肠内营养对重型破伤风患者营养支持的探讨

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.     

肠内营养对重型破伤风患者营养支持的探讨

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.     

肠内营养对重型破伤风患者营养支持的探讨

目的 探讨重型破伤风患者应用肠内营养(EN)支持对患者营养状况的影响.方法 将60例重型破伤风患者随机分为EN组和对照组,每组各30例,EN组在常规治疗的基础上给予肠内营养,对照组在常规治疗基础上给予部分静脉营养,于营养支持前一天及营养治疗后第11天检测两组患者的BMI、TSF、MAMC,TP、PA、ALB及Hb等指标,并且全程观察不良反应及疗效.结果 营养支持10天后两组患者的BMI、TSF、MAMC下降不明显,EN组的TP、PA、ALB及Hb均高于同期对照组(P＜0.05).EN组并发症发生率(16.7%)低于对照组(36.7%),两组比较有统计学意义(P＜0.05).结论 早期EN可改善重型破伤风患者蛋白质代谢和患者营养状况,提高了机体免疫功能,减少并发症.

Abstract：

Objective To study the effect of enteral nutrition on patients with severe tetanus. Methods The patients totaled 60 cases were divided into two groups with 30 cases in each. The patients in EN group were treated with enteral nutrition on basis of routine treatment, control group was treated with total parenteral nutrition (TPN). The indicators values of BMI, TSF, MAMC, TP, PAm, m, ALB and Hb were tested on the day before nutrition supports and after nutrition supports 10 days later in two groups. Adverse reaction and the treatment effect were observed simultaneously. Results With nutritional supports 10 days later, two groups had no obvious decline in BMI, TSF and MAMC. TP, PA, ALB and Hb of EN group were higher than those of control group (P＜0.05) . Complication rate of EN group was lower than that of control group, there was significant differences (P＜0.05) . Conclusions Early EN may improve protein metabo lism in patients with severe tetanus and nutritional status.     

血必净与低分子肝素对严重脓毒症患者凝血功能及预后的影响

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.     

血必净与低分子肝素对严重脓毒症患者凝血功能及预后的影响

目的 比较血必净与低分子肝素(low molecular weight heparin,LMWH)对严重脓毒症患者凝血功能及疾病预后的影响,以指导脓毒症的治疗.方法 将89例经随访取得有效数据的严重脓毒症患者随机(随机数字法)分为3组,血必净组(A组)、LMWH组(B组)和常规组(C组).C组给予常规治疗,A组及B组在常规治疗的基础上分别加用血必净注射液和LMWH联合治疗.3组分别于治疗前及治疗后7 d检测凝血指标,记录APACHE Ⅱ评分,随访统计住院天数及28 d病死率.统计分析采用成组t检验、方差分析、q检验、x2检验和秩和检验,以P＜0.05为差异具有统计学意义.结果 ①治疗后与治疗前组内比较,A组各凝血指标均有明显改善(P＜0.01),其余2组有部分凝血指标改善(P＜0.05或P＜0.01);治疗后经组间比较,A组各凝血指标较其他2组改善明显(P＜0.05),B组与C组比较,只有部分指标改善(P＜0.05).②治疗后与治疗前比较,A组及B组APACHEⅡ评分明显下降(P＜0.05);治疗后经组间比较,A组与B组APACHEⅡ评分差异无统计学意义(P＞0.05),二者分别与C组比较明显下降(P＜0.05).③3组住院天数比较差异无统计学意义(P＞0.05).④3组28 d病死率比较,A组及B组较C组28 d病死率降低,差异具有统计学意义(均P＜0.05).结论 血必净可明显改善严重脓毒症患者的凝血功能,低分子肝素只能改善部分凝血指标;二者均可降低病死率、改善预后.

Abstract：

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.     

自我效能训练对中青年卒中患者依从性的影响

Objective To explore the influence of self-efficiency training on therapy compliance of young stroke patients.Methods According to random sampling survey,120 young stroke patients were selected,there were 60 cases in cintrol group who accepted routine therapy and routine health education,while in experimental group,60 cases accepted not only routine therapy and health education but also four-week self-effciency training.Referring to general self-effciency form and therapy compliance questionnaire to assess the effects of self-efficiency training and therapy compliance before training and after training respectively.Results The self-efficiency of young stroke patients were in the low level,meanwhile,the therapy compliance were generally poor. After four-week training,the scores of experimental group was significantly higher than that of control group in self-efficiency and therapy compliance(P＜0.01,P＜0.05,respectively).There was significant difference betwem them.Conclusions Through self-efficiency taining,the self-efficiency and therapy compliance of young stroke patients could be improved so as to open a new door reduce the incidence and the recurrence recurrence rateof disease.     

