全肠外营养在恶性肿瘤病人围手术期的应用

近 3年来 ,我院在肝、胃癌、大肠癌等恶性肿瘤病人围手术期应用 TPN,积累了一定的经验。1　临床资料1 .1　一般临床资料　 1肝癌 1 0例 ,均为男性 ,年龄38～ 60岁。轻度营养不良 5例 ,中度营养不良 3例 ,重度营养不良 1例 ,营养状况正常 1例。 2胃癌 1 2例 ,男 8例 ,年龄 40～ 60岁 ;女 4例 ,年龄 40～ 55岁。轻度营养不良 8例 ,中度营养不良 2例 ,另 2例营养状况在正常范围。 3大肠癌 8例 ,其中直肠癌 6例 ,结肠癌 2例 ,轻度营养不良 2例 ,中度营养不良1例 ,其余病例营养状况基本正常。1 .2　 TPN治疗　术前 3天和术后 3～ 5天进行TPN,…     

老年病人围手术期的全肠外营养支持

本文报道６６例腹部手术的老年病人，在围手术期辅以全胃肠外营养支持治疗，使病人的营养状态得以改善，加速了术后的恢复，提高了老年病人手术的安全性。并介绍了营养治疗的方法及途径的选择。对老年病人围手术期全胃肠外营养支持的必要性及术后营养物质的需要和代谢问题...     

肠外营养在结肠疾病围手术期的应用体会

本文报告将肠外营养应用于７例结肠疾病围手术期病人，作者探讨了结肠疾病围手术期营养支持的必要性和指征：①择期手术病人伴有营养不良，体重在３个月或半年内下降原体重１０％或１５％以上，白蛋白３５ｇ／Ｌ；②术前因营养不良而给予营养支持，术后继续应用直至恢复口...     

老年病人围手术期的全肠外营养支持

报告６６例腹部大、中手术的老年病人，在围手术期辅以全肠外营养支持治疗，使营养状况得以改善，加速了术后的恢复，提高了老年病人手术的安全性，并介绍了营养支持的方法及途径的选择。对老年病人围手术期全肠外营养支持的必要性及术后营养物质的需要和代谢等问题进行探讨。老年人肠外营养支持应采用低糖、低脂、低热量的原则，总热量不超过１２６ｋＪ．ｋｇ＾－１／ｄ，脂肪提供的热量以不超过４０％为宜。     

肠外营养支持在老年腹部手术病人围手术期的临床应用

目的：研究老年腹部手术病人围手术期肠外营养与普通输液的代谢效应。方法：３２例老年腹部外科病人分成两组，肠外营养组接受肠外营养，非蛋白热量总量１０４．５～１４６．４ｋＪ／（ｋｇ·ｄ），热氮比为４１８～６２７ｋＪ∶１ｑ，糖脂比为４∶６～５∶５。普遍输液组接受葡萄糖供能为主的治疗，术前２天和术后８天观察体重，血浆白蛋白、转铁蛋白、前白蛋白，总淋巴细胞计数，氮平衡等。结果：肠外营养组前白蛋白、氮平衡比术前增加，而普通输液组的体重、前白蛋白下降，治疗后两组比较差异有统计学意义（Ｐ＜０．０５或Ｐ＜０．０１）。结论：适当的肠外营养可使老年病人受益     

营养支持在腹部外科围手术期的应用

本文对３１例接受手术的危重病人在术前和术后进行了营养支持，并观察了氮平衡、血浆蛋白和有关的免疫指标，结果显示，营养支持可使氮平衡改善，血浆纤维连续蛋白明显改善，ＣＤ４＾＋和ＣＤ４＾＋／ＣＤ４＾＋比值明显升高ＮＫ细胞活性明显增强，结合文献对围手术期营养支持的作用，时机的方法进行了讨论。     

