低糖高脂营养膳食对慢性阻塞性肺疾病急性发作并发呼吸衰竭病人疗效的影响

目的:探讨自配低糖高脂营养膳食对慢性阻塞性肺疾病急性发作(AECOPD)并发呼吸衰竭病人疗效的影响. 方法:将78例COPD急性发作(AECOPD)并发呼吸衰竭进行机械通气病人,随机分为试验组(n=38)和对照组(n=40).两组病人均采用鼻饲肠内营养(EN)治疗,试验组采用自配低糖高脂膳食,对照组采用整蛋白营养制剂(瑞素),具体能量摄入依据病人实际情况而定,分别于营养治疗第1天和治疗后第14天测定病人二氧化碳生成量(VCO2)、氧耗量(VO2)、肺活量(FVC)和1 s用力呼气容积占最大肺活量的比值(FEV1/FVC)、二氧化碳分压(PaCO2)、氧分压(PaO2)、pH值以及第14天脱机成功率、机械通气时间、病死率和营养支持费用等指标.结果:治疗前,两组病人的各项指标测定值无显著性差异(P＞0.05).治疗第14天,两组病人的各项指标均较治疗前有所改善,且差异有显著性统计学意义(P＜0.05).试验组较对照组改善更加明显,差异有显著性统计学意义(P＜0.05). 结论:自配低糖高脂营养膳食对AECOPD并发呼吸衰竭病人有明显的临床治疗效果.     

高能低糖营养液在COPD机械通气病人营养支持中的疗效观察

目的:探讨慢性阻塞性肺疾病(COPD)并发呼吸衰竭病人机械通气时,早期应用高能低糖肠内营养对病人治疗效果的影响。方法:将40例病人随机分为试验组(使用高能低糖肠内营养液)和对照组(使用普通肠内营养液),治疗10d。比较两组病人每分钟通气量(VE),二氧化碳生成量(VCO2),动脉血二氧化碳分压(PaCO2),机械通气时间,血清清蛋白,免疫球蛋白,总淋巴细胞计数等。结果:治疗后,试验组病人的PaCO2、VCO2与对照组相比有明显改善(P0.05);机械通气时间亦短于对照组(P0.05)。两组病人的血清清蛋白、免疫球蛋白和淋巴细胞计数等无显著性差异(P0.05)。结论:COPD机械通气病人,尽早合理地应用高能低糖肠内营养支持治疗,能有效地减少病人CO生成量,降低呼吸商,缩短机械通气时间,提高综合治疗的疗效。     

高脂肪低糖肠内营养对呼吸科危重症病人营养状况和呼吸功能的影响

目的:观察呼吸科危重症病人进行高脂肪低糖类肠内营养(EN)治疗后,营养状况和呼吸功能指标的变化。方法:选择呼吸科危重症病人120例,随机分为营养组(60例)和对照组(60例)。两组病人均接受相同的抗感染和对症治疗,营养组采用高脂肪低糖EN液(瑞能),对照组采用普通匀浆膳。分别于营养治疗前1 d和治疗后第14天测定血p H值、二氧化碳分压(Pa CO2)、氧分压(Pa O2)、呼吸商(RQ)、每分钟通气量(VE)、二氧化碳生成量(VCO2)、氧耗量(VO2)、氧合指数(Pa O2/Fi O2)以及血清总蛋白(TP)、清蛋白(ALB)、血红蛋白(Hb)、氮平衡(NB)等指标。结果:治疗第14天后,营养组病人的RQ、VCO2、VO2Pa CO2、Pa O2、Pa O2/Fi O2均较对照组显著改善(P0.05);营养组TP、ALB、NB均明显优于对照组(P0.05)。两组病人治疗后各项指标均较治疗前有明显的改善(P0.05)。结论:呼吸科危重症病人应用高脂肪低糖EN支持可显著改善营养状况和呼吸功能。     

