肝叶切除术后肝功能失代偿病人的营养支持(英文)

目的探讨围手术期肝叶切除病人肝功能失代偿进行营养支持的特点,分析营养支持的效果。方法对8例围手术期肝功能失代偿病人的营养状况、营养支持方法和效果进行回顾性分析。结果本组8例病人术前均行营养支持,且8例病人均顺利度过手术期。8例病人术前存在不同程度的营养不良,肝功能障碍,免疫力偏低,术前营养支持5d后有明显改善(*P<0.05,*#P<0.05);术中发生血糖波动、电解质紊乱;术后出现肝功能失代偿并发症的一系列指征:胆碱酯酶过低、ALT,AST,GGT及总胆红素过高、总蛋白及血清蛋白/球蛋白比值过低,同时出现低钾血症、低钠血症、高血糖症、低蛋白血症等。术后营养支持10d,上述症状都得到显著改善(**P<0.05),病人体重增加。结论适当的营养支持对围手术期肝功能失代偿肝叶切除病人的康复起重要作用。     

围手术期肝叶切除术后肝功能失代偿病人的肠外全营养混合液营养支持

目的探讨围手术期肝叶切除病人肝功能失代偿进行营养支持的特点,分析营养支持的效果。方法对8例围手术期肝功能失代偿病人的营养状况、营养支持方法和效果进行回顾性分析。结果本组8例病人术前均行营养支持,且8例病人均顺利渡过手术期。8例病人术前存在不同程度的营养不良、肝功能障碍、免疫力偏低,术前营养支持5d后有明显改善(P<0.05);术中发生血糖波动、电解质紊乱;术后出现肝功能失代偿并发症的一系列指征:胆碱酯酶过低、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酸转肽酶(GGT)及总胆红素过高、总蛋白及血清蛋白/球蛋白比值过低,同时出现低钾血症、低钠血症、高血糖症、低蛋白血症等。术后营养支持10d,上述症状都得到显著改善(P<0.05),病人体重增加。结论适当的营养支持对围手术期肝功能失代偿肝叶切除病人的康复起重要作用。     

临床药师对消化道肿瘤患者术后全营养混合液组方的干预研究

目的探讨临床药师参与消化道肿瘤患者肠外营养支持并提供个体化全营养混合液(TNA)组方对患者的影响。方法回顾性分析87例行消化道肿瘤切除术患者的临床资料,分为临床药师参与会诊并提供个体化TNA组方的干预组(23例)与临床药师未参与治疗的对照组(64例),比较两组患者术前1 d、术后1 d及5 d的血清总蛋白(TP)、血清白蛋白(ALB)、前白蛋白(PA)与淋巴细胞计数(LYM)的测定值,以及术后并发症、住院时间等。结果干预组术后5 d各营养学指标较术后d1有显著增加(P<0.05);干预组术前1 d各营养学指标较对照组术前1 d无显著性差异(P>0.05),而术后5 d较对照组术后5 d有显著增加(P<0.05);干预组的住院时间(10.8±2.2)d显著低于对照组(14.9±2.4)d(P<0.05);干预组术后并发症与对照组相比无显著性差异(P>0.05)。结论临床药师参与消化道肿瘤患者肠外营养支持并提供药学服务,可以较好地改善患者机体营养状态,提高康复效果。     

肝叶切除患者的围手术期护理

目的探讨肝叶切除患者的围手术期护理措施。方法 77例肝病患者采取肝叶切除术给予围手术期护理,分别于术前及术后第15天测定天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)等肝功能指标。结果治疗后AST、ALT、ALB、TBIL均高于治疗前,差异均有统计学意义(P<0.05)。结论肝叶切除对患者肝功能可能产生一定影响,合理的护理措施可有效避免并发症。     

