早期微量喂养联合静脉营养对早产低出生体重儿的临床体会

目的探讨研究早期微量喂养联合静脉营养对早产低出生体重儿童的临床疗效。方法选取我院早产低出生儿童110例,随机分为两组,试验组55例给予早期微量喂养联合静脉营养,对照组55例给予早期单纯静脉营养。观察两组体重增长、腹胀、呕吐、低血糖、高胆红素血症、胆汁淤积、呼吸暂停发生情况和达到肠内营养时间。结果试验组的体重增长优于对照组(P<0.05),达到肠内营养需要的时间明显短于对照组(P<0.05),相关并发症的发生情况少。结论早期微量喂养联合静脉营养能明显增加患儿体重、缩短患儿对胃肠喂养的适应时间,减少相关并发症的发生,有利于患儿疾病的康复,值得临床推广应用。     

早期微量喂养联合静脉营养在低出生体重儿中的应用

目的：观察早期微量喂养联合静脉营养在低出血体重儿中的应用效果。方法：54例低出生体重儿中24例给予早期微量喂养联合静脉营养，另30例给予早期单纯静脉营养。观察体重变化、需要静脉营养时间、住院时间等，监测血清胆红素、血脂、肾功能改变。结果：早期微量喂养联合静脉营养组低出生体重儿静脉营养时间和住院时间明显缩短，体重明显增加。出生7天血清胆红素、肌酐均低于单纯静脉营养组，而14天两组血清胆红素、血脂、肾功能指标均有显著差异。结论：早期微量喂养联合静脉营养可缩短病程，明显增加体重，使低出生体重儿尽早适应胃肠喂养，同时对肝、肾功能的影响较小。     

早产低体重儿早期喂养的观察

目的 探讨早期喂养对早产低体重儿生长发育及并发症的影响.方法 将早产低体重儿80例随机分成观察组和对照组各40例.观察组在常规处理、部分静脉营养及对症支持治疗的基础上给予早期喂养;而对照组先给予静脉营养,并禁食1～2天,待患儿出现吸吮反射后给予母乳或早产儿配方奶喂养.结果 两组患儿在加奶速度、胎便排空时间、发生黄疸后光疗时间、平均体重恢复时间、平均住院时间、以及到达足量喂养时间方面进行比较,差异均有统计学意义(t值分别为4.231、4.511、4.310、5.611、5.710、10.071,均P＜0.05);低血糖、喂养不耐受发生率比较,差异均有统计学意义(x2值分别为3.120、4.671,均P＜0.05).结论 早期喂养可以促进早产低体重儿胃肠功能成熟及发育,减少并发症的发生.     

早期微量喂养联合静脉营养在早产儿营养支持中的应用

目的探讨早期微量喂养联合静脉营养对早产儿营养支持的作用。方法选取2014年6月-2015年5月该院儿科收治的早产儿89例作为研究对象,随机分为观察组(46例)和对照组(43例),两组患儿均给予外周静脉营养治疗,且观察组在给予外周静脉营养治疗的基础上再给予早期微量肠内喂养治疗。比较两组患儿住院时间、黄疸消退时间、足量喂养所需时间、体质量平均增加情况,检测血糖、尿素氮、血清前白蛋白、总胆红素等血清学指标,并比较并发症情况。结果治疗期间,观察组患儿住院时间、黄疸消退时间、足量喂养所需时间均明显低于对照组(均P0.001);体质量增加量明显高于对照组(P0.05);治疗后,观察组患儿血糖、尿素氮、血清前白蛋白、总胆红素水平均明显高于对照组,并明显高于治疗前(均P0.001);治疗期间观察组患儿并发症发生率明显低于对照组(P0.05)。结论早期微量喂养联合静脉营养对早产儿营养支持既能保证早产儿的能量、营养需求,又有锻炼早产儿胃肠功能,效果显著。     

