蛋白强化的肠内营养改善急性胰腺炎肥胖病人的体脂分布

目的:观察蛋白强化的EN对肥胖的急性胰腺炎(AP)病人体脂分布和蛋白质代谢的影响. 方法:选择符合AP标准,体质量指数(BMI)≥26 kg/m2的病人,前瞻、随机分为对照组(24例)和试验组(29例).分别应用蛋白强化EN和标准EN.记录病人体质量、BMI的变化;测量脂肪群、腹部脂肪比率、肌肉群和蛋白质等指标的改变;检测总蛋白(TP)、ALB、PA、纤维连接蛋白(FN)、TF的变化. 结果:两组病人在EN支持后,体质量、BMI、脂肪群和腹部脂肪比率较营养支持前有所下降,并且试验组下降明显.血清蛋白质较营养支持前均有升高,达到正常水平,试验组病人的PA和FN增加明显. 结论:蛋白强化的EN不仅能改善AP病人的肥胖和脂肪分布异常,而且还能减轻并发症,改善预后.     

早期营养支持对急性重症胰腺炎病人机体组成的影响

目的:探讨早期肠内营养(EN)联合肠外营养(PN)对急性重症胰腺炎(ASP)病人机体组成的影响. 方法:将30例病人随机分成治疗组和对照组.治疗组病人采取早期EN加PN,并逐渐减少PN的用量,直至停止PN.对照组病人采取完全胃肠外营养(TPN).两组病人平均治疗15 d.用皮皱测量法测定两组病人机体密度,用MRI方法测量全身各部位脂肪变化情况,核素稀释法测定全身水量(TBW)、总脂肪量(TBF)、无脂肪体重(LBM)、细胞内液(ICM)、细胞外液(ECM)的变化.同时常规测定血清清蛋白、血红蛋白、转铁蛋白和淋巴细胞数量等. 结果:治疗组在TBW、TBF、LBM、ICM、ECM、血清清蛋白、血红蛋白、转铁蛋白与对照组差异无显著性意义(P＞0.05),治疗组的淋巴细胞数高于对照组(P＜0.05). 结论:早期EN联合PN可以改善ASP病人的机体免疫功能,对机体组成的影响,与TPN无差异.     

Lipid-associated total parenteral nutrition in patients with severe acute pancreatitis

Biochemical data were studied in 18 patients with severe acute pancreatitis receiving lipid associated with total parenteral nutrition. The mean nonprotein energy intake was 30 kcal/kg/day, with 34-70% of the nonprotein calories as lipid. These parameters were no different between patients who survived and those who died. The mean sum of Ranson criteria was significantly higher in patients who died as compared with those who survived. Plasma triglycerides, glucose, albumin, and the amount of insulin supplementation were related to the severity of the disease and to the outcome. Persistent hypertriglyceridemia, hyperglycemia, hypoalbuminemia, and higher insulin requirements were observed in patients who died in comparison with those who survived and this appeared to be an index of fatal outcome. These abnormalities reflect in part an inability to utilize nonprotein energy, because the measured energy expenditure in relation to intake was lower in the patients who died, despite comparable intakes and expected energy expenditures.     

Effect of glutamine-enriched total parenteral nutrition in patients with acute pancreatitis

BACKGROUND: The management of acute pancreatitis (AP) frequently includes parenteral nutrition, but conditionally essential amino acids such as glutamine are not included in conventional total parenteral nutrition (TPN).AIM: This study was conducted to determine whether the inclusion of glutamine has a beneficial effect in patients with AP receiving TPN. METHODS: In a randomized, controlled study 28 patients with AP received either a standard TPN with 1.5 g/kg body weight protein or an isonitrogen, isocaloric TPN which contains 0.3 g/kg L -alanine- L -glutamine. Patients were assessed for nutritional and inflammatory parameters, infectious complications, length of TPN, length of hospital stay (LOS) and cost of TPN. RESULTS: There were no side-effects related to glutamine substitution observed. Glutamine was associated with a significant increase of cholinesterase, albumin and lymphocyte count in AP as well a decrease of C-reactive protein compared to standard TPN at day 14. There was a reduced length of TPN (10 [6-16] vs 16 [10-18] days, P<0.05) and a trend of reduced LOS (21 [14-32] vs 25 [19-40] days) in AP patients receiving glutamine. The overall cost per patient for TPN did not differ (gln+: 929+/-586 vs gln-: 981+/-507 euro/patient). CONCLUSION: Our results suggest that glutamine substitution is beneficial and does not increase the overall cost of parenteral feeding in patients with acute pancreatitis.     

