谷氨酰胺对烧伤后大鼠肠道损伤及炎症反应的影响

目的探讨谷氨酰胺对烧伤后大鼠肠道损伤及炎症反应的影响.方法采用30%体表面积Ⅲ°烧伤大鼠模型,将88只Wistar大鼠随机分为烧伤对照组和烧伤后补充谷氨酰胺(GLN)组.两组大鼠采用等氮、等热量的营养支持,GLN组每天给予1.0 g/kg GLN,对照组给予等量的甘氨酸.观察烧伤前及烧伤后第1、3、5、7、10天大鼠静息能量消耗(REE)的变化,同时检测烧伤后血浆二胺氧化酶(DAO)活性及内毒素(LPS)、肿瘤坏死因子(TNF)和白细胞介素-1(IL-1)的含量.结果烧伤后两组大鼠的REE、DAO、TNF、LPS和IL-1均明显高于烧伤前(P＜0.01),GLN组REE、血浆DAO活性及TNF、LPS和IL-1含量均明显低于对照组(P＜0.05,P＜0.01).结论口服GLN能减轻烧伤后肠道受损程度,降低烧伤大鼠血中炎症介质水平,从而降低伤后机体高代谢反应.     

不同方式营养支持对重症急性胰腺炎患者血浆内毒素水平的影响

[目的]探讨不同方式营养支持对重症急性胰腺炎患者血浆内毒素水平的影响。[方法]采用单纯随机抽样方法将符合入选标准的47例重症急性胰腺炎患者随机分为肠内营养联合肠外营养组(PN+EN组,n=24)和完全肠外营养(TPN组,n=23)。两组病人接受同样的基础治疗,所有病人均于营养支持前及营养支持后d3、d7、d10检测血浆内毒素(LPS)浓度,并观察并发症发生情况。结果EN+PN组治疗后血浆内毒素水平较治疗前逐渐降低,而TPN组较治疗前逐渐增高。治疗d7和d10EN+PN组显著低于TPN组,且差异有统计学意义(P﹤0.01)。PN+EN组的并发症发生率低于TPN组,且腹胀和腹泻发生率显著降低(P﹤0.05)。[结论]早期肠内营养可维持肠道黏膜屏障功能,显著降低SAP患者血浆LPS浓度,减少并发症发生。     

谷氨酰胺强化的肠内营养对烧伤大鼠肠三叶因子表达的影响

目的: 探讨谷氨酰胺(Gln)强化的肠内营养是否能促进烧伤大鼠肠三叶因子(ITF)表达及可能的机制。方法:采用30%体表面积Ⅲ度烧伤大鼠模型,随机分正常对照(C)组,普通肠内营养(EN)组及Gln强化的肠内营养(Gln)组。各组大鼠提供等氮、等能量的营养支持,动态观察烧伤后大鼠血浆Gln浓度和肠组织中ITF 及ITF mRNA的变化。结果: 正常大鼠血浆Gln浓度较高(642.30±85.38 mmol/L),小肠中ITF及ITF mRNA均有一定表达。烧伤后血浆Gln呈不断下降趋势,伤后10 d达最低值,仅为正常值的45%,ITF的表达也明显降低。两组比较,Gln组大鼠血浆Gln含量和肠组织中ITF 及ITF mRNA水平均明显高于EN组,同时Gln组肠粘膜受损程度也明显低于EN组。相关分析显示,血浆Gln浓度同肠粘膜ITF含量呈显著正相关(r =0.94,P<0.01)。结论:严重烧伤后血浆Gln浓度降低,肠道合成和分泌ITF的能力下降,口服Gln能抑制烧伤后机体Gln耗竭,保护肠粘膜正常结构和功能,促进ITF特别是ITF二聚体的合成和分泌。     

