肠内营养支持治疗对食管癌术后的影响及临床价值

目的探讨肠内营养支持治疗对食管癌术后的影响及临床价值。方法手术治疗的食管癌患者92例,随机分为肠内营养支持治疗组和常规液体治疗组,观察两组患者手术切口愈合情况、手术后并发症以及肠蠕动恢复情况、手术前体重与手术后体重变化情况、基本营养指标以及免疫学指标变化情况,采用统计学处理,观察两者的差别。结果肠内营养支持治疗组在肠蠕动恢复、基本营养指标以及免疫学指标改善等方面均优于对照组,两者经统计学处理有明显差异。结论肠内营养支持治疗可以作为食管癌术后较好的营养支持方法。     

食管癌患者术后肠内营养临床效果分析

目的观察肠内营养(EN)与肠外营养(PN)对食管癌患者术后临床效果的影响,评价食管癌术后早期肠内营养支持的临床意义。方法肠外营养组(PN组)术后每日行完全肠外营养支持直到经口进食;肠内营养组(EN组)术后第1日以静脉支持为主,第2日开始经鼻肠营养管滴入肠内营养制剂瑞素,并逐步增大剂量,减少静脉支持。在术后各个不同时间点分别进行各项指标及营养免疫功能指标的测定。结果 EN组术后排气、排便时间和术后平均住院时间均短于PN组。术后EN组营养和免疫功能指标均优于PN组。结论食管癌术后早期肠内营养可促进小肠运动功能恢复,可有效改善食管癌患者术后营养状况和免疫功能。     

老年胃癌合并糖尿病患者术后早期肠内与肠外营养对比研究

目的探讨老年胃癌合并糖尿病患者术后早期肠内营养的合理性和安全性。方法将60例老年胃癌合并糖尿病患者随机分为早期肠内营养组（EEN,30例）和肠外营养组（PN,30例）。检测手术前和手术后第4、10天营养指标和肝功能等变化,详细记录血糖变化,观察临床恢复情况。结果术后肠内营养组血糖水平波动较肠外营养组平稳（P〈0.01）。术后第4天EEN组患者的各项营养指标和肝功能指标恢复明显高于PN组患者（P〈0.01）。并发症发生率EEN组少于PN组,差异有统计学意义（P〈0.01）。结论胃肠肿瘤手术后早期应用肠内营养对老年糖尿病患者是一个较好的方法,方便血糖调控,同时可促进机体康复,减少并发症。     

食管癌术后早期肠内营养应用及进展

目的：研究食管癌术后早期肠内营养的应用及进展。方法将我科2013年收治的60例食管癌患者于术后第1d起进行营养指导,持续10 d,每日给予肠内营养的食谱排列,其中行空场造瘘的5例,行胃十二指肠营养管的40例,行空肠营养管的15例,所有患者均于术后第1 d常规缓慢滴注5%的葡萄糖氯化钠500 mL/d。第2 d起给予全流食,温度为38℃~40℃。并且逐步增加流食的种类,每增加一新种流食,先缓慢滴注2h后根据患者情况逐渐增快,术后3d内,肠内营养不足部分由卡文进行静脉补充,以后随肠内营养液输注量的增多,经静脉营养液逐渐减量至完全停用。结果80%的患者于术后第2 d排气,30%的患者有轻微腹胀。结论食管癌术后早期肠内营养能可以促进肠蠕动[1],显著增强患者术后的营养状况,降低患者并发症,促进患者康复。     

危重症颅脑损伤患者实施早期肠内营养支持与预后的相关性研究

目的：探讨危重症颅脑损伤患者实施早期肠内营养支持与预后的相关性。方法选取我院收治的危重症颅内损伤患者84例，根据格拉斯哥昏迷评分分为对照组和治疗组。治疗组实施早期肠内营养支持；对照组实施传统延迟性胃肠内营养支持；观察比较两组营养指标、并发症情况。结果治疗组血清总蛋白、白蛋白及外周淋巴细胞计数均明显高于对照组，组间差异有统计学意义(P<0.05)；治疗组并发症发生率31.0%，明显低于对照组60.0%，组间差异(P<0.05)。结论对危重症颅脑损伤患者实施早期肠内营养支持能够明显减少并发症，改善和提高患者生活质量及预后，值得临床推广及应用。     

