器官移植病人的营养支持

器官移植已成为各种器官终末期病人优先考虑的治疗方法 ,伴随营养不良的器官移植病术后并发症、死亡率。营养支持能够明显改善器官移植病人的预后     

器官移植术后的代谢调理治疗

器官移植术后移植器官的功能恢复至关重要,用代谢调理治疗取代常规的营养支持,有利于移植器官功能的早期恢复和受者营养状态的改善.     

机械通气患者营养支持

正确合理的运用营养支持有助于机械通气患者的病情缓解和呼吸功能恢复,从而缩短住院时间,改善预后,提高治愈率,降低死亡率。本文探讨了机械通气患者的代谢特点以及在具体实施营养支持过程中的基本原则。     

小肠移植患者的营养支持

小肠移植是治疗不可逆性小肠功能障碍的理想方法，营养支持对移植肠功能的恢复起至关重要的作用。移植术前对患者的营养状况进行综合评估，纠正营养不良；移植术后对患者进行积极有效的营养支持，才能使小肠移植物具有良好功能。适当的营养干预策略能够提高小肠移植患者长期存活率、优化生活质量。     

糖尿病患者的营养支持与治疗

糖尿病病人营养支持的目的是为了维持良好的代谢状况,避免血糖水平异常、水代谢紊乱、酮症或高渗性昏迷、感染及神经损害等并发症的发生;同时改善病人的营养状况,维持人体所需各种营养成分的平衡,以减轻体重.我们对住院的糖尿病患者156例进行了饮食营养支持与治疗,取得了良好的效果.     

老年卒中患者合理营养支持

正老年卒中后营养供给是极为重要的研究内容,合理营养有助于卒中康复;而营养不足、营养过剩、营养失调则有可能加速卒中病情恶化[1-2]。因此,从营养学角度探讨衰老机制和生理变化,研究老年卒中营养需要与合理饮食很有必要。1营养风险筛查合理营养能改善卒中患者的营养状况,调节机体免疫功能,减少并发症的发生,提高患者生存率。老年人基础疾病多,易发生营养不良,特别是脑卒中脑组织受损后可致胃肠     

器官移植急需解决供体缺乏问题

在百里荷花飘香的湖北洪湖,50多岁的农民刘光祥每天捕鱼贩虾,靠辛勤劳动发家致富。当地人都不敢相信:这位20多年前的“换肾人”竟能如常人般地生存至今。1977年,正值英年的刘光祥因严重的肾病几乎丧失了劳动能力。同年10月,武汉同济医科大学器官移植研究所为他成功地施行了肾移植手术,不仅挽救了他的生命,还恢复了他原本正常的生活和工作。那时,器官移植在绝大多数中国人的眼里,还是一个陌生或充满着神奇的新鲜事物。如今,许多人已经知晓:器官移植,就是将患者由于严重的慢性病变而完全丧失功能的器官,通过手术换上他人的健康器官;     

晚期癌症患者营养支持与护理

积极治疗与护理晚期肿瘤患者,对提高他们的生命质量有着重要意义,通过临床护理实践,我们认为,根据晚期癌症患者的生理病理特点,有的放矢地给予营养支持护理,能起到药物所不能起到的作用。 1 营养支持护理的基本原则因癌症患者的治疗需延续相当长的时间,因此,对晚期和年老的癌症患者的营养支持和护理应保持连续性、整体性和有效性,要将该项护理措施列入总体治疗方案内,由医生、护士及家庭和社会共同参与,在     

营养支持在危重症患者的应用

营养不良是危重症患者普遍存在的问题,并且与危重症患者的不良预后密切相关。因此,营养支持已成为危重症综合治疗的一个重要组成部分。认识危重症患者营养与代谢状态的改变,掌握合理的营养支持方法与时机,并通过调整能量的供给、控制高血糖和应用免疫营养素等措施,提高危重症患者营养支持的安全性、有效性,可获得改善危重症患者预后的效果。     

欧洲的器官移植政策

在欧洲供移植用尸体器官的短缺已成为主要矛盾,从而导致为接受移植者的选定标准、对供器官者的法律保护以及决定器官分配的授权机构等都带来了一些问题。但某些欧洲国家的政策制定者出于并非有意的疏忽,对于器官移植问题认识不明确,其结果致使移植的推广、组织以及拨款支持等方面各持不同规划。无移植任务的医院在提供器官方面占有重要位置,各移植中心须要保证质量,从而使大量的先进成果步入领先行列。在欧洲,为发展良好的器官移植事业,国际间合作是迫切的。     

