肠内外联合营养支持对急性重症脑卒中患者临床疗效的影响

目的:探讨肠内营养(EN)+肠外营养(PN)对急性重症脑卒中患者的营养状态和临床疗效的影响。方法:将60例急性重症脑卒中患者随机分为EN+PN组(32例)和EN组(28例)营养支持,住院第1天、14天分别检测2组患者血红蛋白、血清白蛋白,第1天、21天测美国国立卫生院卒中量表(NIHSS)评分,统计感染、肠道并发症,入院第90天时进行改良Rankin评分。结果:住院第14天2组患者各项营养指标均下降,EN组下降更为明显(P<0.05);EN组第14天低蛋白血症发生率及并发症发生率显著升高(P<0.05);EN+PN组第14天感染发生率显著低于EN组(P均<0.05)。第21天2组NIHSS评分均有明显改善,EN+PN组较对照组改善更为显著(P均<0.05),第90天时改良Rankin评分显著高于EN组(P<0.01)。结论:早期EN+PN营养支持可明显改善重症脑卒中患者的营养状况,降低并发症,改善临床预后。     

老年胃肠道手术后患者早期肠内肠外营养支持与肠外营养支持的疗效比较

目的探讨早期肠内肠外营养支持疗法(EEN+PN)与肠外营养支持(PN)对老年胃肠道手术后患者的疗效。方法将106例行胃肠道手术的老年患者随机分为EEN+PN组(n=53)和PN组(n=53),分别于术前1 d和术后第7天测定其相关营养、生化、免疫及炎症指标,比较两组患者胃肠道恢复、住院时间、营养相关费用及术后并发症情况。结果术后第7天EEN+PN组血清白蛋白(ALB)与前白蛋白(PA)水平均明显高于PN组(均P0.05);术后第7天EEN+PN组C反应蛋白(CRP)明显高于PN组,而淋巴细胞计数(LYM)明显低于PN组(均P0.05);EEN+PN组术后首次排气时间、住院时间及营养支持费用均明显低于PN组(均P0.05),EEN+PN组中有5例发生腹泻、腹胀及恶心等并术后发症,PN组3例。结论早期EEN+PN较PN可更有效改善机体营养状况,保护机体免疫能力及胃肠道功能,有助于患者术后恢复,缩短其住院时间,减少营养支持费用。     

三种营养支持方法在胃癌术后的应用

将60例胃癌根治术后患者随机分为三组,分别进行肠外营养支持(PN组)、肠内营养支持(EN组)、肠内外联合营养支持(PN-EN组).观察三组患者并发症的发生率、术后肠功能恢复时间及术后各项参数的变化,进行对比分析.发现三组患者术后血清白蛋白、前白蛋白、转铁蛋自在营养支持后均明显升高,EN组、PN-EN组与PN间有显著差异.EN组患者术后肠功能恢复时间明显早于PN组和PN-EN组.认为三种营养支持方法均能明显改善胃癌术后患者营养状况,肠内外序贯营养支持符合患者的病理生理需求,具有安全、有效、合理的特点.     

急性缺血性脑卒中伴吞咽困难患者营养支持治疗临床观察

目的:探讨三种营养支持治疗方法对急性缺血性脑卒中伴吞咽困难患者的临床价值。方法:回顾性分析急性缺血性脑卒中伴吞咽困难患者150例的临床资料。按不同营养方式分为3组:肠内营养治疗组(EN组),肠外营养治疗组(PN组),肠内外联合营养治疗组(EN+PN组),每组50例。分别于住院第1、第7及第14天检测患者血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、甘油三酯(TG)、血红蛋白(Hb)及淋巴细胞计数(LYM)等,记录3组治疗期间并发症的发生率,并以美国国立卫生研究院卒中量表(NIHSS)评分评价神经功能缺损情况。结果:EN+PN组TP、ALB、PA、Hb及LYM等指标优于EN组和PN组(均P0.05)。而EN组与PN组比较,仅PA下降程度差异有统计学意义。入院第14天时,EN+PN组并发症发生率显著低于EN组和PN组(P0.05),而EN组和PN组比较无明显差异。第14天时,3组神经功能缺损情况与入院时比较差异均有统计学意义(P0.05);EN+PN组神经功能恢复情况显著优于EN组和PN组(P0.05),而EN组和PN组比较差异无统计学意义。结论:采用肠内外联合营养治疗可有效改善患者的营养状况、降低并发症发生率、促进神经功能恢复,短期临床结局优于肠内或肠外营养支持治疗组,而肠内与肠外营养治疗组比较并无优势。     

