外科病人术后营养状况康复及影响因素分析

目的：调查分析外科择期手术病人的术前、术后营养状况。方法：采用人体测量．实验室检查，临床检查．营养素摄入调查。结果：病人术后的营养状况普遍较差．各项营养状况评价指标均较术前显降低。结论：影响病人术后营养状况的主要因素有病人术前的身体指数(BMI)，三头肌皮褶厚度(TST)，术后病人能量及蛋白质的摄入量。术后营养供给方式的单一及不规范可能是造成病人术后能量及蛋白质摄入不足的原因。     

风心病瓣膜替换病人营养状况及并发症的影响因素

目的：探讨风湿性病瓣膜替换病人营养状况及并发症的影响因素。方法：80例风湿性心脏病人按手术类型分两组,单瓣组和双瓣组各40例,所有病人于不同时间检测各营养状况指标,同时观察术后早期并发症的发生情况及其主要影响因素。结果：两组病人术后1周的营养状况指标均有不同程度下降,营养不良的发生率增多,术后3d蛋白质和热能的摄入明显不足（P＜0．001）,1周后双瓣组蛋白质和热能的摄入明显低于术前（P＜0．05）,且男女间差异有显著意义（P＜0．05）。并发症的发生率高达22．50％（18／80）,并发症的发生民体外循环时间和术后3d 蛋白质的摄入密切相关（P＜0．05）。并发症患者的住院时间明显延长（P＜0．001）。结论：风心病瓣膜替换病人术后的营养状况下降,并发症的发生率高,应尽量缩短体外循环时间并重视围术期的营养支持。     

食管癌术后不同途径营养支持方式的比较

目的：比较食管癌术后不同营养支持途径的合理性及临床意义。方法：50例食管癌术后人随机分成两组：单纯肠外营养组（PN）和肠内结合肠外营养组（EN＋PN组），每组25例。术后第1天开始给给予不同途径的营养支持，连续2周。观察两组病人营养素的摄入、营养支持费用、感染性并发症的发生以及术前、术后第1，15天体重、血浆总蛋白、白蛋白、总淋巴计数、血红蛋白和电解质的变化情况。结果：术后PN组平均每日蛋白质的摄入低于EN＋PN组（P＜0．001），营养支持费用高（P＜0．005），感染性并发症的发生以及术前、术后第1，15天体重、血浆总蛋白、白蛋白、总淋巴计数、血红蛋白和电解质的变化情况。结果：术后PN组平均每日蛋白质的摄入低于EN＋PN组的血浆总蛋白、白蛋白和血红蛋白基本恢复到术前水平（P＞0．05），且体重丢失少，血钾和血镁均较术前明显升高，两组间比较差异有显著意义（P＜0．05）。结论：食管癌术后合理的营养支持对预后有重要的临床意义。早期肠内结合肠外、1周后过渡到全肠内的营养支持方式更为合理。     

肾移植术后病人营养状况与需求

随机抽取肾移植术后病人１８６例，对其术后１个月内的营养状况进行回顾性分析。结果显示：病人营养摄取不合理，术后蛋白质、脂肪摄入明显超标，碳水化合物摄入不足，各种维生素、矿物质部分达标，微量元素极少达标。另外，手术后空腹血糖升高者５４例，占２９．０％；胆固醇、甘油三酯升高者１４１例，占７５．８％；血尿酸升高者１３２例，占７１．０％。     

胃肠术后应激性高血糖患者实施早期低能量肠内营养支持的临床研究

目的 研究胃肠切除术后出现应激性高血糖患者实施早期肠内营养支持对血糖控制、胃肠道功能恢复、营养状况改善、并发症预防等方面的效果。方法 将40例胃肠切除术后出现应激性高血糖患者分成标准肠外营养支持组（30kcal/kg/d）、标准肠内营养支持组（30kcal/kg/d）、允许性低热量肠外营养支持组（20kcal/kg/d）及允许性低热量肠内营养支持组（20kcal/kg/d），监测各组术前、术后血常规、肝肾功能、IgA等，并观察有无感染发生现象。结论 术后短期的允许性低能量摄入并不妨碍患者肠功能、营养状况、免疫功能等的恢复及改善，而在此基础上的允许性低能量肠内营养支持依然是适用的。     

饮食干预对胃癌根治术后病人体重的影响

<正>美国癌症中心专家研究认为,有近40%癌症病人根本死因为营养不良,而非癌症本身或后续治疗[1]。胃癌病人术前多有不同程度的营养不良,手术创伤的应激状态会使代谢加快,术后短期内正常摄入受限可使胃癌术后病人营养不良进一步加重,出现负氮平衡,体重减轻,甚至出现术后并发症的几率加大[2]。因此,在胃癌术后病人的护理工作中应尤其重视饮食干预,以纠正病人能量营养消耗与摄入之间的不良状态,改善病人术后营养状况及生活质量[3]。为了防止胃癌根     

