益生菌联合谷氨酰胺在重型颅脑损伤中的应用效果分析

【摘要】 目的 探讨益生菌联合谷氨酰胺在重型颅脑损伤中的治疗效果。方法 选取 2019 年 3 月至 2021年 3 月西平县中医院收治的 66 例重型颅脑损伤患者作为研究对象, 按照随机数表法将其随机分为观察组 (34例)和对照组 (32例)。两组患者除给予机械通气、抗感染、开颅手术等治疗外, 观察组患者采用常规肠内营养联合益生菌与谷氨酰胺治疗, 对照组患者单纯采用常规肠内营养治疗, 对比两组患者治疗前后的肠黏膜屏障功能、营养状况及免疫功能。结果 治疗第 3、7、14 天, 观察组患者乳果糖排泄率、血浆二胺氧化酶 (DAO) 水平均明显低于对照组 (治疗第3天: t = 5.071、2.054, P＜0.001、P = 0.044; 治疗第7天: t = 6.299、4.526, P 均＜0.001; 治疗第14天: t = 9.333、5.404, P 均＜0.001)。治疗第14天, 两组患者白蛋白(ALB)、转铁蛋白(TRF)、前白蛋白 (PAB)以及免疫球蛋白 (Ig) A、IgG、IgM 水平均明显高于治疗前, 且观察组均明显高于对照组(t = 4.750、3.613、9.147、6.948、7.435、5.407, P 均＜0.001)。结论 益生菌联合谷氨酰胺治疗重型颅脑损伤, 可有效保护患者肠黏膜屏障功能, 改善机体营养状况, 提高免疫功能。     

早期肠内营养对重型颅脑损伤患者预后的影响

目的探讨早期肠内营养对重型颅脑损伤患者预后的影响。方法对72例重型颅脑损伤患者(格拉斯哥昏迷评分<8分)采用鼻饲管置管早期实施肠内营养支持作为治疗组。另72例重型颅脑损伤患者(格拉斯哥昏迷评分<8分)采用传统的延迟性胃肠内营养的同类患者作为对照组,进行有关的营养指标、并发症、预后的临床观察及统计学处理,并进行比较。结果治疗组营养指标均优于对照组(P<0.05),治疗组患者中晚期并发症均少于对照组,预后优于对照组(P<0.05)。结论对重型颅脑损伤患者采用鼻饲管置管进行早期肠内营养支持可减少并发症,改善预后。     

重型颅脑损伤术后早期不同营养支持的合理性研究

目的评价重型颅脑损伤术后早期不同营养支持的合理性及临床意义。方法将重度颅脑损伤术后的患者（GCS〈8分）随机分为A组（早期肠外营养组PN）、B组（早期肠内营养组EN）、C组（肠外肠内序贯营养支持）,每组34例。术后36～72h给予相同营养支持,观察各组营养状态的变化及并发症的发生率和预后死亡率。结果①营养评价A、C组比B组好,C组、B组差异显著（P〈0.05）。C组并发症少于B组（P〈0.05）。②C组的预后优于其它两组,C组的病死率最低（P〈0.05）。结论重度颅脑损伤术后患者早期全肠道外营养1周后过渡到肠内营养是比较合理的,这对预后差异有显著性意义。     

早期肠内营养治疗大面积重度烧伤患者疗效分析

【摘要】目的 探讨早期肠内营养治疗对大面积重度烧伤患者的临床疗效。方法 选取2016年1月至2020年1月中国人民解放军联勤保障部队第九九〇医院收治的80例大面积重度烧伤患者作为研究对象,并按照随机数表法将其随机分为观察组与对照组,每组40例,在给予抗感染、抗休克、清创换药等综合治疗的同时,观察组患者入院早期行肠内营养治疗,对照组患者入院早期行肠外营养治疗,对比两组患者血清总蛋白（STP）、白蛋白（ALB）、C反应蛋白（CRP）水平变化情况以及正氮平衡时间、创面愈合时间、创面感染与不良反应发生情况。结果 治疗第7天,观察组患者STP及ALB水平明显高于对照组、CRP水平明显低于对照组（t=3.453、2.354、3.336,P=0.001、0.021、0.001）;观察组患者正氮平衡时间、创面愈合时间均短于对照组（t=6.321、5.056,P均＜0.001）;治疗期间,观察组患者创面感染率与对照组无明显差异（χ2=2.813,P=0.094）,而不良反应发生率明显低于对照组（χ2=6.050,P=0.014）。结论 大面积重度烧伤患者早期行肠内营养治疗,可改善患者机体营养状况,促进创面愈合,减少胃肠道不良反应的发生。     

重度颅脑损伤后早期肠内匀浆膳营养支持的临床观察与护理

目的:探讨重度颅脑损伤后早期给予肠内匀浆膳营养支持的作用及护理。方法:本研究回顾性分析78例重型颅脑损伤临床资料,其中42例在伤后早期(<72 h)给予肠内匀浆膳营养支持,36例采用肠外营养。比较两组在营养状态、血清蛋白水平、相关并发症及临床预后的差异。结果:结果显示早期肠内匀浆膳营养组,在改善患者营养状态、血清生化指标及临床预后方面优于肠外营养组(P<0.05),两组在相关并发症方面无显著差异(P>0.05)。结论:重型颅脑损伤后早期采用匀浆膳肠内营养支持是一种既经济又有效的治疗措施,通过加强消化道护理有助于降低并发症、提高患者抗病能力并改善临床预后。     