老年人腹部手术围手术期营养支持的临床应用

目的 观察围手术期营养支持对老年人腹部手术患者营养状态及术后并发症的影响.方法 选择60例需行营养支持的老年腹部手术患者随机分为肠外营养(PN)组及肠内营养(EN)组;两组营养支持均按等热量、等氮量进行;分别于术前1 d(POD-1)、术后第7天(POD+7)和术后第12天(POD+12)检测体质量、上臂肌围、淋巴细胞总数、血清白蛋白、前白蛋白、转铁蛋白和纤维连接蛋白的营养状态指标;营养支持期间每天测定氮平衡,并计算累计氮平衡;观察两组术后并发症的情况.结果 (1)EN组体质量、上臂肌围、转铁蛋白高于PN组,但差异无统计学意义.EN组白蛋白术后12 d显著高于PN组,EN组前白蛋白、纤维连接蛋白在术后第7、12天显著高于PN组;(2)两组累计氮平衡均为正氮平衡,EN组略高于PN组,但两者之间差异无统计学意义;(3)术后并发症EN组胃肠道二重感染显著低于PN组.结论 与PN相比,EN可有效地改善术后患者的营养状态,减少胃肠道二重感染的发生.     

肝叶切除患者的围手术期护理

目的 探讨肝叶切除患者的围手术期护理措施.方法 77例肝病患者采取肝叶切除术给予围手术期护理,分别于术前及术后第15天测定天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(TBIL)等肝功能指标.结果 治疗后AST、ALT、ALB、TBIL均高于治疗前,差异均有统计学意义(P<0.05).结论 肝叶切除对患者肝功能可能产生一定影响,合理的护理措施可有效避免并发症.     

肝硬化肝切除患者术后早期肠内营养支持及护理研究

目的 探讨肝硬化肝切除患者术后早期肠内营养支持的护理措施及临床效果.方法 对35例合并有肝硬化行肝部分切除术患者,随机分为肠内营养组（EN）和肠外营养组（PN）,EN组于术后24 h内开始实施肠内营养;PN组于术后使用目前认为对肝硬化患者合理的肠外营养溶液,观察两组患者术后肝功能恢复情况、肛门排气时间、并发症、住院时间及费用等资料.结果 两组患者在平均住院时间、术前后肝功能、临床营养指标变化的差异无统计学意义;EN组术后8 d前白蛋白和白蛋白已恢复到术前水平,与营养支持相关的并发症发生率高于PN组,但较PN组轻.EN组术后胃肠蠕动功能恢复较快,平均营养费用低于PN组.结论 对肝硬化肝部分切除患者术后进行早期肠内营养并采取有效的护理措施,能改善肝硬化患者肝叶切除术后患者的营养状况,促进肝脏蛋白质合成代谢,加快胃肠蠕动功能恢复,降低临床营养费用,减少术后严重并发症的发生.     

围手术期营养支持在结直肠癌患者中的应用

目的探讨结直肠癌患者围手术期营养支持的效果。方法把42例伴有营养不良的结直肠癌患者随机分为观察组和对照组,观察组行围手术期营养支持治疗,对照组采用传统方法治疗,两组疗效对比分析。结果术后观察组检测的各项营养指标均高于对照组,术后并发症低,住院时间少。结论结直肠癌患者围手术期营养支持能改善营养状况和机体免疫机能,促进胃肠道功能恢复,减少术后并发症发生。     

胃肠道肿瘤患者围手术期肠内营养支持的观察

目的 胃肠道肿瘤患者大多术前营养状况较差,手术时间相对较长,术后禁食时间较长,因营养不良引起的并发症较多.因此,针对围手术期肠内营养支持的效果,我们对行手术治疗的胃肠道肿瘤患者进行观察.方法 随机选取我院普外科92例胃肠道恶性肿瘤手术患者分围手术期肠内营养支持组及传统处理组,观察术后肛门恢复排气时间、营养状况及生化营养指标、并发症的发生率和住院时间进行对比.结果 与对照组相比,围手术期肠内营养支持组的患者胃肠道功能恢复快,营养状况好,并发症的发生率低,住院时间短.结论 围手术期肠内营养支持有利于胃肠道手术患者的术后恢复,是一种安全和可以被患者接受的治疗方法.     