肾移植术后病人营养状况与需求

随机抽取肾移植技术后病人１８６例，对其术后１个月内的营养状况进行回顾性分析。结果显示：病人营养摄取不合理，术后蛋白质，脂肪摄入明显超标，碳化合物摄入不足，各种维生素，矿物质部分达标，微量元素极少达标，另外，手术后空腹血糖升高者５４例，占２９．０％，胆固醇，甘油三酯升高者１４１例，占７５．８％，血尿酸升高者１３２例，占７１．０％。     

饮食干预对改善胃肠癌化疗病人营养状况的效果观察

[目的]探讨饮食干预对改善胃肠癌化疗病人营养状况的效果。[方法]对246例胃肠癌化疗病人进行饮食干预,比较干预前后营养状况。[结果]饮食干预后营养良好及轻、中度营养不良病人比干预前明显增多(P<0.05)。[结论]保证能量及蛋白质摄入可改善胃癌及大肠癌化疗病人营养状况,护士需了解饮食方面的相关知识,对化疗病人进行饮食干预,改善其营养状况。     

造血干细胞移植后早期不同营养支持方法的比较

目的调查造血干细胞移植患者早期能量和蛋白质对营养支持的影响。方法将30例行造血干细胞移植的患者随机分成两组，实验组15例给予能量、蛋白质等营养素理论需要量，对照组15例主要以经口摄入的方式给予营养素，并对两组患者移植后2周后的血清白蛋白、转铁蛋白、前蛋白进行测定。结果两组患者术后两周血清白蛋白、转铁蛋白、前蛋白比较差异有统计学意义（P〈0．05）。结论造血干细胞移植患者术后早期，蛋白质及能量的供给与吸收在有效营养支持中占主导地位。     

应用手机APP膳食管理对改善食管癌患者术前营养状况的效果研究

目的探讨应用手机APP的膳食管理对改善食管癌患者术前营养状况的效果。方法采用方便抽样方法,选择2018年4月至8月在本院行食管癌根治术的47例患者为对照组,实施常规饮食管理;2018年9月至2019年3月47例患者设为干预组,在常规饮食管理上结合手机APP对患者进行膳食管理,比较干预后两组患者能量及蛋白质摄入量的差异。结果干预后,干预组患者能量及蛋白质的摄入量均高于对照组(P0.001);白蛋白及前白蛋白值均高于对照组(P0.05)。结论应用手机APP膳食管理可增加食管癌术前患者能量及蛋白质摄入,进而改善患者术前营养状况。     

中国国际救援人员营养状况及三大营养素摄入情况分析

目的通过对中国国际救援队执行海外救援时队员营养状况及三大营养素摄入情况分析,探讨特殊环境下的营养支持方法。方法采用整群问卷调查方法对队员身高、体质量、年龄、性别、平日膳食摄入量、救援日膳食摄入量进行调查。结果69名救援人员体质量、体质量指数救援日比平日下降(P<0.01或<0.05);男性、女性摄入热能、脂肪、碳水化合物、总蛋白明显增加(P<0.05或P<0.01)。结论中国国际救援队队员在救援时存在营养摄入不足的情况,特殊环境强体力消耗应激工作状态下应增加热能及优质蛋白的摄入。     

Nutritional care: the effectiveness of actively involving older patients

Aims and objectives. The purpose of the study was to test the effectiveness of nursing care based on active involvement of patients in their nutritional care. It was hypothesized that this type of care could improve energy and protein intake in elder orthopaedic patients. Background. Protein and energy malnutrition and deterioration in nutritional status is a common but neglected problem in hospital patients. Methods. The design was quasi‐experimental with an intervention and control group. The study included 253 patients aged 65 and above admitted for hip fracture, hip or knee replacement. Food intake was recorded on a daily basis during the hospital stay. Results. The daily intake of energy increased with 23% (P = 0.001) and of protein with 45% (P = 0.001). The intake increased from the very first day after the operation. The intake of energy and protein was not correlated with the patient's age, body mass index or type of surgery. Conclusions. The care based on patients’ active involvement in their own nutritional care and was found to be an effective method to raise the intake of energy and protein among elder orthopaedic patients. Relevance to clinical practice. This way of organizing the care identifies patients who do not consume enough energy and protein according to their current requirements and to take appropriate actions to prevent further malnutrition.     

