胃肠外营养在严重多发性创伤病人中的应用

目的研究胃肠外营养支持在治疗严重多发性创伤的效果.方法从110例严重多发性创伤患者中随机选择46例进行胃肠外营养支持治疗,比较营养指标,免疫功能指标变化.结果治疗10天后,患者营养指标及免疫功能指标均明显增高.结论胃肠外营养对严重多发性创伤患者有营养支持和提高免疫功能作用,可减少并发症发生率和降低死亡率.     

严重脑外伤早期胃肠外营养的临床意义

严重脑外伤早期胃肠外营养的临床意义王之敏，惠国桢，周建烈严重脑外伤患者可发生自身性代谢平衡紊乱，包括能量消耗率增加和蛋白质分解率加快。其营养支持以往多采用经胃肠内营养。但也有一些学者在严重脑外伤病例早期采用全胃肠外营养（ＴＰＮ）支持，发现能降低死亡率...     

谷氨酰胺和全胃肠外营养

全胃肠外营养长期使用可引起肠粘膜萎缩、通透性升高，肠道免疫功能障碍和肠细菌移位，谷氨酰胺可减轻全胃肠外营养对肠道的不利影响，增强肠道免疫功能。本文就谷氨酰胺对肠道免疫的正性作用及可能机制作一综述。     

胃肠外静脉营养应用在胃肠吻合口瘘的疗效观察

目的探讨胃肠外静脉营养（PN）在腹部外科术后胃肠吻合口瘘的临床应用价值。方法64例胃肠吻合口瘘患者分成两组，胃肠外静脉营养（PN）为治疗组32例，另未采用PN32例为对照组，进行对比分析。结果两组在治愈率、愈合时间、体重、上臂肌围、血清自蛋白、总淋巴细胞计数等存在显著差异（P〈0．05）。结论在胃肠吻合口瘘临床处理中及时应用胃肠外静脉营养（PN）支持有助于改善愈后。     

同种异体小肠移植应用全胃肠外营养的体会

本文报告二期手术法猪异体小肠移植中应用全胃肠外营养（ＴＰＮ）的体会。７只猪平均接受１．８±１．２次的ＴＰＮ支持疗法，ＴＰＮ应用天数为１４～４７天，平均２８．５±１２．８天。营养供给按代谢支持的原则，每天供给的热量为１２５ＫＪ／ｋｇ，氮０．１５ｇ／ｋｇ，脂肪乳剂占总热量的４０％。本文、还介绍了大动物小肠移植中应用ＴＰＮ的适应证、腔静脉置管和管理、营养液的配制和输注。     

胃癌术后肠内营养和全胃肠外营养的疗效比较

胃肠道肿瘤患者是营养不良的高发人群,手术治疗使营养不良患者的免疫功能严重下降,因此对恶性肿瘤患者围手术期进行营养支持对提高患者生存质量至关重要[1],是减少并发症的有效手段[2]。     

大鼠肝切除全胃肠外营养模型的探讨

我们建立的大鼠肝切除全胃肠外营养模型具有如下特点：①采用术前不禁食、术中皮下输液、避免失血及缩短手术时间的方法，大鼠对手术的耐受性明显提高，可使术后７天死亡率明显下降；②联合使用戊巴比妥钠及少量乙醚吸入麻醉，大鼠术后清醒快且呼吸道感染很少；③术后每天提供５７３ｋＪ／ｋｇ的热量，大鼠能很好地耐受；④应用弹簧及肝素锁双重防旋装置，可有效地防止导管扭曲和液体参漏。     

全胃肠外营养在基层医院的临床应用体会

<正>据报道,我国现有住院患者中40％~50％属营养不良,需营养支持,而实际获得治疗者不足20％。在危重患者中,营养支持显得尤为重要,全胃肠外营养(total parentetal nutritionTPN)是各种营养治疗措施中条件要求较高、操作难度较大者。1994年12月~2000年元月,我们在较为简陋的条件下进行了16例TPN治疗,疗效满意,报告如下。 1 资料和方法     

基层医院86例外科重症全胃肠外营养治疗体会

目的探讨基层医院外科重症全胃肠外营养治疗效果。方法我科自1996年8月～2004年2月运用TPN治疗外科重症86例，其中肠瘘24例，急性胰腺炎30例，肿瘤晚期27例，创伤5例。结果未发生与TPN有关的严重并发症，患者住院时间缩短，提高了生存率。结论运用TPN时应加强管理，严格操作。在能满足临床需要的基础上，监测内容，热量供应可根据具体病情特点．做出适当调整。     

Zinc deficiency during total parenteral nutrition in childhood.