早期肠内外营养对急性胰腺炎预后的Meta分析

目的　分析早期肠内外营养对急性胰腺炎预后的影响。方法　应用计算机检索1996年1月至2013年8月国内外文献数据库,包括万方数据库、维普（VIP）、知网（CNKI）、PubMed、Cochrane Library、CBM、EMBASE等数据库,对急性胰腺炎进行肠内外营养支持治疗的预后对比,涵盖病死率、感染率,多器官功能衰竭及其他并发症等。结果　早期肠内营养较肠外营养对于急性胰腺炎可降低其病死率［OR=0.37,95% CI（0.23, 0.58）,P＜0.000 1］、减少感染率［OR=0.24,95% CI（0.15, 0.39）,P＜0.000 01］、缩短住院时间［MD=-9.87,95% CI（-10.84,-8.89）,P＜0.000 01］、也可减少并发症的发生［OR=0.26,95% CI（0.12,0.58）,P=0.001 0］,但发生多器官功能衰竭事件未见减低［OR=0.35,95% CI（0.10, 1.19）,P=0.09］。结论　对于急性胰腺炎患者,早期肠内营养较肠外营养能有效降低病死率、减轻感染率、缩短平均住院时间、减少并发症发生,但并未减少多器官功能衰竭等危重症,如可能的话,临床可进行早期肠内营养进行营养支持。     

重症急性胰腺炎患者的胃肠外营养

目的为观察胃肠外营养（PN）对重症急性胰腺炎的治疗影响。方法对重症急性胰腺炎（SAP）病人给予PN支持治疗，男性18例，女性24例，手术28例，非手术14例，死亡6例。根据测得血中TG水平给以不同浓度的Intralipid，控制磷脂摄入量。结果用后监测血TG增高不明显，本组治愈率为85．7％（36／42）。结论PN对SAP的治疗效果是肯定和安全的。     

Total parenteral nutrition in severe acute pancreatitis

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/- SD = 3.8 +/- 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of glutamine-enriched total parenteral nutrition on acute pancreatitis

AIM: This study was performed to determine the effects of glutamine enriched total parenteral nutrition (TPN) on the patients with acute pancreatitis (AP). METHOD: Forty patients with AP, who had Ranson's score between 2 and 4 received either standard TPN (control group) or TPN with glutamine (treatment group). The patients in the treatment group received TPN containing 0.3 g/kg/days glutamine. At the end of the study, patients were evaluated for nutritional and inflammatory parameters, length of TPN and length of hospital stay. RESULTS: The length of TPN applications were 10.5+/-3.6 days and 11.6+/-2.5 days, and the length of hospital stays were 14.2+/-4.4 and 16.4+/-3.9 days for the treatment and control groups (NS), and the complication rates in the treatment and control groups were 10 and 40%, respectively (P<0.05). The transferrin level increased by 11.7% in the group that received glutamine-enriched TPN (P<0.05), whereas the transferrin level decreased by 12.1% in the control group (NS). At the end of the study, slight but not significant changes were determined in both groups in fasting blood sugar, albumin, blood urea nitrogen (BUN), creatinine, total cholesterol concentrations, aspartate aminotransferase (AST), alanine transaminase (ALT) and lactate dehydrogenase (LDH) activities, leukocytes, CD(4), CD(8), serum Zn, Ca and P levels compare to the baseline levels (NS). Significant decreases were determined in serum lipase, amylase activities and C-reactive protein (CRP) levels in both groups (P<0.05). CONCLUSIONS: The results of this study have shown that glutamine supplementation to TPN have beneficial effects on the prevention of complications in patients with AP.     

急性胰腺炎PN支持后抗氧化酶活性的变化

目的探讨急性胰腺炎病人接受肠外营养(PN)支持后,抗氧化酶活性的变化及其变化机制.方法测定20例急性重型胰腺炎病人PN支持前后的过氧歧化酶(SOD)和脂质氧化酶(LPO)活性的变化,并作统计学分析.结果PN支持后,SOD值平均升高18.7%(P＜0.05),LPO值下降19.4%(P＜0.05),20例病人均治愈.结论PN支持能帮助损害机体的氧自由基(OFR)的清除,能增强病人抗氧化损伤的能力.     

重症急性胰腺炎早期肠内营养与肠外营养联合的临床疗效分析

目的:探讨重症胰腺炎患者早期肠内营养与肠外营养联合应用的临床疗效。方法:分析2015年11月~2016年12月接受治疗的重症急性胰腺炎患者106例,将早期接受完全肠内营养营养支持治疗的46例定义为EN组,早期接受肠内营养与肠外营养联合支持治疗的60例定义为PN+EN组。检测营养支持治疗前与营养支持治疗2周后血清白蛋白、血红蛋白、C反应蛋白水平及计算APACHE Ⅱ评分。结果:两组治疗前CRP、ALB、Hb、APACHEⅡ变化均较治疗后明显,差异有统计学意义(P0.05),且PN+EN组指标变化的幅度较EN组大,临床价值更高(P0.01)。结论:肠内营养与肠外营养联合支持治疗不仅能维持肠道功能恢复,还可通过下调机体炎症反应,抑制氧化应激反应而发挥全身保护脏器功能作用,改善患者预后。     