老年重症患者低蛋白血症的相关临床指标分析

目的 探讨低蛋白血症对老年危重症患者相关临床指标及预后的影响和意义.方法 回顾性分析160例入住ICU科的老年危重症患者的临床资料,测定入科时血清白蛋白水平并进行如下分析:(1)根据预后分成死亡组与存活组,统计两组血清白蛋白水平变化;(2)根据血清白蛋白水平分成正常白蛋白组及低度、中度、重度低蛋白血症组,对其APACHEⅡ评分、MODS发生率、住院疗程、感染率进行统计分析;(3)对不同血清白蛋白水平患者的呼吸支持治疗及VAP发生情况进行统计分析;(4)对不同营养支持治疗手段纠正白蛋白水平的情况进行统计分析.结果 (1)存活组血清白蛋白水平明显高于死亡组,差异有统计学意义(P＜0.05);(2)正常白蛋白组与低蛋白血症组相比真菌感染率、MODS发生率、住院时间、VAP、病死率均有显著差异.(3)随着血清白蛋白水平的降低,VAP发生率明显增高,脱机时间延长;随着血清白蛋白水平的下降出现VAP的时间提早.(4)多种手段联合治疗低白蛋白血症能有效提高血清白蛋白水平.结论 老年危重症患者的血清白蛋白水平与病情严重程度及病死率密切相关,尽早使用多种营养支持途径纠正低白蛋白血症对提高患者的血清白蛋白水平有重要作用.     

急性脑卒中患者补充肠外营养的短期预后分析

目的探讨急性脑卒中患者出现胃肠功能紊乱时,补充肠外营养(PN)对患者短期预后的影响。方法将吞咽困难而出现胃肠功能紊乱的48例急性脑卒中患者随机分为2组:肠内营养(EN)组21例.营养支持停留在胃肠可以耐受的程度,平均热量为(58.5±15.0)kJ/(kg·d),蛋白质(40.4±11.8)g/d;EN+PN组27例,平均热量为(101.9±22.2)kJ/(kg·d),蛋白质(62.8±9.7)g/d。观察2组营养支持前和营养支持2周后血红蛋白、生化全项、美国国立卫生研究院脑卒中量表(NIHSS)评分及并发症。结果与营养支持前比较,营养支持2周后,EN组患者白蛋白、前白蛋白、血红蛋白和总蛋白明显下降,有显著差异(P0.01);EN+PN组患者总蛋白、白蛋白、前白蛋白虽有下降,但无显著差异(P0.05)。与EN组比较,营养支持2周后,EN+PN组患者血红蛋白、红细胞压积、白蛋白、前白蛋白明显升高、NIHSS评分明显下降(P0.05);EN组泌尿系统感染发生率明显高于EN+PN组(P0.05)。结论对于吞咽困难的脑卒中患者,在给予EN制剂时,如果遇到患者胃肠功能紊乱,应及时PN补充,可以有效地防止低蛋白血症的发生,对神经功能恢复有良好的促进作用。     