Nutritional support for patients with infected wounds

Many factors affect wound healing, including nutritional status and recent nutritional intake. Patients with infected wounds have increased requirements for nutrients and often have a reduced food intake. It is therefore important that nutritional status is carefully considered, and all patients should be screened for malnutrition using a nutrition screening tool. Nutrition plans should aim to provide sufficient energy while maintaining good glycaemic control, adequate protein and hydration, and a minimum of 100% reference nutrient intake for micronutrients. Measures required to achieve this will vary, as all patients should be assessed on an individual basis.     

Postoperative Energy Intake in Patients after Colorectal Cancer Surgery

In a prospective noninterventional study of 75 consecutive patients (mean age 71 ± 12 years) undergoing surgery for colorectal cancer, standard postoperative energy intake was evaluated. Seventeen patients expended 40%–60% of estimated basal energy during hospitalization, 33 patients 60%–80%, 22 patients 80%–100% and three patients 100%–125%. Weight loss was observed in 67 patients (mean loss 4.7 ± 4.4%) during hospitalization. Men had a significantly higher mean total calorie deficit (p < 0.001), and mean weight loss percentage (p < 0.01), compared to women. Preoperative nutritional status, nutrition-associated complications and length of hospital stay did not change the nutritional support and intake. Correlation analyses resulted in significant associations between gender and total calorie deficit (r_s = 0.41, p < 0.01), postoperative weight loss and total calorie deficit (r_s = ?0.32, p<0.01), and between postoperative weight loss and length of stay (r_s = 0.27, p < 0.05). We concluded that the patients' energy intake was insufficient compared to estimated basal energy expenditure. These results suggest a need for individualized nutritional care, based on each patient's energy needs and on registration of daily calorie intake, all with the aim of increasing energy intake postoperatively in standard hospital care.     

The association between depression and widowhood and nutritional status in older adults

This study aimed to investigate the association of depression and widowhood on the nutritional status of older adults. A cross-sectional study of community-dwelling older adults in the rural United States was conducted. Dietary intake was measured via questionnaires. Depression status was classified by asking participants if they have ever been diagnosed with the condition, or by review of medical records. The final sample consisted of 1065 participants with 141 (13.2%) depressed, 384 (36.1%) widowed, and 67 (6.3%) both depressed and widowed. Mean caloric intake for total study population was low; widows and widowers had the lowest energy consumption among all groups. Greater intake of several nutrients was observed in depressed and/or widowed subjects. Nutritional services, such as congregate and home delivered meal programs, were not identified as significant contributors to the nutritional intake in older adults who were depressed, widowed, or both. Health care professionals may contribute to meal-based nutrition programs by offering their assistance in aspects of nutritional education and counseling for the promotion of healthy aging.     

Intensive nutritional counseling improves PG-SGA scores and nutritional symptoms during and after radiotherapy in Korean cancer patients

Purpose

This study was conducted for the nutritional assessment of cancer patients undergoing radiotherapy (RT) and to investigate the changes in nutrition status, oral intake, morbidity and quality of life (QOL) in cancer patients after intensive nutrition counseling.

Methods

Eighty-seven cancer patients were randomized to either a nutrition counseling group (n?=?44, age 58.0?±?2.2 years) or a control group (n?=?43, 62.0?±?1.8 years). Nutrition counseling accompanied RT, and the subjects received at least three sessions of individualized dietary counseling over the duration of RT. Assessment parameters were nutritional intake (24-h recall method), nutritional status Patient-Generated Subjective Global Assessment (PG-SGA), QOL and blood parameters including albumin. All parameters were measured at baseline, at the end of RT, and 1 month after the termination of RT.

Results

Body weight, body mass index (BMI), and energy and protein intake for the intervention and control groups did not differ significantly between baseline and the end of RT. However, at 1 month follow-up, protein intake was significantly decreased in the control group (p?Conclusion We suggest that repetitive and intensive nutritional counseling is necessary to improve QOL and to prevent deterioration of nutritional status in cancer patients receiving RT.     

老年肺结核患者营养状况及其影响因素研究

目的 了解老年肺结核患者营养状况并分析其影响因素,为临床医护人员实施个体化营养干预方案提供依据。方法 采用一般资料调查问卷、微型营养评定法（MNA）、24小时膳食回顾（连续三天）、食物频率调查（三个月内）、心理状况评估表、社会支持量表、家庭功能评定量表对上海市肺科医院结核科共134例老年肺结核患者进行调查。结果 老年肺结核患者MNA营养评估得分为（19.79±4.89）分,其中存在营养不良的风险及营养不良得分分别为（21.10±0.96）分和（13.42±2.75）分。不同年龄、文化程度、婚姻状况、月收入、经济来源、月医药费用、医疗付费方式、结核确诊时长的患者MNA营养评估单因素分析中,差异无统计学意义(P>0.05)。患者的性别、居住情况、患病情况、服药情况、耐药状况的不同,其MNA营养评估单因素分析中,差异有统计学意义 (P<0.05)。多元线性回归分析显示,耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构是老年肺结核患者营养状况的重要影响因素。结论 老年肺结核患者的营养状况不容乐观,影响老年肺结核患者营养状况的因素可能与其耐药状况、服药状况、家庭功能状况、营养素摄入量及膳食结构有关。建议临床医生及营养师针对老年肺结核患者营养不良的特点及膳食营养素的摄入状况,尽早采取临床营养管理工作,制定个体化、精准的营养干预方案,给予合理的膳食结构建议,纠正其营养不良,改善营养状况。     