术前营养风险筛查对结肠癌患者围手术期营养支持的效果评价

目的:评价术前营养风险筛查对结肠癌患者围手术期营养支持的效果。方法:选取2017年6月～2019年5月因结肠癌来某院就诊的病患88例作为本次试验的研究对象,依据围手术期护理方式的不同将其分为研究组与对照组各44例。对研究组病患进行术前营养风险筛查并对筛查结果显示存在营养风险的病患给予特定的营养支持,给予无营养风险的病患传统的营养支持护理,给予对照组病患传统的术前营养支持护理。比较两组病患手术后的治疗效果。结果:显示术后研究组病患体重高于对照组,且血清蛋白、血清白蛋白、前白蛋白、转铁蛋白均较对照组高,两组差异具有统计学意义,P0.05;术后研究组病患出现并发症的总几率为11.36%,对照组为31.82%,两组术后并发症差异存在有统计学意义,P0.05。结论:术前营养风险筛查对结肠癌患者围手术期营养支持效果明确,可以稳定病患的营养学指标,降低并发症出现的风险。     

综合疗法治疗糖尿病足48例临床观察

目的：观察综合疗法治疗糖尿病足的临床疗效。方法：符合病例入选标准的糖尿病足患者96例。将96例患者随机分为治疗组、对照组,每组各48例。对照组采用常规药物控制血糖,治疗组在此基础上进行营养神经、控制感染,并局部外敷。均治疗15d为1个疗程,治疗1个疗程后观察疗效。结果：两组血肌酐（Scr）、尿素氮（BUN）的变化等观察指标治疗前后相比,差异均有统计学意义（P〈0.05）。治疗组患者总有效率为89.58%,对照组患者总有效率为63.58%。两组相比差异有统计学意义,P〈0.05。结论：严格控制血糖、抗感染、改善微循环、营养神经、局部清创及对症支持等综合疗法治疗糖尿病足临床疗效显著,可有效改善微循环障碍及组织缺血缺氧,促进糖尿病足溃疡的修复。     

Activity of octreotide acetate in a total nutrient admixture.

The activity of octreotide acetate in a total nutrient admixture (TNA) and the effect of the drug on the stability of lipid emulsion in the TNA were studied. Octreotide acetate injection was added to a standard solution containing 3% lipids, amino acids, dextrose, electrolytes, vitamins, and trace elements to achieve a theoretical concentration of 45 micrograms/dL. Samples were stored at room temperature for 48 hours. Octreotide concentrations were determined in triplicate by radioimmunoassay; physical stability of the solutions was assessed by lipid particle-size determination, pH measurement, and visual observation of emulsion integrity at 0, 12, 24, and 48 hours. The activity of octreotide in two samples of each solution (with and without lipid) was analyzed immediately after preparation and after seven days under refrigeration. There was no evidence of emulsion breakdown or pH change in any solution over the study period. In addition, particle-size distributions at 48 hours and 7 days were comparable to those at time zero, suggesting physical stability. Octreotide acetate activity was not consistently greater than 90% (mean +/- S.D.) after storage for 48 hours. Octreotide acetate at a theoretical concentration of 45 micrograms/dL in a TNA solution containing 3% lipids appeared to be physically compatible for 48 hours at room temperature and for 7 days under refrigeration. However, the chemical activity of octreotide in TNA was not consistent after storage for 48 hours.     