极低出生体重儿早期不同喂养方法的临床观察

目的:观察对极低出生体重儿早期实施不同喂养方法的临床效果与安全性。方法:将出生体重≤1 500 g的66例早产儿根据其父母是否接受给孩子鼻胃管喂养母乳而分为观察组(31例)与对照组(35例)。在常规综合治疗的基础上,观察组生后12 h内予鼻胃管喂养母乳,同时辅以非营养性吸吮;对照组生后2天给予滴管滴入母乳或用棉签蘸母乳让患儿吸吮。观察两组患儿的吸吮吞咽功能建立时间、达足量肠内营养时间(指经口完成120 ml/kg.d)、达出生体重时间及坏死性小肠结肠炎、吸入性肺炎、呼吸暂停、低血糖、高胆红素血症的人次数。结果:两组患儿吸吮吞咽功能建立时间、发生坏死性小肠结肠炎、吸入性肺炎、呼吸暂停例数无明显差异(P>0.05);观察组达足量肠内营养时间、达出生体重时间较对照组短(P<0.05),而发生低血糖、高胆红素血症的人次数较对照组明显减少(P<0001、P<0.005)。结论:对极低出生体重儿早期实施鼻胃管喂养母乳同时辅以非营养性吸吮,较滴管滴入母乳或用棉签蘸母乳让患儿吸吮容易达足量肠内营养与恢复出生体重,且较少发生低血糖和高胆红素血症。     

早期微量喂养对极低出生体重儿营养及胃肠激素水平的影响

目的:探讨早期微量喂养对极低出生体重儿(VLBWI)营养及胃肠激素水平的影响。方法:将52例VLBWI随机分为2组,2组均应用静脉营养提供部分营养液,此外实验组采用生后24h内早期微量喂养,对照组采用常规喂养,比较两组的第1周末摄入热量、恢复出生体重时间、每日体重增长、达足量喂养时间、喂养不耐受发生的情况,测定两组VLBWI血中胃泌素(GAS)、生长抑素(SS)水平。结果:实验组每日体重增长增多,恢复出生体重时间、达足量喂养所需时间明显缩短,喂养不耐受率下降(P0.05);实验组生后7天的GAS水平比对照组高(P0.05),SS水平比对照组低(P0.05)。结论:早期微量喂养可影响VLBWI胃肠激素的分泌,促进胃肠功能成熟,改善喂养不耐受,促进VLBWI的生长发育。     

不同喂养方式对早产低体重儿体重增长的影响

目的探讨早产低体重儿喂养方式与体重增长的关系。方法将2008年5月—2011年8月收治的68例早产低体重儿随机分为两组。对照组采用静脉营养、早期微量喂养和头高脚低斜坡位;观察组在对照组的基础上加用非营养性吸吮和抚触。结果两组患儿生后4断口生后10d体重差异均有统计学意义（P〈0．05）。结论非营养性吸吮和抚触有利于早产低体重儿体重增加。通过对早产儿及低出生体重儿喂养方式的改善,可防止生理性体重下降幅度过大和维持正常体重增长,从而加快从静脉营养转为全量胃肠喂养速度,达到治疗目的。     

早产低出生体重儿50例静脉营养的临床疗效观察

目的探讨静脉营养对早产低出生体重儿生长发育的影响。方法将93例早产低出生体重儿随机分为静脉营养组50例和非静脉营养组43例。2组均根据病情给予一般性治疗,静脉营养组在24h内开始静脉营养,非静脉营养组则尽早开始母乳或早产儿配方奶,经口或鼻胃管喂养。结果静脉营养组与非静脉营养组病例,宫外生长迟缓(EUGR)发生率分别为16.0%和39.5%,恢复到出生体重的日龄分别为(11.4±4.0)d和(13.4±4.6)d,每日增加体重分别为(21.5±5.14)g/d和(19.3±4.71)g/d差异均有统计学意义(P0.05)。,黄疸消退的时间差异无统计学意义(P0.05)。结论静脉营养可以更好地满足早产低出生体重儿早期生长发育所需,避免发生宫外生长迟缓,同时未增加高胆红素血症等并发症发生的危险。     

新型护理干预对早产低出生体重儿喂养不耐受的影响

目的探讨新型护理干预对早产低出生体重儿喂养不耐受的影响。方法将78例适于胎龄的早产低体重儿分为两组各39例,对照组在常规治疗和静脉营养的基础上采用传统的护理方法,试验组在常规治疗和静脉营养基础上给予非营养性吸吮、微量泵间断胃管喂养、喂养后俯卧位及腹部抚触的措施,并贯穿在早产儿的日常护理中。观察两组喂养不耐受情况及呕吐、腹胀、胃残留发生情况,记录鼻胃管留置时间、恢复出生体质量时间及到达全肠道营养时间等。结果试验组患儿喂养不耐受发生率显著低于对照组(P<0.05);试验组患儿达到全肠道营养时间、恢复出生体质量时间、鼻胃管留置时间、第1次排黄便时间均较对照组显著缩短(P<0.05);试验组喂养出现腹胀、胃残留均显著少于对照组(P<0.05)。结论早产低体重儿喂养时给予新型护理干预能促进胃肠道功能的成熟,提高经肠道喂养的耐受性,有效减少喂养不耐受的发生。     