营养支持对慢性心力衰竭患者的心功能及炎症因子的影响

目的比较肠内肠外联合营养、单纯肠内营养、单纯肠外营养3种营养支持方法对慢性心力衰竭(心衰)心功能及炎症因子的影响。方法入选2012年1月~2014年6月北京军区总医院干部病房住院的慢性心衰患者65例,随机分为3组:肠内营养联合肠外营养组(EN+PN组,21例),肠内营养组(EN组,23例),肠外营养组(PN组,21例)。三组患者常规抗心衰治疗基础上给予三种不同营养支持2周后,采用抽血送检、超声检测等方法临床检测营养指标、血脂情况、心功能及炎症因子。结果同组治疗前后比较,三头肌皮褶厚度(TSF)、上臂肌围(AMC)、血清白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TF)均升高(P0.05),且三组中EN+PN组升高水平明显高于EN、PN组(P0.05),治疗后EN组与PN组差别无统计学意义(P0.05)。EN、PN、EN+PN三组治疗后三酰甘油(TG)、胆固醇(CHOL)均略有上升(P0.05),三组间比较无统计学差异(P0.05)。治疗后,三组心脏超声测量左室射血分数(LVEF),血清学检测血清脑钠肽前体(NT-pro BNP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均有降低(P均0.05);EN+PN组LVEF、NT-pro BNP、IL-6、TNF-α水平明显低于EN和PN组(P0.05);EN组与PN组营养支持前后上述指标差异无统计学意义(P0.05)。结论对于慢性心衰患者,联合营养支持的近期疗效显著优于单独肠内营养支持和肠外营养支持,调节炎症因子水平,进一步改善患者心功能。     

重型颅脑损伤早期应用生长激素对其代谢及预后的影响研究

目的探讨重组人生长激素（rhGH）对重型颅脑损伤患者代谢调控作用的应用价值。方法将40例重型颅脑损伤患者在早期肠内、肠外营养支持的基础上随机分成rhGH治疗组（20例）与对照组（20例）,rhGH治疗组伤后或术后第2～3天开始每日皮下注射重组人生长激素4 IU,共10～14d。应用后第7、14天检测血清总蛋白、白蛋白、转铁蛋白及前白蛋白。结果 rhGH治疗组第14天后血清总蛋白、白蛋白、转铁蛋白及前白蛋白浓度高于对照组,体质量改变率低于对照组,预后优于对照组。结论重型颅脑损伤患者应用rhGH能改善机体对营养底物的利用率,促进蛋白合成、减轻重型颅脑损伤后低蛋白血症,改善预后。     

口服支链氨基酸治疗肝硬化低蛋白血症多中心总结

为验证口服支链氨基酸治疗肝硬化低蛋白血症的疗效,将149例患者随机分为两组,A组口服支链氨基酸,B组口服复方氨基酸胶囊,疗程9周。结果表明:A组血清白蛋白水平由治疗前(32.25±3.11)g/dl升高到(37.61±5.13)g/dl(P<0.05);B组血清白蛋白由治疗前(32.12±2.04)g/dl升高到(36.64±4.66)g/dl(P<0.05),两组对比,支链氨基酸组血清白蛋白升幅明显高于对照组。两组均未发生严重不良反应。因此,支链氨基酸是一种安全有效的提升肝病患者白蛋白水平的药品。     

生长激素治疗肝硬化低蛋白血症的临床研究

目的观察重组人生长激素(rhGH)对肝硬化低蛋白血症的治疗效果。方法60例肝硬化失代偿期患者随机分为两组,每组30例,两组均隔日输注人血白蛋白10g,治疗组每天皮下注射rhGH4IU一次,共14天。治疗前,治疗结束时及停药后1月、6月观察临床症状及肝功能、生化指标的变化。结果治疗结束时,治疗组及对照组的临床症状均有改善,血清白蛋白含量分别由27.5±3.6g/L和25.7±4.2g/L升至33.2±6.4g/L和34.1±3.2g/L(P<0.05),肝功能指标明显好转。停药1月后,对照组血清白蛋白含量开始下降,而治疗组在停药6月后血清白蛋白仍能维持较高水平(35.2±2.8g/L)。结论rhGH可以明显提高肝硬化患者血清白蛋白水平,疗效持久,远期疗效有待进一步研究。     