肠内营养联合生长激素对烫伤大鼠免疫功能和炎症反应的影响

目的:研究肠内营养及联合重组人生长激素对烫伤大鼠免疫功能和炎症反应的影响. 方法:致64只SD大鼠30%TBSA三度烫伤,随机分为肠内营养联合生长激素(ENGH)组及肠内营养(EN)组,另取8只大鼠作为伤前对照组,两组给予等热量肠内营养液.ENGH组于伤后12 h腹部皮下注射重组人生长激素1 U/kg,以后每24 h注射1次;EN组于相同时间注射等体积的等渗盐水.分别于伤前、伤后第1、4、7、10天抽取静脉血,检测血清免疫球蛋白和蛋白质浓度、T淋巴细胞亚群、血清内毒素、IL-6、TNF-α浓度. 结果:烧伤后两组CD3 、CD8 、CD4 /CD8 均显著降低,ENGH组在伤后第7、10天CD3 、CD4 、CD8 、CD4 /CD8 值与EN组相比,差异有显著性意义(P<0.05,P<0.01).烧伤后两组血清IgG、IgM、IgA的水平较对照组明显降低,但ENGH组轻度降低,在伤后第10天与EN组相比,差异有显著性意义(P<0.05);血清总蛋白、清蛋白和转铁蛋白浓度较EN组升高.ENGH组和EN组血清内毒素、IL-6、TNF-α的水平较对照组显著升高(P<0.01),ENGH组血清内毒素、IL-6、TNF-α的水平在伤后较EN组明显降低(P<0.05,P<0.01). 结论:早期肠内营养联合生长激素可促进蛋白质合成,改善烧伤后免疫功能的低下,降低内毒素的移位,减轻烧伤后炎症反应.     

选择性清洁肠道对烧伤大鼠高代谢反应的影响

目的:观察选择性清洁肠道对烧伤后机体高代谢反应的影响. 方法:采用30%体表面积三度烧伤大鼠模型,将88只大鼠随机分为烧伤对照(B)组和烧伤加清洁肠道(SDD)组.观察烧伤前及烧伤后(PBD)1、3、5、7、10天大鼠静息能量代谢率(REE)的变化,检测烧伤后血清胰岛素、高血糖素及皮质醇含量,并进行相关分析. 结果:烧伤后两组大鼠的REE、血清胰岛素、高血糖素和皮质醇含量均明显高于烧伤前.两组相比,SDD组的REE明显低于B组,血清高血糖素和皮质醇略低于B组,胰岛素含量略高于B组,在PBD 3～5天有显著差异.而胰岛素及胰岛素/高血糖素比值则明显高于B组,在PBD 1～10天有显著差异(P<0.05～0.01).相关分析显示,REE同胰岛素/高血糖素比值呈显著负相关(r=-0.78,P<0.05). 结论:烧伤大鼠代谢率明显增高,清洁肠道能有效降低烧伤后高代谢反应.     

谷氨酰胺对大鼠烧伤后代谢率变化及相关激素分泌的影响

目的　探讨谷氨酰胺对大鼠烧伤后代谢率变化及相关激素分泌的影响。方法　采用 3 0 %体表面积Ⅲ度烧伤大鼠模型 ,将 88只Wistar大鼠随机分为烧伤对照 (B)组和谷氨酰胺 (GLN)组。两组大鼠采用等氮、等热卡的营养支持 ,GLN组予 1 0g/kg dGLN ,B组予等量的甘氨酸。观察了伤前及伤后 (PBD) 1、3、5、7、10d大鼠静息能量代谢率 (REE)的变化 ,检测了血中胰岛素、胰高血糖素及皮质醇的含量 ,并进行相关分析。结果　烧伤后两组大鼠的REE、血浆胰岛素、胰高血糖素和皮质醇含量均明显高于伤前。两组相比 ,GLN组的REE明显低于B组 ,血浆胰高血糖素和皮质醇略低于B组 ,胰岛素含量略高于B组 ,在PBD3～ 5存在显著差异。而胰岛素及胰岛素 /胰高血糖比值则明显高于B组 ,在PBD1～ 10存在显著差异 ( P <0 0 5 ,P <0 0 1)。相关分析显示 ,REE同胰岛素 /胰高血糖素比值呈显著负相关 (r=-0 78,P <0 0 5 )。结论　烧伤大鼠代谢率明显增高 ,服用谷氨酰胺能有效降低烧伤后高代谢反应 ,其机制与谷氨酰胺能促进合成激素分泌 ,降低分解激素释放有关     

