Parenteral nutrition hypersensitivity

Total parenteral nutrition (TPN) is widely used. Although mechanical, septic, and metabolic complications are well known, hypersensitivity skin reactions are rare. We describe a 16-year-old boy with Burkitt's lymphoma who developed a urticarial skin rash when treated with TPN and vitamins. The adverse skin reaction was probably caused by the inactive component of excipient, polysorbate.     

早产儿营养管理68例临床分析

目的：观察早产儿生后不同的营养方式对其体重、摄入的能量、食奶量及住院时间的影响。方法：68例早产儿生后6-12时开始喂养,24小时内食奶量,〉15ml/kg者,第2个24小时增量喂养,不足此量则加小儿氨基酸静脉营养;第3个24小时,奶量不足25ml/kg者或总热量不足55卡/kg,加脂肪乳静脉营养,同时参考胎龄、体重、及并发症选择营养方式。设定经肠道喂养者为A组,氨基酸静脉营养者为B组,氨基酸加脂肪乳静脉营养者为C组。结果：A组28例,B组23例,C组17例,其胎龄、体重依次递减;1周后,三组体重增长速度均大于宫内增长速度,出院时食奶量均达到了推荐的食奶量;住院时间C组最长。结论：根据早产儿的具体情况,选择适当的营养供给,对降低医疗成本,减少风险,保障早产儿的安全是可行的。     

全胃切除术后肠内营养和肠外营养的Meta分析

目的:以肠内营养(EN)和肠外营养(PN)治疗为对比,评价全胃切除术后采用不同营养支持方式的有效性、经济性和安全性. 方法:检索国外文献Pubmed数据库,同时检索国内文献CNKI、维普和万方数据库,鉴定为随机对照试验,采用RevMan 5.1软件进行Meta分析. 结果:共纳入23个随机对照试验(RCT),Meta分析结果显示,与PN组比,EN组可提高胃癌全胃切除术的血红蛋白[WMD=3.66,95％ CI(1.21,6.11)]和转铁蛋白含量[WMD =0.22,95％ CI(0.13,0.31)],缩短术后住院时间[WMD=4.95,95％ CI(-6.54,-3.37)],减少术后并发症的发生率[OR=0.38,95％ CI(-6.54,-3.37)]. 结论:采用EN对全胃切除术后进行营养支持,能有效地改善病人的营养状况,缩短病人的住院时间,降低并发症的发生率.     

Parenteral nutrition with n-3 lipids in sepsis

Dietary supplements of n-3 fatty acids have long been used to influence chronic inflammatory disorders. Recent studies with an immune-enhancing diet partly based on n-3 fatty acids report beneficial effects in patients with acute hyper-inflammatory diseases, such as the sepsis syndrome or adult respiratory distress syndrome (ARDS). The possible suppression of exaggerated leucocyte activity, the improvement of microcirculatory events, as well as the opportunity to administer intravenous lipids enriched in n-3 fatty acids signal the possibility of a combination of parenteral caloric support and pharmacological intervention. Using parenteral administration of fish oil-based lipids, a new rapid and highly effective anti-inflammatory agent may allow the option to alter the immune status in hyper-inflammatory diseases such as sepsis and ARDS.     

肠外营养支持在新生儿食管闭锁术后的应用

目的 :探讨肠外营养 (PN)支持在新生儿食管闭锁术后治疗作用及与预后的关系。　方法 :PN组 12例病儿 ,平均胎龄 (39.9± 0 .7)周 ,平均出生体重 (32 11± 431) g,平均禁食时间 (8.3± 2 .8)天 ,术后 1～ 3天开始 ,平均每天给予脂肪乳剂 (1.8± 0 .6 ) g/ kg,氨基酸 (2 .1± 0 .7) g/ kg,葡萄糖 (7.8± 2 .1) g/ kg,平均热量摄入为 (2 38.5±46 ) k J/ kg,热氮比 15 0～ 2 5 0∶ 1,液量 (12 0± 12 ) ml/ kg,PN平均应用时间为 7.6天 ,以“全合一”方式经周围静脉大于 16 h均匀输入。对照组 7例病儿 ,平均胎龄 (39.4± 1.4)周 ,平均出生体重 (2 911± 2 0 4) g,平均禁食时间 (7.0±4.5 )天 ,平均热量摄入 (171.5± 37.6 ) k J/ kg。　结果 :PN组治愈 11例 ,死亡 1例 ,病死率为 8.3% ;存活儿体重增加 5例 ,不变 5例 ,下降 1例 ,平均每天体重增加 (11± 2 7) g。对照组治愈 3例 ,死亡 4例 ,病死率为 5 7.1% ;存活儿体重均下降 ,平均每天体重降低 (2 2± 2 1) g。两组病死率及体重变化经 Student s test及卡方检验统计存在显著差异 (P<0 .0 5 )。　结论 :围手术期积极而合理地应用肠外营养支持可改善食管闭锁术后病儿的营养不良 ,降低病死率 ,改善预后     

Parenteral nutrition in a pregnant cystic fibrosis patient

This case report describes a 30-year-old pregnant woman with cystsic fibrosis who had marasmus as evidenced by clinical examination. The patient was maintained on central venous hyperalimentation for 18 days in her last trimester. The patient delivered a full-term infant via cesarian section with Apgar of 8 and 9, at 1 and 5 minutes, respectively, and adverse affects.     