早期微量喂养联合非营养性吮吸治疗窒息后喂养不耐受新生儿疗效观察

目的探讨早期微量喂养联合非营养性吮吸在窒息后喂养不耐受新生儿中的应用价值。方法选取2014年11月—2017年2月收治的窒息后喂养不耐受新生儿110例,根据随机数表法分为对照组和观察组,每组55例。对照组实施非营养性吮吸治疗,观察组联合早期微量喂养,对比两组喂养效果、血清总胆红素及白蛋白水平、并发症发生率。计量资料比较采用t检验,计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果观察组恢复出生体质量时间、全量肠内营养时间短于对照组(均P<0.05);治疗7 d后,两组血清总胆红素水平降低(均P<0.05)、白蛋白水平升高(均P<0.05),且观察组优于对照组(均P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论早期微量喂养与非营养性吮吸联合治疗窒息后喂养不耐受新生儿,可有效改善血清总胆红素与白蛋白水平,加快患儿胃肠功能恢复,改善患儿营养状况,且安全性高。     

Impact of nutrition behaviour research on nutrition programmes and nutrition policy

Development of a society is interrelated with research. Innovation in food and nutritional sciences enable citizens to live in conditions of food security. Current dietary goals can be reached by understanding the biopsychosocial background of human nutrition behaviour. Examples of diffusion of such findings into practice are presented with emphasis on Germany and the activities of AGEV (the Working Association of Nutritional Behaviour), which was founded 25 years ago. Nutrition behaviour research should strengthen the focus on practical applications of its findings, since the prevalence of nutrition-related problems, like obesity in children and the estrangement on food and nutrition, is increasing.     

Preadmission nutrition screening: expanding hospital-based nutrition services by implementing earlier nutrition intervention

The need to screen patients earlier than within the first 24 hours of hospital admission has resulted in the development of preadmission nutrition screening. At Providence Saint Joseph Medical Center (PSJMC), a 455-bed acute-care facility, this procedure has been used since 1994. The preadmission screening method was developed because of the use of critical pathways for patients in specific diagnosis-related groups. Critical pathways specified that registered dietitians must assess these patients within 24 hours of admission at PSJMC. However, at that time there was minimal data in the chart from which to assess the patient's nutritional status and the ability to interview the patient was often limited as a result of intubation or postoperative pain. Family members were not always available at the hospital to discuss a patient's preadmission nutritional status. To address this problem, we developed a system to call people at home before their admission to the hospital to obtain specific nutrition information. To analyze the effectiveness of the procedure, the Food and Nutrition Services Department developed a process to assess this method of screening and to improve the system. Patients were enrolled in a study over a 1-month period, demographics were identified for this sample population, and patient satisfaction was determined via an interview conducted by a dietetic technician after the patient was admitted. Most patients found this to be a very helpful process and an example is presented here on the role of preadmission nutrition screening in improving patient outcome. To better define the population of the case study presented, additional information was gathered on a second study group of patients screened before admission who were admitted for hip and knee surgery, one of the specific diagnosis-related groups with a critical pathway. Our findings indicate that preadmission nutrition screening has the potential to improve patient outcomes by increasing nutrient intake before their hospital admission, reducing hospitalization length, and enhancing patient satisfaction during their hospital stay.     

Neonatal nutrition: a focus on parenteral nutrition and early enteral nutrition.

No population has benefited more from the development and advancement of specialized nutrition support than pediatric patients. Today, neonates comprise the largest group of pediatric patients receiving parenteral nutrition (PN). Nutrient needs of neonates differ substantially from other populations, presenting unique challenges in optimizing nutrition care. Neonates are highly susceptible to catabolic stress because of reduced energy stores and markedly increased energy needs. Immature organ systems and metabolic pathways further complicate the delivery of adequate nutrition in the preterm neonate. Early nutrition support is essential to improve survival, reduce catabolism, promote growth, and limit developmental complications. This article discusses feeding strategies for PN and early enteral nutrition in neonates, particularly the preterm neonate.     