益生菌(元)联合肠内营养对重症急性胰腺炎大鼠肠道屏障功能的影响

目的:探讨益生菌(元)联合肠内营养(EN)对重症急性胰腺炎(SAP)大鼠肠道屏障及吸收功能的影响.方法:将24只大鼠诱发重症胰腺炎模型后,随机分为四组,分别给予肠内要素营养(A组)、双歧三联活菌 肠内要素营养(B组)、β-葡聚糖 肠内要素营养(C组)以及双歧三联活菌 β-葡聚糖 肠内要素营养,即合生元 肠内要素营养(D组),共持续7天.四组大鼠营养供给为等热量和等氮量.第7天处死大鼠前,先作木糖吸收实验,取血检测血浆二胺氧化酶(DAO)、内毒素、肿瘤坏死因子(TNF)和白细胞介素-6(IL-6)的变化;再处死大鼠,取空肠观察小肠的病理改变,测量黏膜绒毛高度.结果:B组与A组相比,血浆内毒素、DAO、TNF和IL-6明显降低(P＜0.05),C组和D组虽有下降趋势,但无显著性差异(P＞0.05);B组和C组木糖吸收试验较A组明显改善(P＜0.05);病理检查显示,B组小肠结构较完整,黏膜厚度、绒毛高度均比A组明显增加(P＜0.05).结论:益生菌(元)联合EN可保护SAP大鼠肠道屏障及吸收功能;β-葡聚糖对SAP大鼠肠道功能改善不明显.     

围手术期营养支持在胰十二指肠切除术病人的临床应用

目的:比较胰十二指肠切除术病人围手术期肠内营养(EN)与肠外营养(PN)支持的效果. 方法:60例胰十二指肠切除捆绑式胰肠吻合术后病人随机分为全肠内营养(TEN)组和完全胃肠外营养(TPN)两组,每组各30例.手术前3 d开始给予营养支持,TEN组口服百普素,术后24 h内开始经空肠造口管输注;TPN组术前3 d开始经腔静脉置管行PN支持,术后24 h恢复TPN支持,两组营养支持时间均为14 d. 结果:两组病人均完成营养支持计划,未发生吻合口瘘和腹腔感染.两组病人术后的体质量、体质指数、上臂周径均较术前略低,但组间比较无显著性差异(P＞0.05).两组病人血清蛋白水平在手术后均有明显下降,TPN组下降更明显,组间比较有显著性意义(P＜0.05).TPN组术后谷酰转肽酶和乳酸脱氢酶高于TEN组.术后监测氮平衡1周,两组均表现为负氮平衡.TEN、TPN组肠功能恢复时间分别为(2.5±0.5) d和(3.0±0.5) d(P＜0.05).术后排便时间分别为(4.0±1.0) d和(6.0±1.0) d(P＜0.01).两组病人住院天数无显著性差异(P＞0.05),但TEN组伤口愈合情况优于TPN组(P＜0.05),平均住院费用/药物费用TEN、TPN组分别为11 206/4 502元、15 430/7 500元(P＜0.05). 结论:对胰十二指肠切除术病人,术前3 d及术后早期行EN,可改善营养状况,降低蛋白质分解,促进肠功能恢复,符合生理需求.     