自我效能训练对中青年卒中患者依从性的影响

Objective To explore the influence of self-efficiency training on therapy compliance of young stroke patients.Methods According to random sampling survey,120 young stroke patients were selected,there were 60 cases in cintrol group who accepted routine therapy and routine health education,while in experimental group,60 cases accepted not only routine therapy and health education but also four-week self-effciency training.Referring to general self-effciency form and therapy compliance questionnaire to assess the effects of self-efficiency training and therapy compliance before training and after training respectively.Results The self-efficiency of young stroke patients were in the low level,meanwhile,the therapy compliance were generally poor. After four-week training,the scores of experimental group was significantly higher than that of control group in self-efficiency and therapy compliance(P＜0.01,P＜0.05,respectively).There was significant difference betwem them.Conclusions Through self-efficiency taining,the self-efficiency and therapy compliance of young stroke patients could be improved so as to open a new door reduce the incidence and the recurrence recurrence rateof disease.     

小剂量肝素干预治疗热射病非显性DIC患者的临床观察

Objective To investigate the therapeutic effect and safety of low-dose heparin therapy for heat stroke with pre-diffuse intravascular coagulation (pre-DIC). Methods 35 cases of heat stroke with preDIC were randomly divided into two groups, 18 cases were treated with low-dose heparin therapy (treatment group, n = 22, given heparion by 70U/kg for 3 days, 24 hours of continuous pump), 17 cases were treated with conventional therapy(control group). The incidence of DIC and mortality in two groups were observed and compared. Results Incidence of DIC and mortality in treatment group were significant lower than those in control group(P ＜0. 05). After the treatment group therapy, a statistically significant increase BPC (P＜ 0. 01). No significant differences APTT PT, (P ＞ 0.05). Conclusion Low-dose heparion is applied early in heat stroke patients in pre-DIC stage, which could not only prevent efficiently DIC, but also diminish mortality.     

亚低温治疗对心搏骤停心肺复苏患者预后影响

Objective To study clinical effect of moderate hypothennia treatment in patients with cardiac arrest survivors and search a practical monitoring way during moderate hypothennia treatment. Method A total of 40 patients of CPR following the restoration of spontaneous circulation were randomly divided into the hypothermia therapy group ( n= 20) and the routine therapy group ( n= 20), the clinical effect on patient followed for three months is evaluated. At the same time regional cerebral oxygen saturation (rSO2) was detected at different times after moderate hypothennia treatment in two groups. Results The recovery rate were higher and the mutilation rate was lower in hypothermia therapy group than that of the routine therapy group. rSO2 obviously increased after 12 hours of hypothermic treatment, and continuing kept stable level after 24 hours of hypothermic treatment, but it was also higher than routine therapy group (P＜0.01). Conclusions Moderate hypothermia can alleviate the metabolic disorder of the brain tissue and improve the prognosis in patients with cardiac arrest survivors. Noninvasire continuously monitoring of rSO2 has important significance for instructing moderate hypothermia treatment in clinic.     

腹腔压力与重症急性胰腺炎严重程度的关系

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.     

早期胃镜下鼻空肠管置人肠内营养对急性重症胰腺炎内毒素血症的影响

目的观察早期胃镜下置人鼻空肠管行肠内营养对急性重症胰腺炎（SAP）肠源性内毒素血症的治疗作用。方法43例符合条件的SAP患者随机分为两组,肠内营养组24例：早期行胃镜下鼻空肠管置人行肠内营养治疗;全胃肠外营养组19例：行全肠外营养治疗。观察比较患者的腹痛、腹胀时间、血浆内毒素的改变,同时了解血浆白蛋白、淀粉酶恢复时间以及并发症发生率。结果肠内营养组患者腹痛、腹胀缓解时间分别为（3．3±2．2）、（7．6±3．2）d,明显优于全肠外营养组[分别为（7．1±3．8）、（13．3±4．9）d,F值分别为48．038、63．567,P均〈0．01],发生胃肠道出血0例、肺部及肠道感染1例、高血糖2例、胰腺囊肿1例,并发症亦少于全肠外营养组（分别为5、10、8、6例,X2值分别为7．147、13．084、6．777、5．847,P〈0．05或P〈0．001）。血浆内毒素在肠内营养组中下降较早、较快,治疗后14d降至（0．19±0．11）EU／ml,明显低于全肠外营养组的（0．85±0．28）EU／ml,两组间比较差异有统计学意义（t=10．456,P〈0．001）。肠内营养组血浆淀粉酶治疗前及治疗后7、14d分别为（1623±479）、（547±322）、（179±106）U／L,全胃肠外营养组分别为（1467±589）、（789±503）、（233±156）U／L,两组血浆淀粉酶较治疗初期均显著降低,两组间比较在治疗后7、14d时差异无统计学意义（t值分别为3．117、1．889,P均〉0．05）。两组血浆白蛋白治疗后均升高,但两组间差异无统计学意义（P〉0．05）。结论胃镜下鼻空肠管置入早期肠内营养治疗能显著改善SAP患者的症状、减少并发症、保护肠黏膜,有利于SAP肠源性内毒素血症的治疗。     