Total parenteral nutrition and enteral nutrition in diabetes

A quarter or more of critically ill patients are likely to have carbohydrate intolerance or frank diabetes, either pre-existing or secondary to the stress of illness. Those patients who require parenteral nutrition should be treated using regimens similar to those used in nondiabetic patients, along with sufficient insulin (given by separate infusion) to maintain near-normal glycaemia. The role of novel substrates in diabetes remains to be established. In patients who require enteral nutrition, there is accumulating evidence that high-fat (as monounsaturated fatty acid) formulations achieve better overall metabolic control than conventional high-carbohydrate preparations. In view of the fact that macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes in particular, and the fact that the risk of macrovascular complications is relatively unaffected by glycaemic control, the improved lipid and haemostatic profile achieved with preparations that are high in monounsaturated fatty acids is of particular importance in patients on long-term nutritional support.     

老年患者胰十二指肠切除术后不同营养支持方法对肝功能和临床结局的影响

目的比较胰十二指肠切除术后老年患者肠外营养（PN）联合肠内营养（EN）与单纯PN对术后内毒素血症、肝功能与临床结局的影响。方法回顾性总结我院不同时段接受胰十二指肠切除术老年患者共48例,其中术后接受PN联合EN营养支持的患者25例为研究组（PN＋EN组）,单纯给予PN营养支持的患者23例为对照组（PN组）。记录其一般资料、比较术后内毒素水平和肝功能变化,以及临床结局（死亡率、并发症、术后住院日和总住院费用等）。结果两组内毒素水平术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,后随时间逐渐下降,其中术后7和14d分别与术后1d的差值比较,PN＋EN组的下降幅度显著大于PN组（P〈0．01）;两组谷丙转氨酶、谷草转氨酶、总胆红素和直接胆红素值术后1d较术前均有升高趋势,但组间比较差异无统计学意义（P〉0．05）,术后逐渐下降,术后14d与术后1d的差值PN＋EN组下降幅度显著高于PN组（P〈0．05）;PN＋EN组感染并发症（2／25,8．0％）显著低于PN组（6／23,26．0％,P〈0．05）;总并发症发生率、术后住院日、总住院费用两组差异无统计学意义（P〉0．05）。结论老年患者胰十二指肠切除术后PN联合EN可降低内毒素血症、改善肝功能、减少术后感染并发症。     

Towards implementation of optimum nutrition and better clinical nutrition support

Clinical Nutrition Support--defined as nutrition for hospitalized patients suffering from metabolic stress--plays a limited role in the therapeutic routine of the physician. This is not surprising as most research in the field of clinical nutrition is disappointing with regard to the objective outcomes: morbidity and mortality. These reflections advocate a more 'pharmaceutical approach' to nutrition in order to perform more proper studies on the potential effectiveness of this treatment modality. To provide all patients in the Academic Medical Centre (AMC) in Amsterdam, The Netherlands, with optimum clinical nutrition support, a Nutrition Support Team (NST) was established in 1996. This NST is coaching the dieticians and physicians in the AMC regarding clinical nutrition support. In practice this coaching consists of providing clear guidelines on what is supposed to be optimum nutrition, a basic course in parenteral nutrition and further continuous education. The concept of optimum nutrition is spread by the NST through various ways of education, both nationally and internationally. For adults, optimum nutrition is defined as the amount of protein, that stimulates whole body protein synthesis maximally (1.7 g/kg actual body weight) and covers anabolic energy need (35 kcal/kg actual body weight). The dietician is considered to be the expert in the field of optimum nutrition by oral, enteral or parenteral route. The Dietetic Department has increased its influence in the care of the patient by placing nutritional status and care on the chart of the patient's treatment. To provide optimal Nutrition Support for children and severe ill patients (Intensive care department) specialized teams were started which were co-ordinated by the central NST. The central NST has a co-ordinating and educating role, while the Specialized Nutrition Support Teams (Specialized NST) construct guidelines, undertake research and provide continuous optimum nutrition care.     

营养教育对医学生营养知识态度行为的影响

目的探讨营养教育对医学院学生营养知识、态度、行为的影响。方法随机抽取新乡医学院大学本科三年级13个班的学生,以集体授课方式进行营养教育,教育前后分别进行营养知识、态度、行为问卷调查。结果营养教育前后,营养知识、态度得分及总分差异有统计学意义(P<0.01),中国居民平衡膳食宝塔知晓率及营养知识水平差异有统计学意义(P<0.05);营养教育后更多调查对象希望从多种途径获得营养知识,并愿意改变不良饮食习惯(P<0.05);教育后摄入适量动物内脏的人数增加,摄入不健康食品减少(P<0.05),其他行为教育前后无统计学意义(P>0.05)。结论通过营养教育可提高医学生的营养知识水平,并使其愿意改变不良的饮食习惯,营养行为也有一定的转变。