肠内免疫营养对烫伤大鼠免疫功能和炎症反应的影响

目的:研究肠内免疫营养物Stresson对烫伤大鼠免疫功能和炎症反应的影响及机制. 方法:致64只SD大鼠总体表面积(TBSA)30%的三度烫伤,随机分为肠内免疫营养(EIN)组及肠内营养(EN)组.分别于伤前、伤后1、4、7、10天抽取静脉血,检测血清免疫球蛋白、T淋巴细胞亚群、血清内毒素(LPS)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)浓度. 结果:烫伤后EN组CD3 、CD4 CD8 、CD4 /CD8 均显著降低,EIN组在伤后7、10天CD3 、CD4 、CD4 /CD8 比值与EN组相比显著升高(P<0.05或P<0.01).烫伤后两组血清免疫球蛋白IgG、IgM、IgA的水平较伤前对照明显降低,但EIN组略高于EN组.EIN组和EN组血清内毒素、IL-6、TNF-α的水平较伤前对照显著升高(P<0.01),EIN组血清内毒素、IL-6、TNF-α的水平在伤后4、7、10天较EN组明显降低(P<0.05或P<0.01). 结论:早期EIN可以改善烫伤后免疫功能的低下,减轻烫伤后炎症反应.     

早期肠道营养减轻烧伤后内脏自由基损害的效应

目的:比较早期肠道营养与早期静脉营养减轻内脏自由基损害的效应. 方法:将66只大鼠分成正常对照组、早期静脉营养组(PN)、早期肠道营养组(EN).制成30%TBSA三度烧伤模型.分组灌喂或颈外静脉输液给予相同热量和热氮比的营养液.烧伤后6、12、24、48、72 h检测心、肝、肺、肾组织血管通透性、丙二醛(MDA)、超氧化物歧化酶(SOD)和组织含水量的变化. 结果:烧伤后大鼠心、肝、肺、肾组织血管通透性、MDA和组织含水量均较对照组升高,N组在多个时相点低于PN组(P＜0.05,＜0.01).EN组组织SOD在多个时相点高于PN组(P＜0.05,＜0.01). 结论:早期肠道营养可减轻内脏水肿、血管通透性增高及氧自由基损害.     

营养环境与人群营养素摄入水平的相关性

完善了营养环境的概念及指标，提出可以用线性规划建立的数学模型计算营养环境的指标，即由该模型得出的营养素的理论达标率和营养素的边际成本。用天津１９８９年的营养素的理论达标率和１９８８年天津人群的营养素实际达标率进行线性回归分析，得出回归方程：实际达标率（％）Ｙ＝１５．１５（％）＋０．７８８Ｘ（Ｘ为理论达标率，％），其相关性显著（Ｒ＝０．９８６，Ｐ＜０．００１）；还发现天津营养环境中脂肪、动物性蛋白质的边际成本大于零。讨论了上述方程的意义，营养环境与营养干预的关系。认为，改善食物的营养素含量、降低价格、增加营养素含量丰富的食物品种的营养干预措施，效果较好。     

The enteral vs parenteral nutrition debate revisited

Many trials and several meta-analyses have been devoted to comparing enteral with parenteral nutrition support. In this review, these studies are subjected to critical analysis with particular emphasis on their methodology and clinical relevance. Evidence is produced to suggest that the heterogeneous patient populations of the studies and the rigid approach taken to comparing different nutrition therapies inter alia render their conclusions highly questionable and of very doubtful clinical significance. An alternative approach to nutrition research is suggested in which strategies of nutrition support rather than fixed menus are compared. It is suggested that objective measures of intestinal function be evaluated more fully in patients requiring nonvolitional nutrition support, and these are briefly reviewed. In addition, a more scientific approach to evaluating the physiological effects of nutrition support, including chemical tagging and evaluation of muscle function, is recommended.     

Ceramide in Lipid Emulsions Used in Parenteral Nutrition

Parenteral nutrition-associated liver disease is a prevalent and severe complication of long term parenteral nutrition. We present here for the first time data on the presence of ceramide, a bioactive compound involved in a variety of metabolic processes, in different lipid emulsions used in parenteral nutrition. Further research is needed to determine whether this potential harmful bioactive compound is involved in parenteral nutrition-associated liver disease.     