经鼻空肠管肠内营养在急性重症胰腺炎患者中的应用

目的探讨经鼻空肠管行肠内营养在急性重症胰腺炎患者中的应用。方法将急性重症胰腺炎30例随机分为肠内营养组（EN组）（16例）和全胃肠外营养组（TPN组）（14例）,观察两组治疗结果以及临床指标的变化。结果营养支持2周后两组患者的APACHEⅡ评分、CT评分较前显著降低（P〈0．01）,且EN组的各项评分均显著低于TPN组（P〈0．01）。营养支持后两组的血清白蛋白均较前有明显改善（P〈0．01）,但两组比较无显著性差异（P〉0．05）。EN组治疗后血清前白蛋白水平与治疗前明显增高（P〈0．05）,且与TPN组比较亦有显著性增加（P〈0．05）。EN组平均住院天数显著缩短,中转手术率、感染率、死亡率方面EN组均显著低于PN组（P〈0．05）,且MODS发生率两组有显著性差异（P〈0．01）。结论经鼻空肠管肠内营养支持方式的疗效优于完全胃肠外营养,对重症急性胰腺炎的治疗起了积极作用。     

应用品管圈降低鼻空肠管肠内营养堵管发生率

目的 探讨开展品管圈活动降低鼻空肠营养管肠内营养期间堵管的发生率的经验与方法。方法 采用便利取样法，抽取2017年1月至2月江苏大学附属人民医院开展品管圈活动后实施鼻空肠管肠内营养的159例患者作为实施后组。利用品管圈对鼻空肠营养管肠内营养期间的堵管情况进行基线调查、原因分析、对策拟定、实施评价，通过制订规范化的肠内营养护理实施流程并推广实施、促进封管和堵管的规范处理执行流程、制作通俗易懂的健康宣教手册、完善合理用药配伍、配合个体化的功能锻炼计划等措施。将2016年10月至12月未开展品管圈活动前实施鼻空肠营养管肠内营养支持治疗的162例患者作为实施前组。对比品管圈实施前后鼻空肠营养管肠内营养期间堵管的发生率。结果 通过开展品管圈活动，实施后组鼻空肠营养管肠内营养期间堵管发生率为3.77%，低于实施前组的9.25%（X2=3.95，P=0.04）。结论 品管圈活动能有效降低鼻空肠营养管肠内营养期间堵管的发生率。     

胃镜辅助下鼻空肠管置入及空肠营养在神经内科重症监护病房中的应用

目的探讨胃镜辅助下鼻空肠管置入及空肠营养在神经内科重症监护病房(NICU)中的应用价值。方法前瞻性分析该院NICU 2014年5月-2017年5月收治的重症脑血管病患者共56例。上述患者均于入院后72 h内发现胃残余量增多(100 ml)。鼻空肠组行床旁鼻胃镜导丝引导置入并行鼻空肠营养共28例,对照组继续给予普通胃管置入并行肠内营养共28例。对比两组患者胃肠道并发症(包括呕吐、反流、腹胀、腹泻、应激性溃疡)发生率、营养状态参数(包括血清白蛋白、前白蛋白、血红蛋白)、医院获得性肺炎(HAP)发生率、炎症指标[包括血白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)]、入住NICU时间、NICU费用、格拉斯哥昏迷评分(GCS)、病死率。结果经鼻胃镜导丝引导下鼻空肠管置入成功率100.0%。鼻空肠组营养状态参数优于对照组,入住NICU时间较短、NICU费用较低,炎症指标较低,两组胃肠道并发症发生率、HAP发生率、GCS评分和病死率差异无统计学意义。结论对于NICU胃残余量增多的患者经胃镜辅助下置入鼻空肠管行空肠营养值得推荐。     