早期肠内营养在贲门癌术后的临床价值

目的探讨贲门癌术后早期肠内营养的可行性及效果。方法105例贲门癌患者,分成早期肠内营养（EEN）组和常规肠内营养（REN）组。EEN组给予早期肠内营养;REN组在肛门排气后给予肠内营养。两组患者分别于术前1d、术后9d进行营养指标监测、免疫指标监测,并记录肛门排气时间。结果EEN组肛门排气时间较短;并发症率下降,术后9d营养指标、免疫指标EEN组均较REN组改善明显。结论早期肠内营养可以明显改善术后营养状况及提高机体免疫能力并降低并发症发生率。     

胰十二指肠切除术后肠内营养与肠外营养的比较：随机对照研究的Meta分析

目的:对比肠内营养和肠外营养对胰十二指肠切除术(Pancreaticoduodenectomy,PD)术后结局的影响.方法:检索收集截至2020年12月存在于EMBASE、MEDLINE、Cochrane Library、EBSCO、知网、维普和万方数据库中、比较PD术后肠内营养和肠外营养的患者康复情况的文献;主要结局指标是胃排空延迟,次要结局指标包括术后住院时间、术后胰瘘、胰十二指肠切除术后出血和感染性并发症.结果:共纳入10项随机对照研究、984例患者.Meta分析结果显示,与肠外营养组相比,肠内营养组能明显缩短术后住院时间、减少术后感染性并发症,并且不会增加胰十二指肠切除术后出血和胃排空延迟.结论:与肠外营养相比,肠内营养有利于缩短PD术后住院时间及减少术后感染性并发症.     

急性胰腺炎肠外营养和肠内营养治疗的探讨

目的观察肠外和肠内阶段性营养治疗急性胰腺炎的临床效果。方法急性胰腺炎患者60例,分为全胃肠外营养组和肠外加肠内阶段性营养组,全胃肠外营养组患者应用肠外营养持续至可以进食。肠外加肠内阶段性营养组患者在初期应用肠外营养,胃肠功能恢复后逐步减少肠外营养至全部用肠内营养替代,肠内营养持续至过渡饮食。观察两组临床指标及治疗效果。结果肠外加肠内阶段性营养组患者均能耐受早期肠内营养。早期适时由肠外过渡到肠内营养后一周患者的血清总蛋白、白蛋白、血钙水平,与营养支持前、营养支持后全胃肠外营养组相比均增高（P〈0.01）;对肝脏功能的损害减小（P〈0.01）。肠外加肠内阶段性营养组血糖平均水平趋于正常且波动度小,与全胃肠外营养组相比,差异有统计学意义（P〈0.05）。肠外加肠内阶段性营养组平均住院天数（29.93±9.30）d,短于全胃肠外营养组平均住院天数（25.47±7.50）d（P〈0.05）,且每日营养费用及住院总费用减少。结论肠内营养组患者的营养指标、对血糖的影响与全胃肠外营养组相比,效果更好。     

食管癌术后肠内营养液的临床应用

目的：探讨食管癌手术后肠内营养的临床应用与相关护理。方法随机抽取科室食管癌术后的患者80例,均术中留置有十二指肠营养管,术后管饲肠内营养液。结果80例患者中术后恢复好,无1例吻合口瘘等并发症的发生,患者的住院时间明显缩短,费用也有所减少。结论肠内营养液的早期应用大大改善了食管癌的术后预后。     

食管癌患者术后肠内营养护理体会

目的：探讨食管癌术后患者实施肠内营养的护理体会。方法收集苏州大学附属第一医院心胸外科2013年6月~12月102例食管癌手术患者,持续性经营养管滴注肠内营养102例次,间断性灌注法肠内营养85例次。结果腹胀、腹泻、返流等消化道症状及营养管脱落、堵管是肠内营养最为普遍的并发症,但经积极处理,患者均能比较好的耐受肠内营养。结论肠内营养具有价廉、简便的优势,更合乎生理,是食管癌患者术后临床营养支持的一种主要治疗方式。     

早期肠内肠外营养支持对结直肠癌患者术后影响

目的比较不同营养支持途径对结直肠癌患者术后营养指标的影响。方法回顾性分析自2010年1月至2014年1月84例胃癌和结直肠癌根治术后患者的临床资料,其中肠内营养组(EN组)43例和肠外营养组(PN组)41例,分别于术后第1天开始进行肠内和肠外营养,2组患者基本等氮、等热量;每组患者手术前后和术后第7天检测血清白蛋白(ALB)、转铁蛋白(TF)、前白蛋白(PA),观察术后不良反应、胃肠道功能恢复时间、感染、营养支持费用等情况。结果术后EN组和PN组的营养指标和不良反应发生率比较无显著性差异(P0.05);EN组感染发生率低(P0.01)且胃肠道功能恢复时间早(P0.01),与PN组相比较差异具有统计学意义。结论结直肠癌患者术后采用肠内营养方案,不良反应少、胃肠道功能恢复快。     

