母乳嗅觉刺激联合非营养性吸吮对早产儿喂养效果的影响

目的 探讨母乳嗅觉刺激联合非营养性吸吮对早产儿喂养进程及肠内营养并发症的影响,为早产儿营养支持提供参考。 方法 将114例早产儿按照随机数字表法分为对照组和干预组各57例。对照组给予常规管饲喂养护理;干预组在对照组基础上实施母乳嗅觉刺激联合非营养性吸吮,即用0.1 mL母乳（3滴）滴至早产儿舌下,并给予安抚奶嘴进行非营养性吸吮,同时用3 mL母乳将大棉签浸润后放置在距离早产儿鼻腔2～3 cm处进行嗅觉刺激。 结果 干预后,干预组全经口喂养时间、胃管留置时间、肠外营养维持时间及住院时间显著短于对照组（均P＜0.05）。两组开始经口喂养时间、出院体质量、喂养不耐受率及医院感染发生率差异无统计学意义（均P＞0.05）。 结论 母乳嗅觉刺激联合非营养性吸吮有利于缩短管饲喂养早产儿喂养过渡时间、胃管留置时间、肠外营养维持时间及住院时间,促进早产儿生长发育。     

经口喂养困难早产儿的早期综合干预

目的 探讨早期综合干预对早产儿经口喂养困难的防治作用.方法 将64例经口喂养困难早产儿随机分为对照组(33例)和干预组(31例),两组均给予胃肠道外营养和/或鼻饲管喂养、早产儿常规护理、抚触等;干预组在此基础上给予口部感觉运动干预、合适的喂养护理技巧等.观察并记录两组患儿胃肠外营养、鼻饲喂养及平均住院时间;开始经口喂养、达到完全经口喂养、恢复出生体质量时的日龄;恢复出生体质量后体质量增长速率等.结果 干预组胃肠外营养时间、鼻胃管喂养时间、平均住院时间显著短于对照组;开始经口喂养、达到完全经口喂养、恢复出生体质量时日龄均早于对照组;恢复出生体质量后体质量增长速率显著高于对照组(P＜0.05,P＜0.01).结论 早期综合干预能够缩短早产儿经口喂养困难时间,促进早产儿尽早完成向经口喂养模式的转换,是一种安全、有效的早期喂养干预方法.     

自编呼吸训练操在口腔喂养能力障碍早产儿中的应用

目的 探讨呼吸训练操应用于改善早产儿口腔喂养能力的效果。方法 将96例住院早产儿按时间段分为两组各48例,对照组行常规护理,观察组在此基础上采用自编呼吸训练操实施干预。结果 观察组干预10 d、15 d后非营养性吸吮评分显著高于对照组（均P＜0.01）;观察组留置胃管时间、经口喂养至全口喂养过渡时间显著短于对照组（均P＜0.01）。结论 呼吸训练操应用于早产儿可提高口腔喂养能力,加快经口喂养进程。     

多感官干预对早产儿经口喂养效果的影响

目的探讨多感官干预对早产儿经口喂养效果的影响。方法将60例住院早产儿随机分为观察组和对照组各30例。对照组实施常规护理,包括口腔护理和体位护理等。观察组实施听觉、触觉、视觉和前庭的多感官干预。结果观察组27例、对照组29例完成研究。观察组早产儿经口喂养过渡时间、鼻胃管留置时间、住院时间显著短于对照组(均P0.05)。结论多感官干预能改善早产儿经口喂养进程,提高喂养效率。     

早产儿经口喂养综合干预方案的构建与实践

目的 探讨经口喂养综合干预 对NICU早产儿经口喂养能力的影响。 方法 便利选取104例在NICU住院的早产儿,按时间段分为对照组和干预组各52例。对照组进行常规发育支持护理;干预组在常规发育支持护理的基础上进行口腔运动干预、吞咽训练及触觉/动觉刺激联合应用的经口喂养综合干预 。 结果 对照组49例,干预组47例完成全程研究。两组早产儿非营养性吸吮功能评分均逐渐升高,干预组干预第7天、14天时非营养性吸吮功能评分显著高于对照组（均P＜0.05）;开始经口喂养时,干预组经口喂养效率、喂养成效、摄入奶量比显著高于对照组（均P＜0.05）;达完全经口喂养时,干预组早产儿喂养效率和喂养成效显著高于对照组（均P＜0.05）;干预组实现完全经口喂养所需时间显著低于对照组（P＜0.05）。 结论 经口喂养综合干预有助于提高早产儿经口喂养能力,改善经口喂养表现,缩短早产儿经口喂养进程。     

多潘立酮联合腹部按摩治疗早产儿喂养不耐受效果观察

目的观察多潘立酮联合腹部按摩治疗早产儿喂养不耐受的效果。方法将78例喂养不耐受早产儿随机分为观察组（40例）和对照组（38例）．均给予保暖、抗感染、静脉营养、留置胃管鼻饲喂养．同时予以妈咪爱及胃蛋白酶助消化治疗。观察组在此基础上加用多潘立酮、腹部按摩,观察患儿喂养不耐受好转情况。结果观察组腹胀消失时间、达经口全胃肠喂养时间、拔除胃管时间均缩短．胃潴留量减少,与对照组比较,差异有统计学意义（均P〈0．01）。结论多潘立酮联用腹部按摩治疗早产儿喂养不耐受疗效显著。     