Nutrition knowledge and attitudes of New Zealand registered midwives

Aim: The importance of nutrition for a healthy pregnancy is well established. In New Zealand, the majority of women choose midwives as their maternity provider. Therefore, it is important that midwives have an understanding of nutrition issues related to pregnancy. The purpose of the present study was to determine the nutrition knowledge of New Zealand midwives, and to assess the importance they place on nutrition during pregnancy. Methods: An 18‐question postal survey was sent to all members of the New Zealand College of Midwives (n = 1340). Results: A total of 370 questionnaires were returned (response rate of 27.6%). Less than 40% of midwives reported that they had formal nutrition education; however, nearly 75% of respondents indicated that they had received nutrition information through their midwifery education. Most midwives indicated that nutrition was important or very important during pregnancy (98.4%), and that they had a significant or very significant role in educating pregnant women (94.9%) about nutrition. Midwives generally reported a high level of confidence in dealing with nutrition‐related issues. Midwives answered most of the nutrition knowledge questions correctly. However, 64.6% of midwives (n = 369) incorrectly identified spirulina as a good source of iron for vegetarians, 28.1% (n = 104) incorrectly answered that maternal intake of cabbage and beans are often responsible for colic in breastfed infants, and 40.0% (n = 128) incorrectly answered that to reduce food allergies all lactating women should avoid peanuts and shellfish. Conclusion: Overall, midwives were knowledgeable on nutrition issues related to pregnancy and reported a high level of confidence on educating women about nutrition.     

Practice Analysis of Nutrition Support Professionals

Background: The National Board of Nutrition Support Certification (NBNSC) is an independent credentialing board responsible for administering the multidisciplinary certification examination in nutrition support. For an exam to be legally and practically defensible, it must represent practice. Validation is by practice audit, the highest level of supporting evidence. Objectives: To define the role of the nutrition support professional (NSP) and the current elements (knowledge and functions) required for competent NSP practice. Methods: A survey instrument was constructed using a content validation strategy to establish the link between job tasks and the content of the examination. Internet‐based surveys were made available to 5100 NSPs. NSP duties performed and knowledge required for patient safety and welfare were analyzed for the group as a whole and for each profession separately. Results: A total of 765 surveys were completed (return rate of 15%). The results of the practice audit demonstrate a common core of practice across the nutrition support disciplines as well as a universal core of elements believed to be important for competent nutrition support practice. Conclusion: The results of this survey continue to support a common core of practice across nutrition support disciplines as well as a common core of elements believed to be important for competent nutrition support practice. Accordingly, the NBNSC will continue to offer one examination to all disciplines both nationally and internationally and confer the Certified Nutrition Support Clinician (CNSC) credential to all individuals who successfully pass this validated examination.     

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols.Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices.Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important.Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.     

Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants

Background: Despite the availability of international nutrition recommendations, preterm infants remain vulnerable to suboptimal nutrition. The standard approach of assessing nutrient intakes chronologically may make it difficult to identify the origin of nutrient deficits and/or excesses. Objective: To develop a “nutrition phase” approach to evaluating nutrition support, enabling analysis of nutrient intakes during the period of weaning from parenteral nutrition (PN) to enteral nutrition (EN), called the transition (TN) phase, and compare the data with those analyzed using the standard “chronological age” approach to assess whether the identification of nutrient deficits and/or excesses can be improved. Methods: Analysis of a comprehensive nutrition database developed using actual nutrient intake data collected on an hourly basis in 59 preterm infants (birth weight ≤1500 g, gestation <34 weeks) over the period of PN delivery (range, 2–21 days). Results: The nutrition phase analysis approach revealed substantial macronutrient and energy deficits during the TN phase. In particular, deficits were identified as maximal during the EN‐dominant TN phase (enteral feeds ≥80 mL/kg/d) of the infant’s nutrition course. In contrast, the chronological age analysis approach did not reveal a corresponding pattern of deficit occurrence but rather intakes that approximated or exceeded recommendations. Conclusion: Actual intakes of nutrients, analyzed using a nutrition phase approach to evaluating nutrition support, enabled a more infant‐driven rather than age‐driven application of nutrition recommendations. This approach unmasked nutrient deficits occurring during the transition phase. Overcoming nutrient deficits in this nutrition phase should be prioritized to improve the nutrition management of preterm infants.