Changes in plasma zinc levels were studied in 11 pediatric surgical patients treated with total parenteral nutrition. Plasma copper levels were also determined in some patients. In three patients plasma zinc fell to a very low level during long-term total parenteral nutrition, and a syndrome of zinc deficiency developed characterized by dermatitis, alpecia, and enterocolitis with striking response to intravenous zinc therapy. In contrast, plasma zinc levels in the patients with short-term total parenteral nutrition remained in the normal range during the present study. This suggests that one of the mechanisms of zinc deficiency during total parenteral nutrition is insufficient amount of zinc in the nutritional solutions for long-term use, especially for older children. Symptoms of the zinc deficiency also occurred in these patients during the anabolic phase, suggesting that tissue demand for zinc may be increased at that time. Therefore, zinc should be included, on a regular basis, in all parenteral nutritional solutions in amounts sufficient to meet estimated needs for growth and tissue repair.     

不同氮量肠外营养对严重多发伤患者白蛋白水平的影响

目的 评价不同氮量肠外营养对严重多发伤患者白蛋白水平的影响及其安全性.方法 将严重多发伤且需要实施肠外营养治疗的患者随机分为低氮组（n=21）和正常氮量组（n=19）.两组患者均于入科后第1天开始经中心静脉进行全肠外营养输注,每天给予25 kcal/（kg·d）热卡.低氮组非蛋白氮按0.10 g（0.09 ～0.11 g）/（kg·d）给予,正常氮量组按0.20g（0.18 ～0.22 g）/（kg·d）给予.比较两组患者血清白蛋白浓度、白蛋白用量、利尿剂用量及肝肾功能.结果 肠外营养治疗第7天时正常氮量组患者白蛋白平均值明显高于低氮组（P＜0.05）,该组患者白蛋白用量明显少于低氮量组（P＜0.05）,但其利尿剂用量明显较高（P＜0.05）;两组患者肾功能均正常;肝功能相关指标谷丙转氨酶（ALT）入院后升高,3d后开始下降,且正常氮量组肝功能恢复优于低氮组.结论 充足非蛋白氮的补充可以维持严重多发伤患者血清白蛋白水平,但需要使用利尿剂以避免容量负荷过度.     

谷氨酰胺并肠外营养支持在外科术后危重患者中的应用

目的 观察谷氨酰胺并肠外营养支持在外科术后危重患者中的应用价值.方法 外科术后危重患者50例,随机分为观察组和对照组,每组各25例.两组患者均于术后第1天行肠外营养支持,观察组在对照组的基础上加用加丙氨酰-谷氨酰胺20 9(商品名:力太注射液,华瑞制药).治疗后检测两组患者营养指标、免疫指标.结果 观察组治疗第7天营养指标及免疫指标均较对照组明显改善.结论 加用谷氨酰胺的肠外营养支持能明显改善外科术后危重患者的营养状况及免疫功能.     

The metabolic effects of oral L-carnitine administration in infants receiving total parenteral nutrition with fat

beta-Oxidation, an important pathway in the metabolism of free fatty acids, occurs within the mitochondria in mammals. L-Carnitine is an essential cofactor in the transfer of long-chain fatty acids across the inner mitochondrial membrane. Maintenance of normal carnitine concentrations in whole blood and tissues, either through diet or biosynthesis, would appear necessary for adequate utilization of fat as an energy source. Infants, especially premature ones, without an exogenous dietary source of carnitine, have decreased plasma carnitine levels compared with infants receiving carnitine-supplemented feedings. To determine the importance of carnitine supplementation in a total parenteral nutrition program in infants in which a fat emulsion serves as a major calorie source, the following study was undertaken. Twelve infants receiving total parenteral nutrition (TPN) with fat for seven days were divided into two treatment groups. Group 1 was orally supplemented for seven days with carnitine (70 mumol/l/kg/24 h in 24 mL of 5% dextrose), while the second group received seven days of placebo supplementation (dextrose 5%, 24 cc/24 h). Plasma carnitine levels in the carnitine-supplemented group were significantly higher (29 +/- 8 nmol/mL) than in the control group (12.4 +/- 3.5 nmol/mL) after seven days of treatment. However, clearance of serum triglycerides and free fatty acids was not significantly different between the two groups. Baseline triglyceride levels in the carnitine-supplemented group were 96 +/- 42 mg/dL, increased to 242 +/- 101 mg/dL after the lipid challenge and decreased to 121 +/- 47 mg/dL two hours after the lipid infusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