Satisfaction with ambulatory care of persons with AIDS

OBJECTIVE: To examine the relation of patient characteristics and site of care to the perception of ambulatory care quality by persons with AIDS (PWAs). DESIGN: Patient surveys and medical record review were used to determine PWAs’ perceptions of their ambulatory care, self-perceived health status, primary care relationships, sociodemographic characteristics, and severity of illness. SETTING: A public-hospital HIV clinic, an academic group practice, and a staff-model health maintenance organization (HMO) that together care for 20% of all Massachusetts PWAs. PATIENTS: All active patients as of February 12, 1990, and all new AIDS patients at each of the three sites during the subsequent 13 months. MEASUREMENTS AND MAIN BESULTS: The primary outcome measure was a six-item scale of patient-rated quality of care (PRQC), a newly developed measure that combined patients’ ratings of their physician care, nursing care, involvement in medical decisions, and overall quality of care. Multiple logistic regression was carried out with low PRQC (lowest quart He) as the dependent variable, to identify correlates of patient perceptions of poor quality. Patients who had a primary nurse were significantly less likely to have low PRQC scores (OR=0.50, 95% CI=0.26 to 0.97). Black patients and patients who used injection drugs were significantly more likely to rate their care in the lowest quartile (OR=2.22, 95% CI=1.04 to 4.78; and OR=2.43, 95% CI=1.13 to 5.23, respectively), as were those who had lower self-perceived health status, after controlling for confounders; no association was found by site or severity. CONCLUSIONS: These results show that primary nursing may be an important determinant of how PWAs rate the quality of their ambulatory care. Furthermore, PWAs who are black or who are injection drug users are less satisfied than are others with the quality of their ambulatory AIDS care. Presented in part at the annual meeting of the Society of General Internal Medicine, April 30, 1993, Arlington, Virginia. Supported by the Agency for Health Care Policy and Research, grant number HS06239.     

分析老年糖尿病患者应用甘精胰岛素联合阿卡波糖治疗的效果

目的探讨甘精胰岛素联合阿卡波糖在老年糖尿病患者中的临床疗效。方法选取该院2018年7月—2019年7月收治的113例老年糖尿病患者作为研究对象,经随机数字表法,划分A组(n=56,阿卡波糖)和B组(n=57,甘精胰岛素+阿卡波糖),比较两组临床疗效、血糖指标。结果B组患者临床治疗总有效率显著高于A组;经治疗,B组患者空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平明显低于A组。两组之间比较差异有统计学意义(P<0.05)。结论在老年糖尿病患者中应用甘精胰岛素+阿卡波糖,临床疗效显著,使患者的空腹血糖、餐后2 h血糖、糖化血红蛋白等指标得到了明显改善,安全性强。     

Treatment of patients with Eisenmenger's syndrome with Bosentan

We treated prospectively 14 patients with Eisenmenger's syndrome, with a mean age of 10 years, ranging from 3 to 18 years. Treatment continued for 12 months, and demonstrated a lasting symptomatic improvement, but no improvement in terms of mean saturation of oxygen over 24 hours. Exercise capacity, as judged by peak uptake of oxygen, worsened in the six patients able to perform a treadmill test. The symptomatic benefit from dual blockage of endothelin receptors in these patients may be due to mechanisms other than selective pulmonary vasodilatation alone.     

小剂量垂体后叶素合并硝酸甘油治疗咯血

目的评价小剂量垂体后叶素联合硝酸甘油治疗咯血的疗效及不良反应。方法将50例咯血患者随机分为两组,治疗组在常规治疗基础上（n=26）应用小剂量垂体后叶素联合硝酸甘油;对照组（n=24）在常规治疗基础上仅应用小剂量垂体后叶素。分析其疗效及不良反应。结果48小时后治疗组有效率96.15％（25／26）,对照组有效率58.33％（14／24）,差异有统计学意义（P=0.012）;治疗组对血压影响小,无统计学意义（P〉0.05）,对照组能引起血压升高的副作用（P〈0.05）;治疗组出现头晕头痛、胸闷、心悸、腹痛、腹泻、恶心呕吐、出汗、面色苍白等不良反应比对照组少,差异有统计学意义（P〈0.05）。结论小剂量垂体后叶素联合硝酸甘油治疗中量咯血比垂体后叶素单药治疗中量咯血疗效明显提高,且能减少垂体后叶素不良反应。     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.