家属声频音乐疗法联合早产儿口腔运动干预用于早产儿的效果评价

目的 探讨家属声频音乐疗法联合早产儿口腔运动干预对早产儿喂养效果、住院时间及家属满意度的影响.方法 将入住NICU的早产儿按入院时间分为对照组48例和干预组52例.对照组住院期间在常规护理基础上采用口腔运动干预,2次/d,每次5 min;干预组在对照组的基础上,在每次口腔运动干预过程中播放家属录制的音频和(或)视频.结果 干预组干预第3、6、9天口腔运动功能评分显著高于对照组,全经口喂养过渡时间显著短于对照组,且干预组接受康复科会诊次数显著少于对照组,住院时间显著短于对照组,干预组患儿家属出院时满意度评分显著高于对照组(均P＜0.01).结论 家属声频音乐疗法联合口腔运动干预能促进早产儿口腔运动功能,加速喂养进程,促进早产儿康复,从而提升家属满意度.     

非营养性吸吮对早产儿鼻胃管留置时间的影响

目的探讨非营养性吸吮对早产儿鼻胃管留置时间的影响。方法将43例早产儿随机分成两组,非营养性吸吮(NNS)组(22例),在鼻胃管喂养期间给予吸吮空橡皮奶头,1次/3 h,每次吸吮10 min,连续2周;对照组(21例)单纯进行鼻胃管喂养。两组均给予同种早产儿特殊配方奶喂养,热量不足辅以静脉营养。观察期间每日测体重1次,记录生理性体重下降最大幅度、恢复出生体重时间、鼻胃管留置时间和住院时间。结果 体重下降最大幅度 NNS组(8.10±0.86)％,对照组(9.50±0.10)％;恢复出生体重时间 NNS组(8.76±0,83)d,对照组(9.94±1.56)d;鼻胃管留置时间和住院时间NNS组分别为(14.23±2.19)d和(22.47±3.41)d,对照组分别为(16.43±1.46)d和(24.56±3.22)d;两组比较,差异有显著性意义(均 P<0.05)。结论在鼻胃管喂养期问辅以NNS,可明显缩短早产儿鼻胃管留置时间和住院时间。     

早期导尿管球囊扩张联合冰刺激治疗脑卒中后吞咽障碍

目的 促进脑卒中患者吞咽功能的康复.方法 将首次发病的脑卒中后吞咽障碍患者60例随机分为扩张组和对照组各30例,对照组给予常规的药物治疗、功能锻炼,扩张组在此基础上,应用尿管球囊扩张环咽肌、冰水注入球囊刺激咽喉部.结果 扩张组留置胃管时间、住院时间显著短于对照组,吞咽功能康复疗效显著优于对照组(P＜0.05,P＜0.01).结论 对脑卒中后吞咽障碍患者早期采取尿管球囊扩张联合冰刺激干预,可促进脑卒中患者吞咽功能康复,缩短住院时间.     

神经系统疾病伴吞咽困难患者基于容积黏度吞咽试验的喂养管理

目的探讨基于容积黏度吞咽试验对神经系统疾病伴吞咽障碍患者进行喂养管理的效果。方法采用类实验研究方法,选择神经系统疾病伴吞咽困难住院患者,按照入院时间分为对照组(n=47)与观察组(n=61)。对照组实施常规护理,对洼田饮水试验2级患者给予饮食指导,3级及以上留置胃管实施管饲饮食;观察组在常规护理基础上采用容积黏度吞咽试验评估患者吞咽障碍的风险,根据评估结果实施个体化的喂养方案。结果观察组管饲饮食实施率显著低于对照组(24.59%与44.68%,P0.05),胃管留置时间显著短于对照组(10.13 d与14.05 d,P0.05),经口进食患者临床误吸征象发生率显著低于对照组(17.39%与42.13%,P0.05)。结论根据容积黏度吞咽测试可以为吞咽障碍患者提供精准的喂养方案,减少不必要的胃管留置,缩短管饲饮食时间,保障进食安全     

