重症急性胰腺炎合并肠瘘病人早期营养支持治疗单中心回顾性研究

目的：调查重症急性胰腺炎合并肠瘘病人早期营养支持治疗的现状,并分析对病人临床结局的影响。方法：收集2022年5月至2023年5月就诊于东部战区总医院ICU 60例重症急性胰腺炎合并肠瘘病人的临床资料,统计分析病人行早期营养支持治疗的现状,并探究对病人临床结局的影响。结果：有45例（75.00%）和57例（95.00%）病人在入院48 h内开始EN治疗和PN治疗。入院前1周早期肠内营养（EEN）热卡达标率为44.20%,入院前1周早期肠内营养热卡达标组和非达标组,二者机械通气时间和住院费用差异具有统计学意义（P <0.005）,ICU住院时间差异无统计学意义（P> 0.005）。结论：重症急性胰腺炎合肠瘘病人早期肠内营养达标率稍低,与早期肠内营养非达标组相比,肠内营养达标组病人机械通气时间短,病人住院总费用低,可改善病人的临床结局。     

重型颅脑损伤后早期肠内营养相关并发症分析

目的:观察重型颅脑损伤后早期肠内营养(EN)相关并发症的发生特点、相关因素及防治措施.方法:360例接受早期肠内营养支持的重型颅脑损伤病人,入住ICU后进行GCS评分,置鼻胃(肠)管,48 h后开始EN,观察伤后第7 d EN最大输注量(mL/d)、过渡至完全肠内营养(TEN)的时间(d)、伤后第7 d实现TEN的病例数及血糖和血清清蛋白(ALB)和谷丙转氨酶变化,记录各种肠内营养并发症的发生率.结果:颅脑损伤后早期EN并发症发生特点:伤后1周内以腹胀、呕吐、反流和误吸为主,1周后以腹泻为主;腹胀和呕吐的发生与鼻饲管所在位置有关,腹泻发生与GCS评分和ALB水平呈负相关;GCS评分越低,EN耐受的最大输注量越低、过渡至TEN的时间越长、相关并发症的发生率亦增加.结论:重型颅脑损伤后早期肠内营养相关并发症与其损伤程度、血清清蛋白水平等因素呈负相关;使用鼻肠管可降低腹胀和呕吐的发生率.     

急性重症胰腺炎肠内营养的护理

目的探讨急性重症胰腺炎患者留置鼻肠管进行肠内营养的护理。方法对5例进行肠内营养的急性重症胰腺炎患者进行心理护理、肠内营养液置管护理及并发症的护理。结果2例患者发生腹泻,经调整输注速度及肠内营养液浓度后,能继续接受鼻肠管进行肠内营养;2例患者出现咽部炎症;1例患者发生管道堵塞。5例患者在进行肠内营养2周后表现血白蛋白水平较治疗前显著升高,C-反应蛋白、APACHEⅡ评分〈8分,评分较治疗前下降。结论通过采用鼻肠管进行肠内营养,能够改善急性重症胰腺炎患者的预后,降低住院费用,缩短病程。     

脑外科重症病人肠内营养相关并发症分析

目的:观察脑外科重症病人早期肠内营养支持中相关并发症的发生及其相关因素.方法:将78例收住ICU接受肠内营养支持脑外科重症病人(GCS为4～8分),按GCS评分,分为特重症组及一般重症组两组,观察肠内营养喂养量、输注速度、EN天数、血清清蛋白及肠内营养的耐受情况,总结各种肠内营养并发症的发生率.结果:脑外科重症病人在输注速度、最大耐受量、腹泻、腹胀等并发症方面均有明显不同.特重症组肠内营养液输注速度、最大维持量等,均低于一般重症组,EN天数、腹泻、腹胀的发生率高于一般重症组;腹泻发生与ALB、GCS评分水平呈负相关,与输注速度呈正相关.结论:肠内营养相关的胃肠道并发症,与疾病的严重程度、肠内营养输注速度和用量、血清清蛋白水平等因素相关.     

颅脑损伤病人早期肠内营养支持

在该科 1999年 3月～ 11月间收治入院的 2 0例重型颅脑损伤病人中 ,开展早期肠内营养支持治疗 ,对颅脑损伤早期和肠内营养支持期间可能影响营养支持的并发症进行分析总结。结果 :118例病人在伤后 5～ 7天内达到 15 0 0～2 0 0 0 m l/天的鼻饲量 ;2创伤后一周内病人的消化道并发症以腹胀、呕吐、胃内容物反流和误吸多见 ,一周后则以腹泻和便次增多多见 ,多数情况下不必停止肠内营养支持而仅需对症处理即可缓解症状 ;35例病人在创伤早期存在不同程度的上消化道出血 ,其中 4例仍按常规进行肠内营养支持 ,均耐受良好。结论 :多数重型颅脑损伤病…     

重症急性胰腺炎早期肠内营养及护理

目的:探讨重症急性胰腺炎(SAP)早期经鼻空肠管行肠内营养支持的方法和护理措施。方法:对45例SAP患者早期使用鼻空肠管行肠内营养支持和护理的临床资料进行回顾分析。结果:45例患者中均未发生误吸,其中4例发生腹胀,3例发生轻度腹泻,无SAP复发,住院时间明显时缩短,患者均全部痊愈出院。结论:鼻空肠管行肠内营养是SAP患者支持治疗的重要手段,做好鼻空肠管的护理,预防和对症处理并发症,促进了患者的早日康复。     