腹部外科危重患者围手术期的营养支持

腹部外科危重患者围手术期营养支持疗法，可以改善患者的营养状况、提高对手术的耐受性、提高机体免疫功能、降低手术并发症、促进手术后康复。本院自1995年以来，对138例腹部外科危重患者围手术期采用营养支持疗法，取得了较好的疗效，现报告如下。     

肠外营养在肾移植病人围手术期应用体会

手术创伤，排斥反应，免疫抑制剂毒性，消化道出血等合并症可以导致饮食受限，营养不良，从而影响移植肾功能恢复及病人长期存活。现对TPN在肾移植围手术期的应用方法及临床价值做了观察，并结合文献进行讨论。临床资料本组8例病人，男6例，女2例；年龄24～46岁，平均35．1岁。8例病人均予1986年1月～1997年2月接受同种异体肾移植。其中1例原发病是双侧多囊肾，余7例为慢性肾小球肾炎，均系终末期肾病尿毒症。移植术后急性排斥3例，心衰2例，移植肾功能不全合并肝损害2例，消化道出血2例（兼有急性排斥）。营养液包括10％脂肪乳剂，20％脂…     

腹部手术病人应用肠外营养支持的临床观察

目的：评价腹部外科围手术期病人胃肠外营养与普通输液的代谢效应。 方法：３７例腹部外科病人分成两组，胃肠外营养组接受肠外营养，普通输液组接受以葡萄糖供能为主的治疗。术前和术后１周观察血红蛋白、总淋巴细胞计数、血生化、血浆蛋白、氮平衡和体重等的变化。 结果：胃肠外营养组血浆白蛋白、氮平衡比术前增加而普通输液组的体重、血浆白蛋白水平下降，治疗后两组比较差异有统计学意义（Ｐ〈０．０５）。 结论：适当的肠外     

肠内营养和肠外营养在腹部手术患者中的应用

临床营养支持在外科重症患的救治中起重要作用。在90年代以前，主要采用肠外营养(PN)支持，进入90年代以后，越来越多的学倡导用肠内营养(EN)。本就肠内营养提高腹部大手术术后患的营养状况作一前瞻性研究。     

医院腹部外科围手术期抗菌药物应用调查

目的 观察腹部外科围手术期抗菌药物应用情况,为抗菌药物的规范管理及合理使用提供参考.方法 随机选择腹部外科出院病历500份,对围手术期抗菌药物的选择、用法、给药方式、病原学检查、用药时机及时间等进行统计分析.结果 抗菌药物使用率90.0％;静脉给药91.1％、口服4.4％、肌内注射4.4％;使用1～3种抗菌药物分别为17.8％、68.9％、13.3％;使用第三代头孢菌素共270例,二代头孢菌素240例;抗厌氧菌药物210例、其他160例次,共应用抗菌药物16种,4.7％患者做细菌培养;抗菌药物1次/d给药71.1％;2次/d占17.8％;3次/d占11.1％;术前和术后短程应用抗菌药物20.7％,术后应用抗菌药物79.3％,平均10.3d.结论 医院腹部外科使用抗菌药物种类选择基本合理,用药途径正确,也存在某些不合理用药现象,应实施针对性对策以合理应用抗菌药物.     