216例小儿全营养混合液临床应用分析

目的:探讨全营养混合液(Total nutrient admixture,TNA)在小儿患者中应用的可行性及存在的问题。方法:回顾性调查我院小儿外科2000年2月以来输注全营养混合液的小儿216例,统计分析其使用指征及常见并发症的发生率。结果:中、重度营养不良需较长期禁食或慢性消耗性疾病的患儿术前、术后应用全营养混合液超过5天,能明显改善全身状况的及缩短康复时间,术后并发症明显减少;与输注营养液有关的并发症为感染、胆汁淤积和高血糖。结论:中、重度营养不良需较长期禁食或慢性消耗性疾病的患儿术前、术后都具有应用输注全营养混合液的指征,输注过程中应当密切监测胆红素和血糖等,并及时处理。     

1例老年营养不良行全肺切除术患者的围手术期护理

目的 总结1例老年营养不良全肺切除术患者的围手术期护理体会,为临床护理提供参考.方法 在术前加强对患者的肺康复锻炼和营养干预,在术后早期加强对患者的生命体征观察和护理;注意肺康复锻炼和营养支持,保持气道通畅,促进痰液的有效引流;加强疼痛护理和并发症的预防.结果 患者术程顺利,术中出血约200 ml.术后第2天拔除胸管,术后第8天患者出院.结论 对于老年营养不良全肺切除术患者,做好围手术期的康复功能锻炼和营养支持,能有效地预防术后并发症,促进患者的康复,为确保手术的治疗效果发挥重要的作用.     

Effect of various nutrient ratios on the emulsion stability of total nutrient admixtures

The emulsion stability of total nutrient admixtures (TNAs) containing various ratios of amino acids (AA):carbohydrate (CHO):fat (FAT) was studied. Eight different TNA formulations were prepared in duplicate using AA supplied as 8.5% crystalline AA (FreAmine III), CHO supplied as 70% dextrose injection, and FAT supplied as 10 or 20% lipid emulsion (Soyacal). The eight formulations represented AA:CHO:FAT ratios (v:v:v) of 2:1:1, 1:1:1, 1:1:1/2, and 1:1:1/4, respectively, with each lipid concentration. TNAs also contained identical concentrations of electrolytes, trace elements, vitamins, and heparin. TNAs were stored at 4 degrees C for 14 days and then at ambient temperature (22-25 degrees C) for another four days. All TNAs were analyzed for gross visual appearance, pH, osmolality, and particle size and distribution on day 0 and periodically throughout the study period. Particle size was measured by photon-correlation spectrometry and negative-phase light microscopy. Visual examination revealed the presence of creaming in all TNAs, which could be dispersed by gentle agitation. The pH of each TNA decreased slightly during the study period, while the osmolality showed little variation. The mean diameter of particles in the TNAs remained close to that in the original lipid emulsions; 95% of all particles in the TNAs were less than 0.454 micron in diameter, which is within the size range of natural lipid particles or chylomicrons. Based on examination of particle size, each TNA formulation was stable for 18 days under the conditions of this study.     

Growth of bacteria and fungi in total nutrient admixtures

Total nutrient admixtures (TNAs) containing dextrose, amino acids, and fat emulsion were evaluated for their ability to support bacterial and fungal growth. The following solutions were tested: a standard adult total parenteral nutrient (TPN) solution with dextrose, amino acids, and electrolytes, a standard neonatal TPN solution with dextrose, amino acids, and electrolytes, a 10% fat emulsion, a 20% fat emulsion, a TNA with 40% of the total calories as fat, a TNA with 25% of the total calories as fat, a neonatal TNA with 25% of the total calories as fat, a control (fat emulsion was replaced with an equal amount of sterile water) for solution 5, and a control for solution 6. Serial dilutions of each solution were inoculated with 5 X 10(5) bacteria/mL or 5 X 10(3) fungi/mL, incubated, and visually rated on a scale of 0 (no growth) to 4 (maximal growth). Bacterial growth of Pseudomonas aeruginosa, Staphylococcus aureus, Staph. epidermidis, Streptococcus faecalis, and Group JK Corynebacterium was greater in the TNA solutions than in the control or standard TPN solutions. Escherichia coli, Candida tropicalis, and C. albicans grew in all solutions tested. Torulopsis glabrata grew better in solutions that did not contain fat emulsion. Growth characteristics did not differ significantly between the adult and neonatal (more dilute) solutions. The addition of fat emulsion to TPN solutions enhances the ability of these solutions to support bacterial growth; this possibility must be considered when evaluating patients for this type of total parenteral nutrition therapy.     