L-alanyl-L-glutamine-supplemented parenteral nutrition decreases infectious morbidity rate in patients with severe acute pancreatitis

BACKGROUND: The effect of parenteral GLN on recovery from severe acute pancreatitis has not been thoroughly investigated. The aims of this study were to determine whether parenteral GLN improves nutrition status and immune function, and to determine its ability to reduce morbidity and mortality in patients with this condition. METHODS: In a randomized clinical trial, 44 patients with severe acute pancreatitis were randomly assigned to receive either standard PN (n = 22) or l-alanyl-l-glutamine-supplemented PN (n = 22) after hospital admission. Nitrogen balance, counts of leukocytes, total lymphocytes, and CD4 and CD8 subpopulations, and serum levels of immunoglobulin A, total protein, albumin, C-reactive protein, and serum interleukin (IL)-6 and IL-10 were measured on days 0, 5, and 10. Hospital stay, infectious morbidity, and mortality were also evaluated. RESULTS: Demographics, laboratory characteristics, and pancreatitis etiology and severity at entry to the study were similar between groups. The study group exhibited significant increases in serum IL-10 levels, total lymphocyte and lymphocyte subpopulation counts, and albumin serum levels. Nitrogen balance also improved to positive levels in the study group and remained negative in the control group. Infectious morbidity was more frequent in the control group than in the study group. The duration of hospital stay was similar between groups, as was mortality. CONCLUSION: The results suggest that treatment of patients with GLN-supplemented PN may decrease infectious morbidity rate compared with those who treated with nonenriched PN.     

Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome

Malnutrition occurs commonly in patients with acquired immunodeficiency syndrome (AIDS). The efficacy of nutritional support is unknown. A prospective, longitudinal study was conducted to determine the effect of prolonged total parenteral nutrition on body composition in 12 AIDS patients. Five patients were malnourished because of problems with food intake or absorption, while seven had systemic infections, with or without a malabsorption syndrome. The AIDS patients gained body weight and body fat content in response to total parenteral nutrition, while mean body cell mass, estimated as total body potassium content, was unchanged. However, all five patients with altered intake or absorption had significant repletion of body cell mass which was significantly different from the patients with systemic infections. Calorie and nitrogen intake did not differ between the two groups. It is concluded that body mass repletion is possible in AIDS patients in whom malabsorption is the major pathogenetic factor in producing malnutrition and is less successful in patients with serious ongoing systemic diseases. Thus, the response to nutritional support is dependent on the particular clinical circumstances.     

Total parenteral nutrition in severe acute pancreatitis.

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/? SD = 3.8 +/? 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

不同时间开始的肠外营养与肠内营养对急性胰腺炎影响的对比

目的 探讨并对比不同时间开始的肠外营养与肠内营养对急性胰腺炎的影响.方法 在MEDLINE、EMBASE、Cochrane图书馆、万方期刊库和中国期刊网检索1966年1月至2011年1月发表的有关全胃肠外营养和肠内营养治疗急性胰腺炎的随机对照研究.由2名评价者对入选研究的研究设计、研究对象的特征、研究结果等内容独立进行摘录,采用RevMan4.2软件进行分析.结果 有14项研究纳入本研究.本研究结果显示,入院24h后,与全胃肠外营养相比,肠内营养能显著降低感染(P=0.0004)、手术(P=0.0200)、器官衰竭(P=0.0400)及死亡率(P=0.0002);入院48h内,与全胃肠外营养相比,肠内营养能显著降低感染(P =0.0000)、手术(P=0.0001)、器官衰竭(P=0.0006)及死亡率(P =0.0300).结论 肠内营养的疗效可能受营养开始时间的限制,急性胰腺炎患者入院24～48h开始肠内营养优于入院24 h内或48h后开始.     

急性胰腺炎的全肠外营养与生长抑素治疗

目的 :观察在禁食、胃肠减压和预防感染的基础上 ,加用生长抑素和全肠外营养对胰腺炎非手术治疗的影响。　方法 :将 1990年 1月至 1994年 12月底收治的急性胰腺炎 2 6例 ,归为A组。自 1995年以来收治的急性胰腺炎 2 8例 ,归为B组。两组胰腺炎的病因和严重程度无明显差别。B组病人采用全肠外营养支持和生长抑素治疗。　结果 :A组病人入院时血清白蛋白为 (30 .0± 1.2 ) g/L ,治疗 15天后 ,白蛋白仍在 (30 .4± 0 .8) g/L。B组病人于入院后即行全肠外营养支持 ,时间为 (17± 6 )天 ,施他宁使用时间为 (7± 2 )天。其血清白蛋白入院时为 (2 9.0±1.3)g/L ,治疗 15天后 ,白蛋白上升至 (35 .7± 0 .9) g/L ,明显高于入院时 (P <0 .0 1)。B组病人的病死率及住院日、中转手术率、淀粉酶的恢复天数较A组病人有明显改善 ,并发症发生率明显减少。　结论 :在急性胰腺炎非手术治疗原则的基础上 ,通过加用全肠外营养和生长抑素可最大程度地抑制胰腺的分泌 ,改善病人的营养状态 ,减少并发症的发生率与病死率 ,缩短住院时间。     

The influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer

BACKGROUND: According to current evidence, most organizations, including the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), do not recommend the routine use of artificial nutrition for patients with cancer. Despite the recommendation for parenteral nutrition (PN), data for early PN supplementation (PNS) in patients with an advanced malignancy are extremely limited, especially in terms of the affects on nutrition outcomes, body composition, and quality of life (QOL), as well as effects on oncologic outcomes. The aim of the study was to evaluate the effect of PNS on body composition and the quality of life in patients with advanced malignancies. METHODS: One hundred fifty-two consecutive patients with advanced cancer were prospectively randomized to either use of oral enteral nutrition supplement (PN-) or use of oral enteral nutrition supplement plus supplemental PN (PN+). Body weight, body mass index (BMI), and caloric intake were assessed, and hemoglobin (g/dL) and serum albumin (g/L) were measured. Body composition was assessed by body impedance analysis (BIA), and QOL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire every 6 weeks. RESULTS: No significant differences were evident at baseline between the 2 groups for age, gender, medical diagnosis, weight, BMI, or QOL. A statistically significant difference in mean BMI was observed by week 48 for the PN+ group (PN+ = 21.9, PN-= 20.5, p = .0149), by week 6 in mean body cell mass (PN+ = 55%, PN-= 50,1%, p < .001), mean albumin (PN+ = 40.2 g/L, PN-= 36.2 g/L, p = .015), mean QOL (PN+ = 55.7, PN-= 50.9, p = .035). The cumulative survival rate was significantly greater in the PN+ group (p < .0001). CONCLUSIONS: According to the positive effect of supplemental PN on survival, body composition, and QOL, additional controlled studies must be conducted to confirm these findings.     

Total parenteral nutrition in the mouse: body composition and plasma chemistries

Mice that were maintained in energy and nitrogen (N) balance by total parenteral nutrition (TPN) for 12 days were analyzed for changes in organ weight, carcass and liver N and fat, and plasma glucose, urea N, and total protein. The results are compared with two other groups: (1) PO, which consisted of mice that were given the TPN solution per os in amounts equivalent to the TPN group, and (2) AL, which consisted of mice allowed to consume a stock diet ad libitum. In comparison with group AL, the TPN-fed mice had normal liver, kidney, and lung weights but heavier spleens and hearts. Group PO had an increase in liver weight only. Hepatic lipid content declined in group TPN but increased markedly in PO-fed mice. The latter group also demonstrated a 35% increase in carcass fat whereas it was unchanged in the TPN group. No differences were found in plasma urea N and total protein among the groups but plasma glucose increased 2-fold in group PO. It appears that our technique of parenteral feeding in mice maintains fairly normal body composition and plasma chemistries. However, mice drinking the TPN solution (group PO) exhibited the greatest number of alterations. These results are discussed in relation to differences in route of feeding, diet composition, feeding pattern, and the possible influence of circadian rhythms. The dilemma of choosing appropriate control groups in TPN studies is also discussed.     

肠外与肠内营养对胰腺外分泌和急性重症胰腺炎的影响

肠外营养(PN)不能改变胰腺炎自然病程,能降低并发症和病死率,但导管感染和肠源性并发症增加。近年来,肠内营养（EN）应用受到重视,但在急性重症胰腺炎（SAP）中的应用仍有争议。从EN对胰腺外分泌和SAP自然病程的影响分析,提出经空肠喂养不会刺激胰腺分泌,也不会加重SAP的病情。在临床实际应用中,应结合SAP的分期和临床状况,采用PN和EN联合应用来达到营养支持的目的。     

The impact of total parenteral nutrition on antithrombin III

A prospective study was undertaken to elucidate the effect, if any, of total parenteral nutrition on plasma Antithrombin III levels. A total of 309 patients were included in the study. The patients suffered from cancer, or chronic illness, or major trauma which necessitated total parenteral nutrition. Each patient acted as his own control. Pre and postinfusion Antithrombin III levels were measured at regular intervals. Statistically, the results of the study have shown that total parenteral nutrition does not significantly alter Antithrombin III levels.