早期肠内营养支持在神经外科的临床应用

颅脑损伤或颅脑手术患者,术后会出现明显高代谢过程,能量消耗大增,又因多数患者进食困难,长期静脉营养风险及并发症较高,故早期肠内营养(enteral nutrition,EN)十分必要。EN给予前需要认真评估患者营养需求及可行的管道给予方式和营养组分,建立个体化的EN给予模式。EN同样存在一定风险或并发症,常见如腹泻、便秘等胃肠道症状、误吸导致的感染性病变、管道阻塞及位置变化引起的梗阻症状等,因此需要及时发现、及时处理。总之,早期个体化EN给予可以使神经外科术后患者明显获益,需要临床医护人员高度重视。     

Sports nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and conditioning specialists

Context:

Coaches, athletic trainers (ATs), strength and conditioning specialists (SCSs), and registered dietitians are common nutrition resources for athletes, but coaches, ATs, and SCSs might offer only limited nutrition information. Little research exists about sports nutrition knowledge and current available resources for nutrition information for athletes, coaches, ATs, and SCSs.

Objective:

To identify resources of nutrition information that athletes, coaches, ATs, and SCSs use; to examine nutrition knowledge among athletes, coaches, ATs, and SCSs; and to determine confidence levels in the correctness of nutrition knowledge questions within all groups.

Design:

Cross-sectional study.

Setting:

National Collegiate Athletic Association Division I, II, and III institutions across the United States.

Patients and Other Participants:

The 579 participants consisted of athletes (n = 185), coaches (n = 131), ATs (n = 192), and SCSs (n = 71).

Main Outcome Measure(s):

Participants answered questions about nutrition resources and domains regarding basic nutrition, supplements and performance, weight management, and hydration. Adequate sports nutrition knowledge was defined as an overall score of 75% in all domains (highest achievable score was 100%).

Results:

Participants averaged 68.5% in all domains. The ATs (77.8%) and SCSs (81.6%) had the highest average scores. Adequate knowledge was found in 35.9% of coaches, 71.4% of ATs, 83.1% of SCSs, and only 9% of athletes. The most used nutrition resources for coaches, ATs, and SCSs were registered dietitians.

Conclusions:

Overall, we demonstrated that ATs and SCSs have adequate sports nutrition knowledge, whereas most coaches and athletes have inadequate knowledge. Athletes have frequent contact with ATs and SCSs; therefore, proper nutrition education among these staff members is critical. We suggest that proper nutrition programming should be provided for athletes, coaches, ATs, and SCSs. However, a separate nutrition program should be integrated for ATs and SCSs. This integrative approach is beneficial for the continuity of care, as both categories of professionals might be developing and integrating preventive or rehabilitative programs for athletes.     

Maternal food restriction: Effects on offspring behavior and development

Pregnant rats were placed on reduced food intake or remained on adequate diet during gestation and lactation. Offspring were cross-fostered to provide for independent experiences of prenatal and/or postnatal mother malnutrition. All offspring were placed on an ad lib diet at time of weaning. When evaluated in adulthood, offspring whose mother was food-deprived during the lactation period showed body weight deficits and increased errors on the Hebb-Williams maze as compared to controls. There were no observed effects of the prenatal deprivation.     

Leczenie żywieniowe pacjentów poddawanych przeszczepieniu macierzystych komórek krwiotwórczych

Hematopoietic stem cell transplantation (HSCT) – the highly aggressive therapeutic process – is connected with high risk of side effects and complications, which influence nutritional management.Moreover, limitation of possibility of nutrients delivery is accompanied by simultaneous increase in requirement for nutritional elements. Thus, implementation of nutritional support as an element of supportive treatment is advisable or necessary in many of these patients.Unfortunately, there is a lack of uniform clinical nutrition guidelines for HSCT patients. Currently, special attention is paid to: suitable qualification for different form of nutritional support, consideration of routine implementation of nutritional support after myeloablative conditioning (especially with total body irradiation), avoidance of unjustified arrest of oral/enteral nutrition (probably higher risk of Graft-vs-Host disease – GvHD) and likely clinical advantages of the use of glutamine and/or omega-3 fatty acids in nutritional mixtures.Moreover, in the context of clinical nutrition, patients with severe gastro-intestinal toxicity and persons with GvHD grade > II with intestinal failure require special attention. For these patients, primary nutritional support is parenteral nutrition (PN).The indications of PN implementation include: impossible, ineffective (e.g. nutrients absorption <50% daily requirements) or contraindicated oral/enteral feeding and progressive undernutrition. In case of use of myeloablative conditioning with total body irradiation and high-dose chemotherapy, the routine PN initiation should be taken into consideration according to preemptive strategy.Composition of intravenous nutritional mixtures is also very important. Based on scientific references and own study, the addition of glutamine and omega-3 fatty acids seems to be advisable (e.g. positive influence of mucous membrane regeneration and hematopoietic recovery, less complications). However, not all clinical studies confirmed above mentioned advantages. Moreover, optimal daily dose of these substrates is currently unknown.     