重症急性胰腺炎早期肠内营养及护理

目的：探讨重症急性胰腺炎(SAP)早期经鼻空肠管行肠内营养支持的方法和护理措施。方法：对45例SAP患者早期使用鼻空肠管行肠内营养支持和护理的临床资料进行回顾分析。结果：45例患者中均未发生误吸,其中4例发生腹胀,3例发生轻度腹泻,无SAP复发,住院时间明显时缩短,患者均全部痊愈出院。结论：鼻空肠管行肠内营养是SAP患者支持治疗的重要手段,做好鼻空肠管的护理,预防和对症处理并发症,促进了患者的早日康复。     

重症急性胰腺炎不同营养支持方式的护理和效果

目的 :比较肠外营养和经鼻-空肠管途径肠内营养在治疗重症急性胰腺炎病人中的应用效果,总结护理方法。方法 :将收治的85例重症急性胰腺炎病人按入院先后分为试验组和对照组。对照组病人给予常规肠外营养支持治疗及相应理,试验组病人则采用鼻-空肠管行肠内营养支持治疗,并在治疗期间给予相应的临床护理干预,就两组病人的各项临床指标进行比较分析。结果 :两组病人护理干预前的血清CRP、ALB、TP水平比较无统计学差异(P0.05);营养治疗及护理干预后,两组病人的CRP、ALB、TP水平均有改善,但试验组改善幅度明显大于对照组,组间差异有统计学意义(P0.05)。试验组病人治疗后BMI指数于对照组未见明显差异(P0.05)。同时其首次下床时间、机械通气时间、腹胀缓解时间、血淀粉酶以及尿淀粉酶恢复时间均较对照组有明显降低(P0.05)。两组病人腹胀、腹泻、恶心呕吐、上消化道出血等并发症比较,试验组均明显低于对照组(P0.05)。结论 :经鼻-空肠肠内营养支持治疗在有效纠正重症急性胰腺炎营养不良的同时,还能够对胃肠道起到保护作用,降低并发症的发生率。良好的临床护理干预能够保证肠内营养的顺利实施。     

腹内压联合胃残余量监测对急性胰腺炎患者早期肠内营养耐受性的评估价值

目的探讨腹内压联合胃残余量监测在急性胰腺炎患者早期肠内营养耐受性观察中的作用。方法选取2015年1月—2018年8月住院治疗的通过鼻空肠管进行肠内营养的急性胰腺炎患者264例为研究对象,根据监测手段不同分为A、B、C三组,每组患者88例,A组联合腹内压和胃残余量监测早期肠内营养耐受性; B组仅观察腹内压监测急性胰腺炎患者早期肠内营养耐受性; C组仅观察胃残余量监测急性胰腺炎患者早期肠内营养耐受性。比较各组早期肠内营养并发症(腹胀、呕吐、腹泻)发生率,置入营养管术后第72 h、6 d和10 d的血清CRP、血清钙、腹腔内压、腹腔引流量,以及各组治疗效果(腹痛缓解时间、ACS发生率、达到目标喂养量的住院时间以及行胰腺坏死组织清创术比率)。结果 A组腹胀、呕吐和腹泻发生率显著低于B组和C组,差异具有统计学意义(P <0. 05);三组患者术后第72 h的血清CRP、腹腔内压和腹腔引流量均开始下降,血清钙均开始升高,A组患者第6天和第10天的血清CRP、腹腔内压和腹腔引流量下降幅度较B组和C组更大,血清钙升高幅度较B组和C组更大,差异具有统计学意义(P <0. 05); A组患者腹痛缓解时间较B组和C组患者短,ACS发生率以及行胰腺坏死组织清创术比率较B组和C组患者低,A组住院时间也显著少于B组和C组,差异具有统计学意义(P <0. 05)。结论通过加强监测腹内压和胃残余量来控制患者肠内营养的量及速度,能有效避免不耐受症状的发生,使患者早日达到目标喂养量,值得在临床上推广使用。     

纤维型肠内营养制剂治疗菌群失调性腹泻的疗效观察

目的:观察纤维型肠内营养制剂纽纤素对重度脑损伤并发菌群失调性腹泻的治疗作用. 方法:随机选择20例重度脑损伤并发菌群失调性腹泻的病人作为临床观察组,使用肠内喂养输注系统,泵入或重力滴注纽纤素;用传统方法治疗20例病人作为对照组. 结果:临床观察组所有病人于7～10 d内腹泻得到控制,而且肠内营养达全量.观察20 d,血清清蛋白维持在正常水平,内环境稳定.应用传统方法治疗的病人腹泻10～15 d逐渐控制,肠内营养支持不能正常进行,营养状况较差. 结论:纤维型肠内营养制剂纽纤素对重度脑损伤并发菌群失调性腹泻具有治疗作用,从而达到不停止肠内营养治疗而止泻的目的.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.