplines as well as a common core of elements believed to be important for competent nutrition support practice. Accordingly, the NBNSC will continue to offer one examination to all disciplines both nationally and internationally and confer the Certified Nutrition Support Clinician (CNSC) credential to all individuals who successfully pass this validated examination.     

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols.Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices.Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important.Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.     

Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants

Background: Despite the availability of international nutrition recommendations, preterm infants remain vulnerable to suboptimal nutrition. The standard approach of assessing nutrient intakes chronologically may make it difficult to identify the origin of nutrient deficits and/or excesses. Objective: To develop a “nutrition phase” approach to evaluating nutrition support, enabling analysis of nutrient intakes during the period of weaning from parenteral nutrition (PN) to enteral nutrition (EN), called the transition (TN) phase, and compare the data with those analyzed using the standard “chronological age” approach to assess whether the identification of nutrient deficits and/or excesses can be improved. Methods: Analysis of a comprehensive nutrition database developed using actual nutrient intake data collected on an hourly basis in 59 preterm infants (birth weight ≤1500 g, gestation <34 weeks) over the period of PN delivery (range, 2–21 days). Results: The nutrition phase analysis approach revealed substantial macronutrient and energy deficits during the TN phase. In particular, deficits were identified as maximal during the EN‐dominant TN phase (enteral feeds ≥80 mL/kg/d) of the infant’s nutrition course. In contrast, the chronological age analysis approach did not reveal a corresponding pattern of deficit occurrence but rather intakes that approximated or exceeded recommendations. Conclusion: Actual intakes of nutrients, analyzed using a nutrition phase approach to evaluating nutrition support, enabled a more infant‐driven rather than age‐driven application of nutrition recommendations. This approach unmasked nutrient deficits occurring during the transition phase. Overcoming nutrient deficits in this nutrition phase should be prioritized to improve the nutrition management of preterm infants.