高能低糖肠内营养液改善机械通气COPD患者的临床疗效

目的观察高脂肪(50%)、低碳水化合物(32%)肠内营养液对机械通气慢性阻塞性肺疾病(COPD)患者的临床疗效。方法我院32例机械通气COPD患者,平均年龄(70.4±17.4)岁,体重为(45.4±6.6)kg,均明显低于正常值(P<0.01);并伴有明显的营养不良。随机分为高能低糖肠内营养组(n=18)和传统肠内营养组(n=14)。两组均采用鼻饲肠内营养支持,每天供给热能125kJ(30kcal)/kg,蛋白质0.8~1.0g/kg,热氮比值为627.6kJ比1g。分别于营养治疗前一天及治疗后第10天测定血常规、电解质、呼吸商(RQ)、每分钟通气量(VE)、二氧化碳生成量(VCO2)、氧耗量(VO2)、二氧化碳分压(PaCO2)、氧分压(PaO2)、pH值以及血清总蛋白、白蛋白、血红蛋白、淋巴细胞比例等指标。结果治疗前两组患者的各项指标测定值相近,治疗10天后高能低糖组患者的VE、VCO2、VO2、RQ均较传统营养组显著降低(P<0.05)。传统营养治疗前后VE、VCO2、VO2、RQ无明显变化。两组患者的血气分析均有不同改善,高能低糖肠内营养组的PaCO2较传统肠内营养组降低,PaO2增高,但两组的差异无显著性。两组血液生化和血常规结果均无显著差异。结论高能低糖营养制剂能降低VCO2和RQ,减少VE和VO2,对于失偿期COPD患者有明显的临床治疗效果。     

碳水化合物热卡摄入比例变化对重症慢性阻塞性肺病患者通气和代谢的影响

目的：比较10例重症COPD患者在机械通气时，进行等热量不同碳水化合物热卡比例的全胃肠外营养，观察COPD患者通气及代谢的变化。方法：应用间接热卡仪测定能量需要量，给予三种等热量不同碳水化合物热卡的营养液，即40％糖、40％脂肪、20％蛋白质，60％糖、20％脂肪、20％蛋白质和75％糖、5％脂肪、20％蛋白质，并用间接热卡仪测定二氧化碳产生量（VCO2）、氧耗量（VO2）、呼吸商（RQ）、每分通气量（VE）、肺泡通气量（VA）、死腔通气量（Vd），并测定二氧化碳分压（PaCO2）等通气及代谢参数。结果：随着碳水化合物热卡摄入比例的增加，COPD患者的VCO2、VO2、RQ、VE、VA、Vd、PaCO2等通气及代谢指标均无显著变化，碳水化合物热卡摄入量与VCO2、VE、VA、PaCO2无显著相关关系，而RQ与VA呈显著正相关（r＝0．439，P＜0．05）。结论：在COPD患者的营养支持中，合理能量的摄入对减少营养支持并发症的发生更为重要。     

黄芪肠内营养对2型糖尿病合并缺血性卒中病人免疫功能影响

目的:研究黄芪肠内营养对2型糖尿病合并缺血性卒中病人体液免疫(IgA、IgG、IgM)和细胞免疫(T细胞亚群)的影响.方法:将64例病人随机分为治疗组和对照组,每组32例.治疗组给予黄芪水煎液(相当于生药60 g)加改良匀浆膳;对照组给予能全力,共30 d.两组肠内营养支持前后均测定IgA、IgG、IgM和T细胞亚群,同时监测空腹血糖、血浆清蛋白、转铁蛋白和血红蛋白等营养指标.结果:①治疗组肠内营养支持后,IgG、IgM、CD4和CD4/CD8比值均升高,与对照组比较,差异有显著性意义(P＜0.05,P＜0.01);②治疗组肠内营养支持后空腹血糖降低,与对照组比较,差异有显著性意义(P＜0.01).③两组病人经营养支持后,转铁蛋白升高(P＜0.05).结论:黄芪肠内营养可明显改善2型糖尿病合并缺血性卒中病人免疫功能及空腹血糖.     

低糖类肠内营养制剂对高血糖危重症病人的影响

目的:评价低糖类肠内营养制剂对高血糖危重症病人的影响.方法:将52例病人随机分成研究组和对照组,分别给予相同热量和氮量的肠内营养支持.研究组用康全达,对照组用能全力.观察治疗前后血糖、血浆清蛋白、血红蛋白、血脂、二氧化碳分压和氧分压的变化.结果:研究组病人空腹血糖水平变化小,无需加用胰岛素;对照组病人空腹血糖明显升高,需加用胰岛素治疗.研究组治疗后与对照组比较,血气分析指标变化差异有显著性意义(P＜0.05).两组病人肠内营养支持后的清蛋白和血红蛋白水平明显升高,而血脂变化差异无显著性意义.结论:低糖类肠内营养制剂对控制危重症病人的高血糖、改善呼吸功能和营养状况有一定的作用.     