肝硬化患者围手术期的营养支持

肝硬化患常存在营养不良和高分解代谢，手术时应予营养支持。富含支链氨基鞍的溶液可抗代谢并刺激肝细胞再生，可作为蛋白质的来源。术后残存肝脏主要利用脂肪鞍提供能量。过多的糖可抑制内源性脂肪利用。中链脂肪鞍比长链脂肪鞍更容易被利用，且不在肝脏沉积，因而更可取。肝硬化患注射三配甘油后，游离脂肪鞍及甘油有在体内聚集的趋势，因而应间断应用。临床研究表明，肝硬化患进行大肝叶切除或进行肝移植时，围手术期营养支持有利于患恢复。营养成分的选择、导管的护理以及对输注液体的限制都是有效的围手术期营养支持的前提，是手术成功的保障。     

肝移植术后营养支持

目的 探讨肝移植术后的营养支持方法。方法 对２例肝移植病人术后的营养方法和营养状况进行了回顾性分析,在术后２～３天内采用全肠外营养（ＴＰＮ）,并辅以人血白蛋白以维持血浆白蛋白水平,在术后第３－４天开始肠内营养（ＥＮ）结合肠外营养（ＰＮ）,并逐渐过渡为完全经口饮食,结果 ２例病人现生活质量均良好,结论 术后应视移植肝功能恢复的程度,适当控制营养供给量,并循序渐进,一旦病人胃肠功能恢复,宜尽早开始ＥＮ     

The Role of Nutritional Support for Cancer Patients in Palliative Care

The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.     

机械通气患者营养支持及护理进展

本文结合近年来一些国内外文献以及研究成果，较详细介绍了机械通气患者营养支持的适应证、营养管的置入途径、营养的时机、给与方式、营养品的选择；阐明早期给营养支持对危重病人的重要意义及对现存问题的护理干预；强调合理的营养支持可以提高患者的免疫力、减少并发症的发生，有利于患者平稳脱机。高质量的护理可保证营养支持发挥其最大效应。     

系统性红斑狼疮合并麻痹性肠梗阻的营养支持

目的探讨系统性红斑狼疮(SLE)合并麻痹性肠梗阻营养支持和综合治疗改善营养状况的方法。方法对5例临床确诊SLE合并麻痹性肠梗阻发生营养不良的患者,给予营养支持等综合治疗。结果经过肠外及肠内营养支持后,肠梗阻的症状改善,血清白蛋白由治疗前(25.3±6.9)g/L增至(32.2±8.5)g/L(P=0.09),总蛋白由(53.2±8.7)g/L增至(63.8±10.3)g/L(P=0.11),血红蛋白由(90.6±22.8)g/L增至(109.8±15.3)g/L(P=0.15),体重增长(1.3±2.4)kg,营养状况有改善的趋势并最终出院。结论SLE合并麻痹性肠梗阻可严重影响患者的营养状态,合理的肠外及肠内营养支持等综合治疗可能逐步改善患者的营养状态。     

Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards

Severe acute pancreatitis (SAP) leads to numerous inflammatory and nutritional disturbances. All SAP patients are at a high nutritional risk. It has been proven that proper nutrition significantly reduces mortality rate and the incidence of the infectious complications in SAP patients. According to the literature, early (started within 24–48 h) enteral nutrition (EN) is optimal in most patients. EN protects gut barrier function because it decreases gastrointestinal dysmotility secondary to pancreatic inflammation. Currently, the role of parenteral nutrition (PN) in SAP patients is limited to patients in whom EN is not possible or contraindicated. Early versus delayed EN, nasogastric versus nasojejunal tube for EN, EN versus PN in SAP patients and the role of immunonutrition (IN) in SAP patients are discussed in this review.     

L-精氨酸强化膳食营养对慢性阻塞性肺病营养不良患者的作用

目的评价L-精氨酸强化膳食营养对慢性阻塞性肺病(COPD)营养支持的作用。方法对30例COPD患者进行营养支持治疗，总能量摄人为静息能量消耗(REE)的1．5倍，其中蛋白质占20％，脂肪：30%，碳水化合物50％。A组12例为精氨酸治疗组，每日口服L-精氨酸10g3次／d，B组18例为对照组。结果营养支持后，A组肱三头肌皮褶厚度、前白蛋白、体脂等营养参数较B组明显改善，呼吸肌力显著提高，REE显著下降；A组的免疫指标较B组改善更显著；A组住院费较B组低。结论L-精氨酸不仅可改善COPD的营养、免疫状况和呼吸肌力量，而且能显著降低患者的能量消耗，达到强化营养支持的效果，同时可改善预后，减少医疗费用。     

Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure

Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.     

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.