Preventing hypophosphatemia during total parenteral nutrition

Phosphate supplementation during total parenteral nutrition (TPN) is essential to prevent hypophosphatemia but individual phosphate requirements vary. We reviewed 68 courses of TPN in 61 patients to determine the incidence of hypophosphatemia and to identify factors which indicate a need for additional phosphate supplementation. Eight (12%) patients were hypophosphatemic before initiation of TPN. Sixty (88%) patients were normophosphatemic when TPN was initiated and 25 (42%) became hypophosphatemic. Of these 60 patients, 20 (38%) of 52 patients became hypophosphatemic when supplemented with 13.6 mM phosphate/liter or more, whereas five (63%) of eight patients became hypophosphatemic when supplemented with only 6.8 mM phosphate/liter TPN fluid. More hypophosphatemic patients required insulin during TPN (48 vs 26%), were initially hyperglycemic (24 vs 9%), were alcoholic by history (24 vs 11%), had evidence of chronic weight loss (64 vs 46%), and had a history of recent diuretic (40 vs 23%) or antacid therapy (56 vs 43%). Hypophosphatemia occurs frequently after initiation of TPN therapy despite phosphate supplementation. Provision of 13.6 mEq phosphate/liter prevents hypophosphatemia in most patients. However, patients who are hyperglycemic, require insulin during TPN, or have a history of alcoholism, chronic weight loss, or chronic antacid or diuretic therapy may require greater supplementation to prevent the development of hypophosphatemia. Chronically malnourished patients require a slower initial rate of infusion as well.     

Vitamin status during total parenteral nutrition

Plasma concentrations of vitamins A and E, serum and erythrocyte folic acid, serum B12 and erythrocyte enzyme activations (to assess vitamins B1, B2 and B6 status) were measured at the start and finish of 39 courses of total parenteral nutrition (TPN). The daily regimen was standard. Plasma vitamin A, E, and folate concentrations and vitamin B6 status improved significantly during TPN. Three patients developed low levels of vitamin A and two patients developed high transketolase activations (B1 depletion) during therapy. The adequacy of vitamin replacement and the monitoring of vitamin status during TPN is discussed.     

Hyperammonemia during total parenteral nutrition in children

Serial blood ammonia (NH3) determinations in 19 low birth weight (LBW) infants, 14 term neonates and 12 children receiving total parenteral nutrition (TPN) have shown that 73% of patients had one or more elevated NH3 values (greater than 150 micrograms/dl). The mean blood NH3 was 220 +/- 13 micrograms/dl in LBW infants, 180 +/- 9 micrograms/dl in 10 infants, and 140 +/- 7 micrograms/dl in children. All of these values are significantly higher than normal (p less than 0.001). There was no difference in incidence or mean blood ammonia concentration between patients receiving casein hydrolysate and those receiving a crystalline amino acid solution. Only four patients were symptomatic and several infants remained fully alert despite blood NH3 concentration in excess of 400 micrograms/dl. One infant who had sustained hyperammonemia was given another amino acid source (Travasol) containing 1.2 mmol/dl of arginine; blood NH3 promptly fell to the normal range. However, six of seven additional infants had hyperammonemia while receiving Travasol (mean = 184 micrograms/dl). Hyperammonemia is common during TPN in children, often is not recognized clinically, and occurs with equal frequency in infants and older children. The high levels observed in LBW infants may be due to hepatic immaturity. Blood NH3 concentration should be monitored frequently during TPN. Persistent hyperammonemia should be treated by decreasing protein content of the infusate. The role of supplemental arginine is unclear.     

Acetate and hypercalciuria during total parenteral nutrition

Hypercalciuria and negative calcium balance are complications of total parenteral nutrition (TPN). Because metabolism of the TPN formula generates an acid load that can induce hypercalciuria, we evaluated the effect of supplementing the formula with acetate. In a randomized crossover study six patients on continuous and six on cyclic TPN received no added acetate or 160 mmol acetate/d replacing 160 mmol chloride/d for 3 d each. Blood and urine measurements were obtained on day 3 of each formula. Acetate, which is metabolized to bicarbonate, increased blood pH and decreased renal acid excretion. Urinary Ca decreased in every patient from 422 +/- 63 to 240 +/- 46 mg/d (10.5 +/- 1.6 to 6.0 +/- 1.4 mmol/d) and from 468 +/- 68 to 285 +/- 54 mg/d (11.7 +/- 1.7 to 7.1 +/- 1.3 mmol/d) during continuous and cyclic TPN, respectively. Filtered Ca load decreased slightly whereas renal tubular Ca reabsorption increased significantly with acetate. Serum parathyroid hormone, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and urinary cyclic AMP were not different.