脑卒中合并吞咽功能障碍的老年病人序贯肠内营养支持治疗的研究

目的:探讨序贯肠内营养(EN)支持治疗在脑卒中合并吞咽功能障碍老年病人治疗中的应用和临床效果. 方法:将62例急性缺血性脑卒中合并吞咽功能障碍的老年病人随机分为研究组和对照组.研究组(n=32)病人给予短肽型EN制剂,逐步过渡至整蛋白型EN制剂的序贯EN治疗方案.对照组(n=30)病人直接给予整蛋白型EN制剂.观察两组病人人组第1和第14天的营养指标、免疫功能指标和神经功能缺损评分(NIHSS)的变化以及并发症的发生情况. 结果:入组第14天,两组病人的营养指标、免疫功能指标和NIHSS评分均较第1天明显下降(P＜0.05).研究组与对照组比,营养指标和免疫功能指标下降的程度均较轻(P＜0.05),NIHSS评分下降程度无显著性差异(P＞0.05).研究组病人总并发症的发生率少于对照组(P＜0.05). 结论:序贯EN支持治疗能减轻脑卒中合并吞咽功能障碍的老年病人营养不良发展程度和免疫功能下降程度,促进神经功能恢复,降低并发症发生的风险.     

经鼻空肠管早期肠内营养在重症胸外伤老年病人中的应用

目的:探讨经鼻空肠管早期肠内营养(EEN)在伴呼吸功能衰竭的重症胸外伤老年病人中的应用.方法:将42例伴呼吸功能衰竭的重症胸外伤老年病人随机分为试验组和对照组.试验组经鼻空肠管行EEN;对照组病人早期给予全胃肠外营养(TPN)支持,比较两组营养、炎症、免疫和临床观察各项指标.结果:两组病人在机械通气开始时营养、炎症、免疫指标均无显著性差异.经营养支持后,试验组病人营养指标和免疫功能指标均优于对照组(P＜0.05,P＜0.01),炎症指标均低于对照组(P＜0.05,P＜0.01);病死率、肺部感染率和机械通气时间显著低于对照组(P＜0.01).结论:伴呼吸功能衰竭的重症胸外伤老年病人经鼻空肠管EEN安全可行,可提高免疫功能,改善营养状况,减轻炎症反应,减少伤后并发症的发生率,从而提高生存率.     

复方氨基酸注射液(17AA-H)在肝功能不全病人中的应用研究

目的:评价复方氨基酸注射液(17AA-H)对肝功能不全病人的营养支持效果及对肝功能恢复的影响. 方法:选择肝功能不全病人59例,给予肠外营养(PN)支持,采用回顾性非随机对照研究方法,根据氮源的不同分为两组.研究组29例使用复方氨基酸注射液(17AA-H),对照组30例使用复方氨基酸注射液(18AA-Ⅱ).比较两组病人PN前后营养指标(总蛋白、清蛋白)、肝功能指标(谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酸转肽酶)等变化. 结果:两组病人PN支持后营养指标均有所改善,总蛋白、清蛋白组内比较有显著性差异(P＜0.05).研究组病人谷丙转氨酶、谷草转氨酶、总胆红素等有所恢复,前后比较有显著性差异(P＜0.05). 结论:使用17AA-H作为PN氮源,有助于改善肝功能不全病人的营养状况和肝功能恢复.     

Comparison of low, medium, and high carbohydrate formulas for nighttime enteral feedings in cystic fibrosis patients