心理干预对肠内营养治疗慢性阻塞性肺病患者焦虑情绪的影响

目的：探讨心理干预对肠内营养治疗慢性阻塞性肺病患者焦虑情绪的影响。方法将52例慢性阻塞性肺病患者随机分为两组,均接受呼吸内科常规治疗及护理,并予以肠内营养治疗,研究组在此基础上联合心理干预。观察2周。采用焦虑自评量表评估患者的焦虑情绪。结果置管后两组焦虑自评量表评分均较置管前显著升高（P＜0．01）,置管7 d末研究组较置管3 d末显著降低（P＜0．05）,且显著低于对照组（P＜0．05）。结论肠内营养治疗慢性阻塞性肺病患者均存在不同程度的焦虑情绪,对其予以心理干预能有效缓解或消除患者的焦虑情绪。     

高龄食管癌患者术后早期肠内营养的临床研究

目的 探讨高龄食管癌患者术后早期肠内营养的意义.方法 选取62例70岁以上食管癌患者,随机分肠内营养(EN)组和肠外营养(PN)组,对术前、术后第1天、术后第8天的血清白蛋白、前白蛋白、外周血淋巴细胞、血清免疫球蛋白(IgG、IgM、IgA)、补体C3和C4进行测定.并观察术后感染性并发症和心血管并发症发生状况.结果 术后第8天2组比较,tALB=2.535、tPA=2.880、t淋巴细胞数=2.720、tIgA=2.166、tIgM=2.065、tC3=4.103、tC4=2.478,P均＜0.05,表明EN组在改善营养状况、增强免疫力方面优于PN组.术后并发症比较,x2感染性并发症=4.24、x2心血管并发症=15.55,P均＜0.05,表明EN组并发症的发生率低于PN组.结论 高龄食管癌患者术后早期肠内营养能明显改善患者营养状况、增强机体免疫力、减少并发症的发生率.     

早期肠内营养支持对接受机械通气治疗的急危重症患者的效果

目的 探讨早期肠内营养（enteral nutrition, EN）支持对接受机械通气治疗的急危重症患者的效果。方法 将急危重症患者70例,随机分为A组35例和B组35例。两组均进行常规治疗,A组给予早期肠内营养支持,B组于入院48 h后给予肠内营养支持。对治疗后的营养学指标、免疫学指标、营养不良发生率、呼吸机相关肺炎（VAP）发生率、机械通气时间及住院时间进行比较。结果 两组治疗后血红蛋白、血清清蛋白均较治疗前高,A组较B组高（P＜0.05）。两组治疗后血清总蛋白均较治疗前低,A组较B组低（P＜0.05）。两组治疗后免疫功能指标均显著改善（P＜0.05）。A组免疫功能指标中的CD3+、CD4+、CD4/CD8水平均高于B组,CD8+水平低于B组（P＜0.05）。治疗后A组营养不良发生率（8.57%）、VAP发生率（2.86%）均较B组不良反应发生率（42.86%）、VAP发生率（28.57%）低（P＜0.05）。A组治疗后的机械通气时间和住院时间均较B组短（P＜0.05）。结论 为有效预防机械通气治疗中急危重症患者发生营养不良,在常规药物治疗的基础上给予早期肠内营养支持具有较为显著的临床效果。     

鼻肠管肠内营养在神经外科昏迷患者营养支持中的应用

目的探讨鼻肠管肠内营养在神经外科昏迷患者营养支持中的应用效果。方法选取神经外科手术昏迷患者78例,随机分为鼻胃管组与鼻肠管组。鼻胃管组给予鼻胃管肠内营养,鼻肠管组给予鼻肠管肠内营养,比较2组治疗前、治疗后14 d血清白蛋白(Alb)、血红蛋白(Hb)、血清前白蛋白(PAB)水平和并发症发生率。结果治疗后14 d,2组Alb、Hb、PAB水平均较治疗前明显升高(P0.05或P0.01),且鼻肠管组改善程度明显优于鼻胃管组(P0.01)。鼻肠管组并发症总发生率明显低于鼻胃管组(P0.01);2组误吸和返流发生率比较差异有统计学意义(P0.05)。结论神经外科昏迷患者经鼻肠管给予肠内营养治疗,能明显改善患者营养状况。     

营养泵在气管切开患者肠内营养中的应用及护理

目的探讨气管切开患者用营养泵行肠内营养支持的临床应用价值及护理方法。方法将70例气管切开患者随机分为观察组和对照组各35例,观察组采用营养泵控制肠内营养液的速度行持续泵入法,同时使用加温器保持营养液温度在35～40℃。对照组采用传统30ml注射器缓慢推注营养液的方法。观察两组并发症的发生情况。结果观察组反流、呕吐、呛咳、腹泻、吸入性肺炎的发生率明显低于对照组,差异有统计学意义（P〈0．05或P〈0．01）。结论应用营养泵行肠内营养支持的方法可有效降低气管切开患者并发症的发生,且应用简便、省力、安全。