肠内外营养支持治疗重症急性胰腺炎的临床对比分析

目的 对比肠内外营养支持方式对重症急性胰腺炎(SAP)患者的治疗作用,阐明肠内营养的优点.方法 59例SAP患者,分为全胃肠外营养(TPN)组24例及肠内营养(EN)组35例,分别检测分析两组的营养学指标,对比观察两组的治疗效果.结果 两组血清白蛋白、前白蛋白、转铁蛋白、血红蛋白治疗后与治疗前相比,均有改善(P<0.05);血清前白蛋白、转铁蛋白EN组与TPN组比较,差异有统计学意义(P<0.05).无论治疗后1周还是治疗后2周,APACHE Ⅱ评分EN组均低于TPN组(P<0.05).EN组的胰腺胰周感染率、其他并发症发病率、经口进食时间及治疗费用均低于TPN组(P<0.05),虽然病死率、住院天数两组间无统计学差异(P>0.05). 结论 EN可以改善SAP患者的营养状况,且具有保护肠黏膜屏障功能,减少细菌及毒素移位,调节炎症和感染反应,降低医疗费用等优点,是治疗SAP理想的营养支持方式.     

The effects of total parenteral nutrition on gastrointestinal growth and development

Total parenteral nutrition (TPN) is vital for the nutritional support of infants with disorders of the gastrointestinal tract that prevent adequate enteral intake. Studies in adult rodents maintained on TPN have demonstrated intestinal atrophy and decreased activity of the brush border enzymes of the small bowel mucosa. We studied the effects of TPN during the phase of rapid intestinal growth and development in piglets. Matched groups of three 6-week-old weaned piglet littermates received a glucose (45 g/kg/d), amino acid (8 g/kg/d), and fat (2.5 g/kg/d) solution intravenously (IV) or by gastrostomy (GF), or were given hog chow (Chow) at an equivalent caloric value for three weeks. No differences were noted in the mean weight gain (13-15 g/kg/d), total serum protein (4.5-4.8 g/dL), BUN (9-12 mg/dL), or Hct (25% to 30%). The IV and GF animals, compared to the Chow animals, had decreased growth of the stomach, small bowel, and pancreas with decreased small bowel mucosal disaccharidase activity. The IV group, compared to Day 0 animal measurements, had decreased small bowel length and weight and pancreatic weight. Histology of the proximal small bowel mucosa in the IV animals showed decreased mucosal depth, villus height, crypt depth, and epithelial cell number from the crypt base to the midvillus. These findings suggest that stomach, small bowel, and pancreatic growth are dependent on the route of administration and/or the composition of the diet, the small bowel mucosa and the pancreas atrophies in young piglets maintained on TPN, the activity of some intestinal brush border disaccharidases are decreased in the small bowel in piglets maintained on either an intravenous or an intragastric infusion of a TPN solution.     

重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

目的 观察重症急性胰腺炎(SAP)完全胃肠外营养(TPN)与肠外营养(PN)联合肠内营养(EN)治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组(14例)和PN+EN组(15例),并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白(ALB)、总蛋白(TSP)、血钙(Ca2+)、谷丙转氨酶(ALT)、谷草转氨酶(AST) 较营养支持前均显著升高(P<0.05);各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降(P<0.05);各组血总胆红素(TB)治疗前后差异无统计学意义(P>0.05);PN+EN组血WBC显著低于TPN组(P<0.05),其余化验指标组间比较差异无统计学意义(P>0.05);各组APACHEⅡ评分较治疗前显著降低(P<0.05),PN+EN组评分显著低于TPN组(P<0.05).PN+EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组(P<0.05).结论 PN联合EN治疗SAP优于TPN.