慢性重症肝炎患者营养支持及疗效评价

目的: 评价慢性重症肝炎患者营养状况、营养支持及疗效。方法: 143例慢性重症肝炎患者,入院后进行SGA评估,明确营养状况。分三组,肝病综合治疗和肠内营养+肠外营养;综合治疗+肠外营养;综合治疗+肠内营养。监测0~6 w肝功能及营养指标变化,最后评价临床疗效。结果: 90%以上患者存在中重度营养不良。综合治疗+肠内和肠外营养方案改善肝功能(ALT、Tbil)及营养指标(TP、TC)效果最好,显效率明显高于另两组(P<0.05)。肠内营养略好于肠外营养方案。结论: 慢性重症肝炎患者多数存在营养不良。综合治疗的同时肠内+肠外营养支持疗效最好,应鼓励患者适量进食。     

慢性放射性肠损伤病人的围手术期营养支持

目的:探讨慢性放射性肠损伤(CRII)病人围手术期营养支持情况。方法:采用主观全面评价(SGA)系统回顾性总结206例CRII病人围手术期营养支持情况,并对CRII病人的营养状况进行评估。结果:206例CRII病人接受手术229例次,86.16%的病人入院时有营养不良。经围手术期营养支持和手术治疗后,病人的营养状况得到了明显改善,但营养不良发生率仍然较高。结论:CRII病人的营养不良发生率甚高,围手术期营养支持时间较长,围手术期营养支持和手术能明显改善病人的营养状况。     

重症监护科老年患者肠内营养支持的护理

目的:通过对长期住院的老年重症患者实施监测,给予合理的肠内营养支持,以维持生理功能,改善临床症状,提高生命质量。方法:为患者制定完整的肠内营养管理流程,包括准确评估营养不良的程度,预测营养不良的风险,采取营养支持方法,及时监测病情,加强并发症护理等。结果:通过对本组患者的监测和护理,改善了营养状况,无一例因为营养不良而死亡或加重病情。结果:合理的肠内营养管理措施,能有效的改善营养状况,提高危重患者抢救的成功率。     

呼吸科住院患者营养状况和疾病负担调查分析

目的调查呼吸科住院患者营养状况和疾病负担,了解对患者进行营养支持的情况,分析营养支持的效果和营养支持对疾病负担的影响。方法采用营养风险筛查(NRS 2002)对呼吸内科2016年6—8月入住的192例住院患者进行营养风险筛查,分别在入院后、住院或营养干预7天后检测患者总蛋白、白蛋白、前白蛋白和血红蛋白,了解患者的营养状况。统计并分析营养风险、营养不良发生情况、营养支持情况以及患者住院天数和住院总费用。结果慢性阻塞性肺病住院总费用较高,呼吸科60岁以上老年患者营养不良发生率明显高于非老年患者(P0.05)。经过营养支持的存在营养风险或营养不良患者总蛋白、白蛋白和前白蛋白较入院时明显改善(P0.05),但是住院时间、住院总费用并没有明显减少(P0.05)。呼吸科未接受营养支持或营养干预的患者住院期间总蛋白、白蛋白有下降趋势(P0.05)。结论呼吸科住院患者营养不良发生主要集中在老年人群。营养支持虽然能明显改善患者营养状况,但无法减少住院天数和总费用。无论有无营养风险或营养不良,如果不适时予以营养干预或患者自身认识不够,其营养状况均有下降趋势。     

神经性厌食合并肝损害肠外营养治疗1例

神经性厌食是一类由心理因素引起的以怕胖、进食行为紊乱、体重明显下降、体象障碍等为主要特征的慢性难治性精神障碍, 患者因长期进食不足常导致重度营养不良, 甚至合并肝功能损害, 这类患者通过个性化的营养治疗可逐步改善营养状况和肝功能。本案例为1例重度营养不良合并肝功能损害的神经性厌食症患者制订了个性化的营养治疗方案, 充分评估了再喂养综合征的风险后, 通过肠外营养过渡到口服营养补充+膳食营养治疗方法, 逐渐改善了患者的营养状况, 病情稳定后好转出院。     

