门诊老年慢性肾功能不全患者营养状况评价及健康教育

目的了解门诊老年慢性肾功能不全患者营养状况、营养素摄入量及膳食结构,为饮食治疗提供依据。方法对57例60岁以上长期门诊老年CRF患者、30例肾功能正常老年人进行膳食调查、直接人体测量和生化参数测定。结果调查的老年CRF患者普遍存在营养不均衡。53.2%患者热能摄入不足具有潜在营养不良,46.8%热能摄入基本正常;营养素摄入不均衡,蛋白质摄入基本正常,碳水化合物的摄入量偏低,占总热能的(52.1±12.0)%;脂肪摄入偏高,占总热能的(35.0±11.9)%。老年CRF患者同时还患有其他多种慢性病。结论营养不良及营养过剩都将对肾功能产生不良影响。门诊医护人员应根据每个老年CRF患者的具体情况,为老年CRF患者确定每日热能和营养素供给量以及各种食物的合理搭配,并在随诊时给予指导调整。     

门诊老年慢性肾功能不全患者营养状况评价及健康教育

目的 了解门诊老年慢性肾功能不全患者营养状况、营养素摄入量及膳食结构,为饮食治疗提供依据.方法 对57例60岁以上长期门诊老年CRF患者、30例肾功能正常老年人进行膳食调查、直接人体测量和生化参数测定.结果 调查的老年CRF患者普遍存在营养不均衡.53.2%患者热能摄入不足具有潜在营养不良,46.8%热能摄入基本正常;营养素摄入不均衡,蛋白质摄入基本正常,碳水化合物的摄入量偏低,占总热能的(52.1±12.0)%;脂肪摄入偏高,占总热能的(35.0±11.9)%.老年CRF患者同时还患有其他多种慢性病.结论 营养不良及营养过剩都将对肾功能产生不良影响.门诊医护人员应根据每个老年CRF患者的具体情况,为老年CRF患者确定每日热能和营养素供给量以及各种食物的合理搭配,并在随诊时给予指导调整.     

某高校大学生营养状况调查分析

目的了解大学生营养状况，为大学生提出科学饮食的方法。方法采用问卷法、个别询问等对200例在校大学生进行营养状况调查。结果膳食结构不合理主要表现在食物来源在质和量方面较差，营养素来源以碳水化合物所占比例偏多，其中蛋类、鱼类、奶类、豆类等优质蛋白丰富的食物摄入量明显低于标准供给量（RDA）；男、女生蛋白质、脂肪、钙、维生素B、维生素C和维生素A的摄入明显不足，蛋白质摄入量男、女生分别占RDA的81．1％和71．5％；三大热能营养素比例失衡，男、女生均存在蛋白质占热能比不足（为10．6％），而碳水化合物占热能比偏高的问题（70.3％）；三餐热能比分配不合理，表现为早餐能量摄入偏低，占全日总能量的22％；而晚餐摄入量偏高，占全日总能量的44％。造成部分大学生出现肥胖或慢性营养不良性疾病。结论大学生营养状况较差。应全面增加各种营养素摄入量，努力改善膳食结构，以提高营养水平。     

120例社区老年人膳食中三大产热营养素摄入情况调查分析

目的 提高老年人生活质量，防止热能摄入比例不合理，预防心、脑血管疾病及并发症的发病率。方法 对120例社区老年人进行了3天膳食调查对其热能的摄入是否平衡进行了分析。结果 发现三大产热营养素所产热能占总热能比例均不合理，占调查总数的22％。脂肪占总热能30％以上者占70％，蛋白质占总热能15％以上占88．3％，碳水化合物占总热能55％以下占75％(有14例在40％以下)。肥胖者占12．5％。冠心病患者占调查人数65％，高血压患者占调查人数42．5％，糖尿病患者占调查人数33％等。并发现部分老年人对饮食结构不合理未引起足够的重视，其原因主要是观念陈旧及缺少正确信息来源。结论 对患慢性病恢复期的社区老年人在进行健康教育时应加强三大产热营养素摄入平衡的指导。     