持续泵入鼻饲方式对相关并发症影响的系统评价

目的系统评价持续鼻饲和间歇鼻饲对并发症发生率的影响。方法计算机检索Cochrane图书馆、JBI循证护理中心图书馆、MEDLINE、EMbase、CINAHL、中国生物医学文献数据库(CBMdisc)、中国知网(CNKI)、中文科技期刊数据库(VIP),收集所有关于持续鼻饲或间歇鼻饲对并发症发生率影响的随机对照试验,同时筛检纳入文献附录的参考文献。由2名研究员按照纳入和排除标准筛选文献并提取资料,参考Cochrane系统评价手册的质量评价标准进行质量评价,使用RevMan5.1软件对符合质量标准的随机对照试验进行meta分析。结果共纳入16项研究。meta分析结果显示,持续泵入鼻饲营养液的方式与传统分次推注营养液的方式比较,腹泻、腹胀、胃潴留、反流、误吸、吸入性肺炎、应激性胃溃疡等并发症发生率差异均有统计学意义(P0.05,P0.01)。但是4项关于24h持续泵入与24h间歇泵入两种鼻饲方式的研究结果示,腹泻发生率差异无统计学意义(P0.05)。结论采取持续鼻饲方案,可以降低腹胀、胃潴留、腹泻、反流、误吸、吸入性肺炎、应激性溃疡等并发症的发生率,进而提高鼻饲的安全性和有效性。     

Implantable technology for pain management

Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact in patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.     

Comparison of the Interference Effects on Somatosensory Evoked Potential from Tonic,Burst, and High-dose Spinal Cord Stimulations

Spinal cord stimulations have been used widely to treat intractable neuropathic pain. The conventional spinal cord stimulation paradigm, the “tonic” type, suppresses excessive activation of wide dynamic range neurons in the dorsal horn via the collateral branch from the dorsal column. Therefore, preserved dorsal column function is an important prerequisite for tonic spinal cord stimulations. A tonic spinal cord stimulation requires eliciting paresthesia in the painful area due to stimulation of the dorsal column and dorsal root. Recent spinal cord stimulation paradigms, including burst and high-dose, are set below the paresthesia threshold and are proposed to have different pain reduction mechanisms. We conducted an interference study of these different stimulation paradigms on the somatosensory evoked potential (SEP) to investigate differences in the sites of action between tonic and new spinal cord stimulations. We recorded posterior tibial nerve-stimulated SEP in seven patients with neuropathic pain during tonic, burst, and high-dose stimulations. The total electrical energy delivered was calculated during SEP-spinal cord stimulation interference studies. High-dose stimulations could not reduce the SEP amplitude despite higher energy delivery than tonic stimulation. Burst stimulation with an energy similar to the tonic stimulation could not reduce SEP amplitude as tonic stimulation. The study results suggested different sites of action and effects on the spinal cord between the conventional tonic and burst or high-dose spinal cord stimulations.     

Implantable technology for pain management

Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact on patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.     

孕激素阻断LH峰用于促排卵的方案应用进展

随着卵泡发育基础内分泌理论的深入研究,以及胚胎玻璃化冷冻和冻融胚胎移植(FET)技术的不断完善,近年来控制性卵巢刺激(COS)方案呈现许多新进展,越来越趋向于简单化、多样化、个体化。孕激素阻断LH峰用于促排卵的方案简称孕激素阻断方案,是利用内源或外源性孕激素阻断LH峰,结合促排卵药物进行卵巢刺激的一种促排卵策略,包括黄体期促排卵(LPS)、卵泡期联合黄体期双重刺激(duostim),卵泡期高孕酮状态下促排卵(PPOS),以及其它孕激素方式下的促排卵方案。本文对孕激素阻断方案发展历史,作用机制,临床应用及适用人群等方面进行综述。     

Laparoscopic feeding jejunostomy: also a simple technique

Summary Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility. We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy.     

鸟嘌呤核苷补料发酵条件研究

采用新菌株Bacillus subtilis JSIM-518，在22L自控发酵罐上进行不同补料方式和所补原料的发酵研究，酵母粉连续补料，对鸟苷积累不甚明显，应用指数函数补料方式，匀速补入RNA和腺嘌呤物质，添加速率K值显得非常关键，当K=0．16时积累鸟苷最高，积累质量浓度为34．14g／L，高于和低于此值时，鸟苷的积累量都呈递减的趋势。     

Electromyogram-Controlled Functional Electrical Stimulation for Treatment of the Paralyzed Upper Extremity

Spinal cord lesions at level C5 to C6 lead to loss of hand functions and lesions at C4 to additional deficits of arm functionality. The presented dual channel surface stimulator with dual channel electromyogram (EMG) measurement was developed to investigate control strategies for an EMG-controlled implantable stimulation system and serves in addition as a therapy device for patients with partial innervation but weak muscle force. Four different control strategies for stimulation amplitude are available. The amplitude can be preset manually or can follow the preprocessed EMG signals proportionally. The shoulder control program allows proportional control of both stimulation channels with one EMG channel while the second EMG channel serves as the channel selector. Finally, a special feedback training program triggers a stimulation burst when EMG activity is detected. During a 2 year patient study, 18 patients from 2 hospitals and 1 rehabilitation center performed the feedback training. Almost all patients obtained an improvement of functionality. Apart from muscle strengthening, the feedback effect led to an improvement of proprioception and supported relearning of motions. For the documentation of the training status, functional muscle test (British Medical Research Council) and measurements of power, angle, torque, muscle fatigue, and EMG were performed. Obviously, EMG triggered stimulation provides several advantages compared to conventional passive electrical stimulation.