肺癌重症患者的营养状况评估及营养支持特点

目的探讨肺癌重症患者的营养状况评估及营养支持特点。方法选取本院于2016年11月——2017年12月期间纳入的肺癌重症患者共计80例,利用专用型营养风险筛查表,对患者入院时所存在的营养状况进行评估,从中剖析营养支持临床结局、入住ICU时间及机械通气的影响。结果入住时,在40例存在营养风险与营养不良患者中,接受早期营养支持40例;在没有营养风险的40例患者中,接受营养支持5例。NRS评分> 3分的肺癌重症患者,早期行营养支持者的入住ICU时间、机械通气时间及病死率较未接受营养支持者,均明显偏低(P <0. 05)。结论一些肺癌重症患者在入院时,便已经存在营养风险及营养不良,需根据患者病情及需要,制定有效的营养支持计划。若入院时的NRS评分> 3分,那么开展早期营养支持,能显著改善肺癌重症患者的临床结局。     

慢性肝病的营养支持

营养不良在肝病患者中很常见,其严重程度直接关系到患者的短期生存率,营养支持作为治疗慢性肝病的重要手段,对于慢性肝病患者的长期治疗与恢复非常必要.评价慢性肝病患者营养状态有多种方法,包括直接人体测量法、生化指标检测、免疫学指标、营养评定工具、人体组成测定等,各有优缺点,可从不同侧面综合评价营养状况.在进行营养支持时,应结合肝病的具体情况与患者的耐受能力,选择合适的营养物质与营养途径.     

慢性肝病的营养支持

营养不良在肝病患者中很常见，其严重程度直接关系到患者的短期生存率，营养支持作为治疗慢性肝病的重要手段，对于慢性肝病患者的长期治疗与恢复非常必要。评价慢性肝病患者营养状态有多种方法，包括直接人体测量法、生化指标检测、免疫学指标、营养评定工具、人体组成测定等，各有优缺点，可从不同侧面综合评价营养状况。在进行营养支持时，应结合肝病的具体情况与患者的耐受能力，选择合适的营养物质与营养途径。     

内镜下放置小肠营养管治疗慢性呼吸衰竭伴营养不良患者20例护理体会

目的观察内镜下放置小肠营养管对改善呼吸衰竭患者的营养状况及临床症状改善的疗效。方法选择40例在我院住院的慢性呼吸衰竭伴营养不良患者．通过口胃肠道和小肠营养管两种途径予以营养干预，经过精心护理21天后评估临床症状及体征的改善情况．进行人体测量学测量、血清蛋白数值等检测以及血气分析，观察营养干预的效果。结果经过21天的营养干预治疗和护理发现小肠营养管组的效果明显优于口胃肠组。结论两种营养干预方式对慢性呼吸衰竭伴营养不良患者的营养状况均有不同程度的改善，但内镜下放置小肠营养管疗效更显著，具有实用性和可行性，值得临床选用。     

营养支持对慢性阻塞性肺疾病患者营养状况的影响研究

目的研究营养支持对慢性阻塞性肺疾病患者营养状况产生的的影响。方法将200例慢性阻塞性肺疾病患者随机分为实验组对照组,为对照组施行机械通气、糖皮质激素、抗生素、支气管扩张药等的基础治疗方法。实验组在基础治疗外加用营养支持疗法,14天之后将两组患者疾病恢复情况进行对比。结果治疗前两组FVC与FEV相比无明显差别,治疗后实验组这两项指标显著改善,FVC与FEV明显优于对照组。结论营养支持治疗可以显著改善慢性阻塞性肺疾病患者的营养状况。     

营养支持对慢性呼吸衰竭危重症病人免疫功能的影响

目的:探讨营养支持对慢性呼吸衰竭危重症病人免疫功能的影响. 方法: 选择ICU病房应用呼吸机的慢性呼吸衰竭病人85例,分为TPN组、EN组和对照组,分别进行人体组成测量,生化指标和免疫功能测定. 结果: 本组营养不良的发生率达100%,营养治疗组较对照组体质量、皮下脂肪、ALB、氧合指数和免疫指标均有显著改善. 结论: 慢性呼吸衰竭危重症病人给予合理的营养支持, 能改善病人的营养状况、肺功能和免疫功能.     

COPD机械通气患者营养支持研究进展

慢性阻塞性肺疾病(COPD)的患者由于疾病本身的影响造成营养素的摄入不足、吸收不良及消耗量增加等,易导致机体的营养不良。良好的营养状态对COPD患者的预后有着积极的作用,而合理的营养支持有助于改善患者的营养不良状态。在营养支持过程中,营养支持方式及时机的选择、营养配方的选择以及一些特殊营养物质的添加都会直接影响营养治疗的效果。同时,在进行营养治疗过程中,易出现腹胀、腹泻、胃潴留、返流、吸入性肺炎等常见并发症,这些并发症如何处理也会影响患者的预后。营养支持的监测可以为营养治疗方案的调整提供依据,因此应该如何通过相关生化指标的监测来评估营养支持的效果也是一个重要的问题。作者对这些相关问题作一讨论。     

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.     