持续性非卧床腹膜透析患者膳食调查及营养状况

目的通过膳食调查了解持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者食物和膳食营养素摄入量,评估膳食营养素摄入量对CAPD患者营养需求的满足程度,为合理营养干预提供科学依据。方法采用24h膳食回顾法对70例CAPD患者进行膳食调查。根据每日蛋白质摄入量(daily protein intake,DPI)水平将患者分为膳食蛋白摄入正常组[DPI≥1.08g/(kg·d)]和膳食蛋白摄入不足组[DPI1.08g/(kg·d)],评价2组患者每日食物及营养素摄入量并进行营养不良的评定。结果 70例CAPD患者中有54例(77.1%)膳食蛋白质摄入量不足。与膳食蛋白摄入不足组相比,膳食蛋白摄入正常组的谷薯类、蔬菜类、禽畜类的摄入量多(Z值分别为-3.089,-2.088,-3.465;P值分别为0.002,0.037,0.001)。膳食蛋白摄入正常组的每日能量摄入量(daily energy intake,DEI)及DPI高于膳食蛋白摄入不足组(t值分别为4.400,8.562;P值分别为0.001,0.001)。与膳食蛋白摄入不足组相比,膳食蛋白摄入正常组的总蛋白和动物蛋白摄入量多(t值分别为6.171,5.246;P值均为0.001),植物蛋白摄入量少(t=3.387,P=0.001),动物蛋白占总蛋白比例超过60%(t=2.216,P=0.031)。与膳食蛋白摄入不足组相比,膳食蛋白摄入正常组的维生素A、维生素B_1、维生素B_2、维生素C、维生素PP(t值分别为2.841,4.821,4.314,2.480,5.109;P值分别为0.006,0.001,0.001,0.016,0.001)、钾、钠、钙、镁、铁、锰、锌、铜、磷、硒(t值分别为5.003,2.500,2.593,4.359,5.660,3.443,5.721,4.480,5.789,3.065;P值分别为0.001,0.016,0.012,0.001,0.001,0.001,0.001,0.001,0.001,0.003)摄入量多。结论 CAPD患者普遍存在膳食摄入不足的问题,膳食蛋白质摄入量不能满足CAPD患者营养需求,膳食蛋白摄入不足组患者膳食营养摄入状况较膳食蛋白摄入正常组差,建议加强营养宣教和个体化的饮食指导。     

高原地区慢性肺原性心脏病缓解期患者营养状况与肺功能的关系

目的：对高原地区慢性肺原性心脏病(简称肺心病)缓解期患者营养状况进行调查，分析营养状况与肺功能的关系，为开展慢性肺心病的饮食干预提供参考依据。方法：2000—01／2003—12在解放军第四医院兰州军区呼吸内科中心住院的高原地区慢性肺心病缓解期患者180例，符合纳入标准的慢性肺心病缓解期患者60例。对60例高原地区慢性肺心病缓解期患者，采用24h膳食回忆法，计算连续5d膳食的摄入。进行身高、体质量、实际体质量占理想体质量百分比(percentage of ideal body weight，IBW％)、上臂中部周径(mid—upper arm circumference，MAC)、上臂中部肌围(mid—arm muscle circumference，MAMC)、肱三头肌皮褶厚度(triceps skiufold thickness，TSF)测量和血清白蛋白、肺功能测定，分析营养指标与肺功能的关系。结果：高原地区慢性肺心病缓解期营养不良患者热能、蛋白质、脂肪和碳水化合物营养素摄入明显不足。48％的患者IBW％低于90％(体质量降低患者)。体质量降低患者MAC，MAMC，TSF，血清白蛋白，第1秒用力呼气量(forced expiratory volume in 1 second，FEV1)占预计值百分比(FEV1％)、用力肺活量(forced vital capacity，FVC)、FEV1／FVC[(22．1&;#177;2．0)cm，(18．5&;#177;1．9)cm，(10．1&;#177;4．5)mm．(36．2&;#177;2．6)g／L，(40．4&;#177;6．5)％，(0．8&;#177;0．3)L，(42．5&;#177;7．1)％]均显著低于体质量正常患者[(29．3&;#177;3．2)cm．(22．8&;#177;2．9)cm．(22．9&;#177;6．4)mm．(41．7&;#177;3．5)g／L，(44．7&;#177;6．3)％，(1．2&;#177;0．4)L，(47．8&;#177;7．2)％](t=2．81—9．56，P&;lt;0．01)。热量、蛋白质、脂肪、碳水化合物，IBW％，血清白蛋白，MAC，MAMC，TSF与FEV1％，FVC，FEV1／FVC呈显著正相关(r=0．278—0．545，P&;lt;0．05～0．01)。结论：能量消耗增加和多种营养素摄入不足是导致高原慢性肺心病营养不良的主要原因，营养不良可影响肺的通气功能。     

慢阻肺缓解期患者营养不良及其相关因素分析

观察７６例慢阻肺缓解期患者的肺功能，饮食摄入情况与营养状况的关系，并探讨了ＣＯＰＤ患者营养不良发生的机理。结果显示５４．０％的ＣＯＰＤ患者体重低于理想体重的９０％。８４．２％的患者膳食中热能摄入量低于正常人标准供给量。ＦＥＶ１占预计值百分比，ＦＥＶ１／ＦＶＣ％与饱含中总热能摄入量占正常人标准供给量的百分比呈正相关，ＦＶＣ占预计值百分比与Ｅ％ＲＤＡ相关无显著性。     