早期肠内营养在重型颅脑损伤治疗中的作用

目的：探讨早期肠内营养在改善重型颅脑损伤病人营养状况中的作用及其安全性。方法：选择80例重型颅脑损伤病人并随机分为早期肠内营养组和肠外营养组,肠内营养组在伤后48h内放置鼻饲管后使用自配营养液实施早期肠内营养支持,肠外营养组使用氨基酸、脂肪乳及葡萄糖实施肠外营养支持,两组病例均按14～18cal/（kg·d）实施早期营养过渡支持,1周后两组病人均按30cal/（kg·d）提供营养支持。观察指标包括上臂肌围、血清总蛋白及白蛋白,每个指标在营养支持实施前测定1次,以后每周测定1次。结果：两组病人各自在改善上臂肌围、血清总蛋白以及白蛋白方面差别有统计学意义（P〈0.05）。在整个试验中未发现病人出现误吸及吸入性肺炎、腹泻、败血症等并发症。结论：早期肠内营养在改善重型颅脑损伤病人的营养状况中的作用是肯定的,亦是安全的。     

颅内压监测下阶梯式减压在重型颅脑损伤患者术中的应用

目的 探讨颅内压监测下阶梯式减压在重型颅脑损伤患者术中的应用效果。方法 选取2019年3月至2020年6月开封市中心医院收治的58例重型颅脑损伤患者作为研究对象,根据治疗方法将其分为观察组（29例）与对照组（29例）。观察组患者行颅内压监测下阶梯式减压术治疗,对照组患者行传统大骨瓣减压术治疗,对比两组患者格拉斯哥昏迷指数（GCS）评分变化情况、术后并发症（急性脑膨出、迟发脑血肿、术后脑梗死等）发生情况及死亡率。结果 术后1个月,观察组患者GCS评分为（10.67±2.19）分,明显高于对照组患者的（8.66±1.88）分（t=3.750,P＜0.001）;观察组患者术后出现急性脑膨出2例、术后脑梗死1例,并发症发生率为10.34%,对照组患者术后出现急性脑膨出5例、迟发脑血肿1例、术后脑梗死3例,并发症发生率为31.03%,两组间差异无统计学意义（χ2=3.783,P=0.052）;观察组患者中死亡6例,死亡率为20.69%,对照组患者中死亡12例,死亡率为41.38%,两组间差异无统计学意义（χ2=2.900,P=0.089）。结论 颅内压监测下阶梯式减压相对于传统大骨瓣减压而言,可明显促进患者意识恢复,提高患者预后。     

早期高压氧治疗对重型颅脑损伤患者并发症发生率的影响

目的:探讨高压氧（HBO）治疗对重型颅脑损伤并发症发生率的影响。方法:回顾性分析2016年2月至2021年2月石岛人民医院神经内科收治的重型颅脑损伤患者284例的临床资料,按照HBO首次治疗时间的不同分为早期组（ n=85）、中期组（ n=102）和晚期组（ n=43）。早期组为入院...     

肠内营养在颅脑损伤伴意识障碍患者中的临床效果分析

目的:探讨不同方式肠内营养对颅脑损伤伴意识障碍患者的临床效果。方法:颅脑损伤伴意识障碍患者分为治疗组和对照组,分别给予正规的肠内营养制剂治疗和家庭自制匀浆治疗。比较各营养指标、预后指标、感染并发症的发生率。结果:治疗组各项营养指标均高于对照组;预后好于对照组;感染并发症的发生均少于对照组。结论:给予正规的肠内营养制剂治疗可有效地改善患者的营养状况,降低感染并发症,改善患者预后,提高生存率。NRS2002方法和前清蛋白、转铁蛋白两项临床指标,可以及时发现颅脑损伤患者营养风险,为临床医生提供正确、合理的营养支持提供技术支持。     

肠内营养管理对高压氧治疗颅脑损伤患者消化道并发症的疗效

目的 探讨高压氧治疗中重型颅脑损伤患者实施早期肠内营养及高压氧治疗期间调整管饲液配方预防上消化道出血、肠胀气的效果.方法 中重型颅脑损伤伴昏迷患者分成观察组和对照组,各31例,观察组应用适宜营养制剂行早期肠内营养,在高压氧治疗期间应用自制管饲液行肠内喂养;对照组早期行静脉营养,高压氧治疗期间选用市售能全力制剂.观察上消化道出血、肠胀气发生率.结果 高压氧治疗前观察组发生上消化道出血2例(6.5%),对照组8例(25.8%);高压氧治疗时观察组发生肠胀气3例(9.7%),对照组10例(33.0%).2组比较,上消化道出血与肠胀气发生率差异均有统计学意义(P＜0.05).结论 适宜营养制剂进行早期肠内营养,可以减少颅脑损伤患者上消化道出血,利于患者进行早期高压氧治疗;在高压氧治疗期间自制管饲液可以减少高压氧治疗时的肠胀气发生率,减轻胃肠不适,利于康复.     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.