Nutrition and alcoholic liver disease

While the rate of malnutrition is relatively modest in alcoholic patients without alcoholic liver disease, the rate of malnutrition is virtually 100% in patients with alcoholic hepatitis and/or alcoholic cirrhosis. The reasons for malnutrition in the alcoholic hepatitis patient include various factors such as anorexia, poor diet, malabsorption, and altered metabolic state. When the patient is hospitalized, the malnutrition frequently worsens because of fasting for tests, continued anorexia, and complications such as gastrointestinal bleeding. Patients with severe acute hepatitis appear to be both hypermetabolic and hypercatabolic, whereas data are much more conflicting concerning patients with more stable liver disease. Most studies suggest that patients with alcoholic liver disease require at least 60 g of protein per day to maintain positive nitrogen balance. Consistent alterations in plasma amino acid profiles occur in alcoholic liver disease, and specialized nutritional formulations have been devised to correct this amino acid profile with the intent of improving overall nutritional status, hepatic encephalopathy, and mortality. The effects of nutritional support (including use of specialized products) on outcome, on acute hepatic encephalopathy, and on chronic or latent portal systemic encephalopathy are reviewed.     

Treatment of protein-energy malnutrition in chronic nonmalignant disorders.

Protein-energy malnutrition (PEM) is common in connection with chronic disease and is associated with increased morbidity and mortality. Because the risk of PEM is related to the degree of illness, the causal connections between malnutrition and a poorer prognosis are complex. It cannot automatically be inferred that nutritional support will improve the clinical course of patients with wasting disorders. We reviewed studies of the treatment of PEM in cases of chronic obstructive pulmonary disease, chronic heart failure, stroke, dementia, rehabilitation after hip fracture, chronic renal failure, rheumatoid arthritis, and multiple disorders in the elderly. Several methodologic problems are associated with nutrition treatment studies in chronically ill patients. These problems include no generally accepted definition of PEM, uncertain patient compliance with supplementation, and a wide range of outcome variables. Avail-able treatment studies indicate that dietary supplements, either alone or in combination with hormonal treatment, may have positive effects when given to patients with manifest PEM or to patients at risk of developing PEM. In chronic obstructive pulmonary disease, nutritional treatment may improve respiratory function. Nutritional therapy of elderly women after hip fractures may speed up the rehabilitation process. When administered to elderly patients with multiple disorders, diet therapy may improve functional capacity. The data regarding nutritional treatment of the conditions mentioned above is still inconclusive. There is still a great need for randomized controlled long-term studies of the effects of defined nutritional intervention programs in chronically ill and frail elderly with a focus on determining clinically relevant outcomes.     

Nutrition in pediatric patients before liver transplantation

Malnutrition leading to growth failure is one of the main problems in maintainig children with chronic liver diseases. The pathogenesis of malnutrition is complex and includes reduced calorie intake, fat malabsorption, impaired protein metabolism and increased energy expenditure. The nutritional status is an important risk factor for survival post liver transplantation. Aggressive nutritional support with careful monitoring is essential, particularly where liver transplantation is considered. When the oral nutrition is inadequate, the enteral feeding with nocturnal intragastric tube should be started. In case of gastrointestinal intolerance, severe malnutrition and gastrointestinal bleeding, parenteral nutrition should be considered.     

慢性肝病患者肠外肠内营养支持与膳食干预专家共识

肝脏是人体最重要的代谢器官，肝脏发生疾病时可出现复杂的营养素代谢改变和不同程度的营养不良（不足），而营养状态又反过来影响肝病的发生、发展和预后，形成恶性循环。营养支持（肠外营养支持、肠内营养支持、膳食干预）在慢性肝病患者（代偿期/失代偿期肝硬化、慢加急/亚急性肝衰竭、慢性肝衰竭）的治疗中起重要作用。但此领域缺少大样本、高质量的临床研究报告，且国内尚无有关临床诊疗的“共识”。从合理应用营养支持疗法，改善慢性肝病患者临床结局出发，本“共识”专家组系统总结相关文献，并结合我国慢性肝病的临床实践，完成此共识，以期为慢性肝病诊疗有关的医师、护士（师）、营养师、药剂师们提供临床参考。