乌鲁木齐、伊宁、阿图什318名维吾尔族孕妇膳食结构调查

目的：了解维吾尔孕妇膳食营养素摄入水平的食物种类，以利于提出孕妇及胎儿健康生长发育的合理膳食建议。 方法：于2004—03／2005-05随机调查乌鲁木齐、伊宁、阿图什当地医院门诊就诊的维吾尔族孕妇318名，年龄22～30岁，孕早期组（1～12周）113名、孕中期组（13～27周）104名、孕晚期组（28周一产前）101名。3组孕妇在胎次、职业、烟酒嗜好、生活水平条件上比例均衡，且无口服避孕药史及叶酸服用史，无慢性疾病，无妊娠并发症。采用24h回顾法进行膳食营养状况调查，记录24h进食量，结果采用营养计算器软件V1．6（以国内最新版的“中国食物成分表2002”为基础数据库）计算，计算出平均每人每日食物消耗量和各种营养素摄入量，并与国内修订的《每日膳食中营养素供给量》标准进行比较分析。主要观察膳食构成、热能和各营养素的摄入量、孕妇三大产热营养素的供热比、蛋白质的来源及分布、维生素和矿物质营养情况。 结果：纳入对象318名，均进入结果分析。①孕妇的膳食构成中粮谷类占摄入量的35．03％，动物性食品占9．01％，蔬菜、水果分别占11．17％和32．30％，蛋类及乳制品摄入量明显缺乏，仅为1．61％和9．50％。从中国营养学会提出的居民平衡膳食宝塔考虑，需要增加蛋类、奶类、鱼类的摄入量，食物多样化，从而达到平衡营养的需要。②蛋白质的供热比为13．28％，比推荐标准（10％～12％）偏高，碳水化合物的供热比为67．71％，比推荐标准（60％～65％）偏高；脂肪供能比为19．01％，比推荐标准（20％～25％）偏低。③钙的摄入量偏低，为357mg，仅占供给量标准的30％，铁的摄入量偏低，为2lmg，仅占供给量标准的60％，而钠、硒、铜、锰的摄入量严重超标分别为3204，78，2．7，6．2mg，分别占供给量标准的212％，156％，135％，177％。同时抗坏血酸（维生素C）摄入一般，达供给量标准的60％。视黄醇、硫胺素（维生素B1）的摄入量分别达供给量标准的97％和79％，但核黄素（维生素B2）摄入偏低，为供给量标准的52％，维生素E的摄入量过高，达供给量标准156％。 结论：孕妇膳食中三大营养素分配比例不合理，营养素摄入量普遍不足，孕妇偏食现象严重，维生素A、维生素C、维生素B1、维生素B2易缺乏。     

长春市社区老年高血压患者膳食结构现状调查

目的了解社区老年高血压患者膳食结构,为实施护理干预提供依据。方法通过方便取样对长春市某社区104名老年高血压患者膳食结构进行自制问卷调查。结果被调查的老年高血压患者平均每人每日食物摄入中三大营养素供能比例不平衡,脂肪供能偏高,占34％,碳水化合物供能偏低,占54％,蛋白质供能较合理,占12％;相关营养素摄入量：钠偏高,而钾、钙、镁偏低。结论与中国居民膳食指南比较,目前老年高血压患者膳食结构不合理,应通过合理的、有针对性的护理干预使老年高血压患者建立正确的膳食观念、膳食习惯。     

慢性肾衰竭病人的饮食现状调查

[目的]了解慢性肾衰竭病人饮食现状，为临床饮食指导提供依据。[方法]调查52例慢性肾衰竭第4期、第5期病人的营养状况，饮食蛋白质、热量和盐的摄入以及是否曾接受过营养师的指导。[结果]明确诊断为慢性肾功能不全的时间3.03年±3.60年，仅1人回答曾经接受过营养师的指导。其中营养良好者占82.7%，营养不良者占17.3%；仅有21.2%的人饮食蛋白质摄入量符合推荐要求，病人饮食中高生物价蛋白质量占总蛋白摄入量的比例仅9.6%的病人符合推荐要求；在饮食热量摄入方面符合推荐要求的病人仅为21.2%；在饮食盐控制方面42.3%的人自己报告符合推荐要求。[结论]慢性肾衰竭病人的饮食需要专科营养师在饮食营养素结构方面调整和技巧方面的指导。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.