This study examined whether the increase in CO2 production (VCO2) and ventilatory demands by carbohydrate loading with different formulas during nighttime enteral feedings could be detrimental in young adult cystic fibrosis patients with moderate to advanced lung disease. Ten patients age 17 to 24 (mean 21.4 years) received 1000 kcal/M2 of a low (Pulmocare), medium (Ensure Plus), and high (Vivonex HN) carbohydrate formula in random order. Eight patients had severe, and two moderate obstructive pulmonary disease; nine used nighttime oxygen therapy. Basal energy expenditure (BEE) without feedings averaged 120% of that predicted by the Harris-Benedict equation. The metabolic expenditure by indirect calorimetry during nighttime feedings was 25 to 36% greater than the BEE. Oxygen consumption (VO2) increased 21 to 27% during nighttime feedings with no difference between formulas. VCO2 increased 29% for Pulmocare, 46% with Ensure Plus, and 53% with Vivonex HN. The increase in VCO2 with Pulmocare was significantly less than Ensure Plus (p less than 0.05) and Vivonex HN (p less than 0.005). The respiratory quotient (RQ) (VCO2-/VO2) for Pulmocare (0.88) was the same as the BEE, but increased with Ensure Plus (1.00), and Vivonex HN (1.08). The 41% increase in minute ventilation with Vivonex HN was greater than the 25 to 28% increase observed for Pulmocare and Ensure Plus (p less than 0.05). Transcutaneous oxygen saturation fell no more than 2% with all formulas. PCO2 changed +/- 5 torr during enteral feedings with similar changes in any patient with all formulas.(ABSTRACT TRUNCATED AT 250 WORDS)     

高脂低糖肠内营养制剂对ICU机械通气病人营养及肺部功能影响的研究

目的:观察高脂低糖肠内营养制剂对ICU机械通气病人的营养以及肺部功能的影响。方法:将271例病人随机分为试验组和对照组,分别给予高能低糖肠内营养制剂和通用型肠内营养配方制剂,观察病人治疗前后前白蛋白、白蛋白、血气分析、IgG、CD4、CD4/CD8、机械通气时间等指标。结果:经过营养支持治疗,两组前白蛋白、白蛋白均明显改善,两组间无明显差异;两组血气分析、IgG、CD4、CD4/CD8、营养费用、机械通气时间等均明显改善,且试验组优于对照组。结论:高脂低糖肠内营养制剂可以改善ICU机械通气病人的营养状态和肺部功能,可以缩短机械通气时间、节约医疗费用,是一种理想的肠内营养制剂。     

Effect of glucose to fat ratio on energy substrate disposal in children with cystic fibrosis fed enterally

High fat containing diets lower VCO(2)in patients with impaired pulmonary function fed at a high level of energy intake. We tested the effect of a high fat enteral nutrition on VCO(2)and substrate oxidation in cystic fibrosis patients fed enterally 130% RDA. VCO(2)and substrate oxidation were studied in a group of eight 6-19 year old patients while receiving for 1 month and in a random order isocaloric (1000 kcal/m(2)), isonitrogenous enteral diet with a normal fat and a high fat content (40% and 67% of non-protein energy intake).Substrate oxidation and net balance were estimated using indirect calorimetry at the end of each study period. Overnight high fat enteral infusion resulted in no significant change in VCO(2)and VO(2)but lowered RQ (0.84 +/- 0.01 vs 0.88 +/- 0.01, P= 0.02) and non-protein RQ (0.83 +/- 0.01 vs 0.88 +/- 0.01). In spite of a higher glucose oxidation rate (8.1 +/- 0.5 vs 6.3 +/- 0.5 g. h(-1), P= 0.04), glucose net balance was significantly higher during normal fat formula administration (+2.5 +/- 0.8 v -0.3 7plusmn; 0.7 g/h, P< 0.05).The present study failed to show any benefit of a high fat diet on VCO(2)in non oxygenodependant cystic fibrosis children and adolescents fed slightly above RAD. Normal fat enteral formula led to higher glycogen repletion.     

In vitro evaluation of a compact metabolic measurement instrument

The ability of the Datex Deltatrac (Sensor-Medics, Anaheim, CA) to accurately measure oxygen consumption (VO2v) and carbon dioxide production (VCO2) was examined in vitro using the carbon dioxide addition and nitrogen dilution methods. The accuracy of respiratory quotient (RQ = VCO2/VO2) measurements was assessed using methanol combustion (RQ = 0.67). Both in the canopy (blow-by) and respirator (FiO2: 0.21-0.6, PEEP: 0-12 cm H2O) modes the Deltatrac's measurements of VO2 and VCO2 were within +/- 7% of values predicted from CO2 and N2 simulations. Similar results were obtained with methanol combustion. In vitro testing revealed that the Deltatrac accurately measures VO2 and VCO2 under a variety of simulated clinical conditions.     