异丙酚与异氟醚麻醉对上腹部手术围术期应激变化的影响比较

目的:比较异丙酚与异氟醚对上腹部手术患者围手术期应激变化的影响。方法:将60例拟行上腹部手术患者随机均分为异丙酚组(A组)和异氟醚组(B组),并分别应用异丙酚与异氟醚麻醉。分别于麻醉前5min(T1)、麻醉后60min(T2)和术后24h(T3)采集患者静脉血,应用放射免疫法测定血清生长激素、皮质醇含量及血糖水平并监测其血液流变学指标。结果:2组患者T2时间点血糖、皮质醇均显著升高,且B组血糖、皮质醇升高更为显著(P<0.05);2组患者T3时间点血糖、皮质醇均不同程度下降,且A组下降更为显著(P<0.05)。A组T2、T3时间点血液流变学指标下降与B组比较更为显著(P<0.05)。结论:异丙酚较异氟醚对机体内分泌系统的影响小,对围手术期强烈的应激反应抑制效果较好,且能有效降低血液黏度。     

水蛭素药物治疗尿微量白蛋白为主要表现的糖尿病肾病和高血压肾病的临床研究

目的探讨水蛭素药物对以尿微量白蛋白（UA）为主要表现的糖尿病肾病和高血压肾病患者的治疗作用。方法将尿微量白蛋白筛查均为阳性的糖尿病肾病和高血压肾病患者60例随机分为治疗A组、治疗B组及对照组,各20例。入选患者在血糖、血压控制治疗的同时,A组患者全程口服水蛭素药物脑血康;B组患者静脉输注水蛭素药物疏血通治疗15d后再口服脑血康治疗。治疗6个月后观察尿微量白蛋白的变化情况、血脂4项、凝血5项等疗效评价指标。结果 A组患者治疗1个月后尿微量白蛋白较治疗前有显著改善（P〈0.05）,B组患者治疗15d后尿微量白蛋白较治疗前有显著改善（P〈0.05）;A、B组患者凝血功能5项指标改善优于对照组（P〈0.05）;3组患者血脂4项指标均无明显变化（P〈0.05）;结论水蛭素有降低尿中微量白蛋白、改善高凝状况的作用,对糖尿病肾病和高血压肾病患者的肾脏有较好的保护作用。     

Growth of microorganisms in total nutrient admixtures

It has been reported that intravenous fat emulsions, because of their isotonicity and neutral pH, support microbial growth, but traditional parenteral nutrition solutions, being hypertonic and more acidic, are not as supportive. To date, few studies have documented microbial growth in total nutrient admixtures (TNA) containing dextrose, amino acids, fat, electrolytes, vitamins, and trace elements. This study was undertaken to analyze the growth of Staphylococcus aureus, Candida albicans and four gram-negative enteric bacilli in three different nutrient admixtures, with and without the inclusion of 5% fat emulsion. The composition of the admixtures was either 5, 10, or 25% dextrose; either 0 or 5% fat; and 3% amino acids, electrolytes, vitamins, and trace elements. All admixtures were innoculated with 100 colony-forming units per milliliter, incubated at room (25 degrees C) or refrigerated (4 degrees C) temperature, with samples withdrawn at 0, 3, 6, 12, 24, and 48 hours and plated in triplicate. Only C. albicans demonstrated any significant growth regardless of fat content. The pH of the admixtures was similar (acidic), and all solutions were hypertonic and found to inhibit bacterial growth. Conclusions suggest that TNA, when formulated with normal concentrations of additives, is no more likely to support growth of contaminant organisms than the traditional solutions. This contradicts the notion that the addition of fat to total parenteral nutrition will enhance the ability of these admixtures to support microbial growth.