肠内和肠外营养对上消化道肿瘤术后肠瘘患者的临床应用研究

目的提高上消化道肿瘤术后并发肠瘘患者的营养支持效率.方法 28例患者随机分为肠内和肠外营养支持两组,前者用市售普通营养制剂由空肠营养管持续滴入,进行管饲调节喂养.瘘口封闭后改由口服.后者采用深静脉置管,进行静脉营养支持.两组在热卡,糖、蛋白质、脂肪的组成比例及电介质、微量元素的含量等均相似.营养支持开始后第7、14、21、28、35天清晨空腹采血.检测血浆丙二醛（MDA）及超氧化物歧化酶（SOD）活力变化.测定血浆前白蛋白及转铁蛋白、血浆内毒素.结果肠内营养组的MDA及内毒素水平明显低于肠外营养支持组.结论肠内营养支持可保护肠道功能,减轻肠道缺血再灌注损伤,降低循环内毒素水平,明显改善患者的营养状态.     

早期肠内营养治疗重症急性胰腺炎的回顾性研究

目的 探讨早期肠内营养（EEN）在重症急性胰腺炎（SAP）治疗中的价值.方法 选取2003年1月-2013年10月收住蚌埠医学院第一附属医院重症医学科的符合纳入标准的SAP患者45例进行回顾性分析.根据肠内营养的启动时机分为早期肠内营养组（EEN组,23例）和非早期肠内营养组（NEEN组,22例）,观察两组患者入重症监护治疗病房（ICU）时、治疗第7天和第14天的急性生理学和慢性健康评估（APACHE）Ⅱ评分、血白蛋白（BAlb）、C反应蛋白（CRP）、血糖（BG）、血钙（BCA）等各项临床指标,以及ICU留治时间和预后.结果 与入ICU时比较,两组患者经治疗各项临床指标均有改善,在治疗第14天,两组各项临床指标均明显优于入ICU时（P值均＜0.05）;但各项临床指标在EEN组改善较快,在治疗第7天,APACHEⅡ评分、BG、BCA等指标比较,EEN组均优于NEEN组（P值均＜0.05）;在治疗第14天,APACHEⅡ评分、BAlb、CRP、BG、BCA等各项临床指标比较,EEN组均优于NEEN组（P值均＜0.05）.EEN组ICU留治时间[（15.87±2.74）d]短于NEEN组[（19.27 ±3.67）d],差异有统计学意义（P =0.001）.两组病死率比较,差异无统计学意义（8.7％ vs13.6％,P=0.958）.结论 EEN在SAP治疗中效果肯定,值得推广应用.     

Personal food systems of male collegiate football players: a grounded theory investigation

Context:

Factors that affect food choices include the physical and social environments, quality, quantity, perceived healthfulness, and convenience. The personal food choice process was defined as the procedures used by athletes for making food choices, including the weighing and balancing of activities of daily life, physical well-being, convenience, monetary resources, and social relationships.

Objective:

To develop a theoretical model explaining the personal food choice processes of collegiate football players.

Design:

Qualitative study.

Setting:

National Collegiate Athletic Association Division II football program.

Patients or Other Participants:

Fifteen football players were purposefully sampled to represent various positions, years of athletic eligibility, and ethnic backgrounds.

Data Collection and Analysis:

For text data collection, we used predetermined, open-ended questions. Data were analyzed using the constant comparison method. The athletes'' words were used to label and describe their interactions and experiences with the food choice process. Member checks and an external audit were conducted by a qualitative methodologist and a nutrition specialist, and the findings were triangulated with the current literature to ensure trustworthiness of the text data.

Results:

Time was the core category and yielded a cyclic graphic of a theoretical model for the food choice system. Planning hydration, macronutrient strategies, snacks, and healthful food choices emerged as themes.

Conclusions:

The athletes planned meals and snacks around their academic and athletic schedules while attempting to consume foods identified as healthful. Healthful foods were generally lower in fat but high in preferred macronutrients. High-protein foods were the players'' primary goal; carbohydrate consumption was secondary. The athletes had established plans to maintain hydration. Professionals may use these findings to implement educational programs on food choices for football players.