Technical and clinical testing of a computerized indirect calorimeter for use in mechanically ventilated neonates

Testing of a proprietary indirect calorimeter (MGM, Jr.) was performed by using nitrogen displacement and added carbon dioxide to simulate oxygen consumption (VO2), carbon dioxide production (VCO2), and the respiratory quotient (RQ; VCO2/VO2). Errors in measured VO2, VCO2, and RQ were less than or equal to 2.5% when VO2 and VCO2 were 4-43 mL/min and flow rate was 100-2000 mL/min. The relative error in predicted VO2 was increased as the inspired oxygen concentration (FiO2) was raised but the error was less than 4% when the value of FiO2 minus expired oxygen concentration (FeO2) was greater than or equal to 0.015 and the FiO2 was less than or equal to 0.6. Sixteen studies were performed on seven very-low-birth-weight (VLBW), mechanically ventilated infants aged less than or equal to 11 d. VO2 was 8.37 +/- 1.81 mL.kg-1.min-1, VCO2 was 8.15 +/- 2.03 mL.kg-1.min-1, and RQ was 0.969 +/- 0.061 (means +/- SD). The MGM, Jr. is accurate for studies of low-birth-weight infants on mechanical ventilators when VO2 and VCO2 are greater than or equal to 4 mL/min, flow rate is less than or equal to 3000 mL/min, and FiO2 is less than or equal to 0.6. Clinical testing resulted in values similar to previously published data but the variability was higher.     

无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床研究

目的 探讨无创正压通气在慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭中的治疗作用.方法 将76例COPD合并Ⅱ型呼吸衰竭患者随机分为对照组和治疗组,每组各38例,在进行抗感染、对症等常规治疗的同时,分别给予持续静脉滴注尼可刹米或无创正压通气治疗6 h,比较两组治疗前后生命体征及血气分析变化.结果两组治疗6 h后,治疗组在收缩压、心率、呼吸频率方面改善均显著优于对照组(P<0.05或<0.01);对照组pH值无改善,而治疗组pH值显著改善,两组比较差异有统计学意义(P<0.05);治疗组和对照组治疗后均有动脉血氧分压上升[(81.7±6.3)mm Hg(1 mm Hg=0.133 kPa)比(50.6±4.3)mm Hg,(67.6±7.4)mm Hg比(50.8±5.2)mm Hg]和且动脉血二氧化碳分压下降[(49.6±4.5)mm Hg比(78.5±10.4)mm Hg,(60.8±6.1)mm Hg比(76.8±8.3)mmHg],治疗组改善更明显(P<0.01).结论 无创正压通气治疗适合COPD合并Ⅱ型呼吸衰竭患者,其在改善临床症状和动脉血气指标方面均优于常规治疗,值得临床推广.     

颅脑损伤病人静息能量消耗的观测

目的 研究不同颅脑损伤病人伤后静息能量的变化。方法 用开放式间接测热法测定40例不同程度颅脑损伤病人伤后前5天的氧耗量(VO2)、二氧化碳生成量(VCO2)、呼吸商(RQ)、静息能量消耗(REE)和24小时尿氮排出量。结果 有脑损伤组患者伤后氧耗量、静息能量消耗、24小时尿氮排出量比无脑损伤组明显增加，且与脑损伤程度成正比。结论 颅脑损伤患者脑组织和全身处于高能量代谢状态，对氧和能量的需求急剧增加，应根据损伤程度合理、适时地补充营养，以利康复。     

A water-sealed indirect calorimeter for measurement of oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure in infants

We have developed a water-sealed infant calorimeter (IC) system which uses the techniques of closed-circuit spirometry to measure oxygen consumption (VO2) in premature and full-term infants. Carbon dioxide production (VCO2) is simultaneously calculated from the effluent mixed expired CO2 and the circulating flowrate. Respiratory Quotient (RQ) and Energy Expenditure (EE) are then calculated from the primary data. Measurement of VO2, VCO2, and calculation of RQ were +/- 5.0% of predicted values determined by burning ethyl alcohol or volume extraction and CO2 infusion in our bench model. Measurement in 11 premature infants produced mean values for VO2 and VCO2 of 8.5 +/- 2.5 ml/min/kg and 8.5 +/- 2.4 ml/min/kg, respectively. This system is noninvasive, does not interfere with infant tube feedings or iv infusions, and permits safe, long-term monitoring of the infant's metabolic activity. It allows a more exact matching or oral or intravenous feedings to the actual energy expenditure of the infants, and offers potential advantages for the nutritional management of sick infants.