Parenteral nutrition in obstetric patients

PN is required to maintain or restore an anabolic state when oral enteral routes are not feasible. Despite 22 years of experience with PN, its use during pregnancy has only recently been reported. Most of this information is anecdotal but suggests that this mode of therapy is safe, effective, and occasionally lifesaving. PN during pregnancy has been used most often to provide adequate nutrition for those who suffer from prolonged hyperemesis or who have difficulty absorbing adequate nutrients because of such conditions as Crohn's disease. The proper selection and administration of dextrose, fat, protein, vitamins, trace elements, and electrolytes for pregnant women have been associated with favorable perinatal outcomes. Fat emulsion use does not appear to be associated with any abnormal outcomes. Preterm deliveries and intrauterine fetal growth retardation appear to relate to preexisting or coexisting medical or obstetric complications. Principles for PN with all patients would apply during pregnancy. As with any therapy, the benefits must be weighed against the risks and costs. Sufficient favorable clinical experience over the last 10 years suggests that PN is a relatively safe and effective method for reversing maternal malnutrition and promoting normal fetal growth and development.     

全肠外营养相关肝损害小鼠模型的建立

目的:为进一步研究肠外营养(PN)相关肝损害(PNALD)的患病机制及干预措施,建立有效的小鼠模型。方法:将20只小鼠随机分为对照组和模型组,对照组小鼠正常饮食、颈静脉置管后微量泵持续输注等渗盐水;模型组小鼠禁食后颈静脉置管,用微量泵持续输注PN液。1周后比较两组小鼠体重变化,血清生化指标以及肝组织学改变。结果:模型组小鼠体重明显低于对照组(P<0.05),直接胆红素、总胆红素和胆固醇均显著高于对照组(P<0.05),且肝组织在光镜下可见广泛性肝细胞脂肪变性,细胞质内出现大小不一的空泡,主要集中于中央静脉周围。脂肪变性评分为(3.1±0.5)分,显著高于对照组(1.0±0.0)分。结论:模型组小鼠与成人PNALD病人初期的临床和病理改变相似,可用于该病的患病机制,药物治疗疗效以及具体机制的观察和研究。     

Parenteral nutrition in acute renal failure

This article reviews the current practice of parenteral feeding in patients with acute renal failure. Assessment of nutritional requirements and the provision of nutrients are discussed. Practical guidelines are provided for dietitians to use in the clinical setting.     

Parenteral nutrition in bone marrow transplantation

Twenty-nine patients undergoing bone marrow transplantation (BMT) were randomised prospectively to evaluate the effect of parenteral nutrition (TPN) on morbidity and mortality. Fourteen patients received a standard regimen of TPN for 10 +/- 4 days (mean +/- SD). All patients had free access to oral diet, which was significantly reduced compared to pre-transplant intake. In the TPN group, serum bilirubin by day 14 and serum bilirubin and gamma glutamyl transferase by day 21 were significantly higher than in the controls (p < 0.05). These differences probably reflect the higher incidence of serious pyrexia (T > 38.5' C) and blood culture positive rates in the TPN group. Weight loss in the control group was significantly greater than that of the TPN group (p < 0.05). TPN did not affect time to grafting or incidence of graft-versus-host disease. The use of TPN in the nutritional support of patients in small BMT units requires careful consideration.     

Parenteral nutrition for patients with advanced ovarian malignancy

Background: Parenteral nutrition (PN) in patients with disseminated ovarian cancer remains controversial. The role of PN in providing nutrition and improving quality of life is unclear. The present study aimed to determine the pattern of prescribing in a large teaching hospital, and to identify subgroups where the use of PN was justified. Methods: Sixty‐five patients with advanced ovarian carcinoma received PN between January 2002 and May 2008. A retrospective case note review was undertaken to retrieve data on PN prescribing and outcomes in terms of duration of PN provision, complications, and survival. Results: Three subgroups were identified. Group I consisted of 18 (28%) patients who received PN for a median [interquartile range (IQR)] of 5 (2–11) days. The majority of these 18 patients (n = 13, 72%) had disease‐related terminal bowel obstruction. Out of 18 of these patients, 17 (95%) had poor performance status. The median (IQR) survival was 12 (6–28) days. Group II consisted of 40 (61%) patients who were re‐established on enteral nutrition. The median (IQR) duration of PN administration was 10 (6–17) days. The most common indication of PN was protracted ileus (n = 25, 63%). Out of 40 of these patients, 35 (88%) patients had good performance status. The median (IQR) survival was 264 (96–564) days. The third group of patients required home PN (n = 7, 11%). Four (58%) patients had short bowel syndrome and three (42%) had terminal intestinal obstruction. All of the patients had good performance status. The median (IQR) duration of PN administration and survival was 241 (90–305) days. Conclusions: Administration of PN appears to be justified in those patients with a good performance status (i.e. patients capable of self‐care), which constituted three‐quarters of this cohort. In the remaining patients with poor performance status, and particularly those with terminal intestinal obstruction, PN administration was difficult to justify. PN should not be denied based purely on the pathology, although cautious judgment is required to select those who are most likely to benefit.     

Parenteral nutrition: multidisciplinary management

Parenteral nutrition may be needed to give nutritional support to patients with severe acute (temporary or reversible) or chronic intestinal failure. Parenteral nutrition needs to be given only by health workers trained in its use otherwise life-threatening complications (especially sepsis) may occur.