Cancer: disease and nutrition are key determinants of patients’ quality of life

Goals of work The aims of this study were (1) to evaluate quality of life (QoL), nutritional status and dietary intake taking into account the stage of disease and therapeutic interventions, (2) to determine potential interrelationships, and (3) to quantify the relative contributions of the cancer, nutrition and treatments on QoL.Patients and methods In this prospective cross-sectional study conducted in 271 head and neck, oesophagus, stomach and colorectal cancer patients, the following aspects were evaluated: QoL (EORTC-QLQ C30), nutritional status (percent weight loss over the previous 6 months), usual diet (comprehensive diet history), current diet (24-h recall) and a range of clinical variables.Main results Usual and current intakes differed according to the site of the tumour (P=0.02). Patients with stage III/IV disease showed a significant reduction from their usual energy/protein intake (P=0.001), while their current intakes were lower than in patients with stage I/II disease (P=0.0002). Weight loss was greater in patients with stage III/IV disease than in those with stage I/II disease (P=0.001). Estimates of effect size revealed that QoL function scores were determined in 30% by cancer location, in 20% by nutritional intake, in 30% by weight loss, in 10% by chemotherapy, in 6% by surgery, in 3% by disease duration and in 1% by stage of disease. Likewise in the case of symptom scales, 41% were attributed to cancer location, 22% to stage, 7% to nutritional intake, 7% to disease duration, 4% to surgery, 1% to weight loss and 0.01% to chemotherapy. Finally for single items, 30% were determined by stage, 20% by cancer location, 9% by intake, 4% by surgery, 3% by weight loss, 3% by disease duration and 1% by chemotherapy.Conclusions Although cancer stage was the major determinant of patients QoL globally, there were some diagnoses for which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be more important than the stage of the disease process.Conflict of interest statement: The authors assert that they have no financial or personal relationships with other people or organizations that could inappropriately influence their work.     

Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy—a pilot study

Goals of the work The aim of this study was to examine the effect of nutrition intervention on outcomes of dietary intake, body composition, nutritional status, functional capacity and quality of life in patients with cancer cachexia receiving chemotherapy.Patients and methods Patients received weekly counselling by a dietitian and were advised to consume a protein- and energy-dense oral nutritional supplement with eicosapentaenoic acid for 8 weeks. The medical oncologist determined the chemotherapy protocol. Eight patients enrolled and seven completed the study.Main results There were significant improvements in total protein intake (median change 0.3 g/kg per day, range –0.1 to 0.8 g/kg per day), total energy intake (median change 36 kJ/kg per day, range –2 to 82 kJ/kg per day), total fibre intake (median change 6.3 g/day, range –3.4 to 20.1 g/day), nutritional status (patient-generated subjective global assessment score, median change 9, range –5 to 17), Karnofsky performance status (median change 10, range 0–30) and quality of life (median change 16.7, range 0–33.3). There were clinically significant improvements in weight (median change 2.3 kg; range –2.7 to 4.5 kg) and lean body mass (median change 4.4 kg, range –4.4 to 4.7 kg), although these were not statistically significant. Change in nutritional status was significantly associated with change in quality of life, change in Karnofsky performance status and change in lean body mass.Conclusions Nutrition intervention together with chemotherapy improved outcomes in patients with pancreatic and non-small-cell lung cancer over 8 weeks. Supplement intake does not inhibit meal intake.This work was presented as a poster at the 16th MASCC International Symposium, Miami, 2004.     

Energy and nutrient intake of patients in acute care

There have been numerous reports that the nutritional intake of many hospitalized patients is sub-optimal, but there is little published information about patients' diets in Australian hospitals. In this study, the nutritional intake of patients in general medical wards of an Australian acute care hospital was assessed. Although the hospital diet can provide adequate energy and nutrients, many patients may not consume sufficient food to meet their needs. The estimated energy intake of about one-third of patients was very low, and vitamin C, calcium and zinc intakes were also of concern. The implications are discussed and recommendations for improved nutritional care are suggested.