Total parenteral nutrition and enteral nutrition in diabetes

A quarter or more of critically ill patients are likely to have carbohydrate intolerance or frank diabetes, either pre-existing or secondary to the stress of illness. Those patients who require parenteral nutrition should be treated using regimens similar to those used in nondiabetic patients, along with sufficient insulin (given by separate infusion) to maintain near-normal glycaemia. The role of novel substrates in diabetes remains to be established. In patients who require enteral nutrition, there is accumulating evidence that high-fat (as monounsaturated fatty acid) formulations achieve better overall metabolic control than conventional high-carbohydrate preparations. In view of the fact that macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes in particular, and the fact that the risk of macrovascular complications is relatively unaffected by glycaemic control, the improved lipid and haemostatic profile achieved with preparations that are high in monounsaturated fatty acids is of particular importance in patients on long-term nutritional support.     

胃癌术后肠内营养与肠外营养的护理分析

目的：探讨胃癌术后肠内营养与肠外营养的护理。方法：研究我院2014年3月至2015年12月期间随机抽取的胃癌术后患者80例,分为对照组与观察组各40例,其中对照组运用肠外营养支持护理,观察组运用肠内营养支持护理,分析两组患者营养支持护理效果差异。结果：在护理前后各蛋白指数上,观察组改善幅度高于对照组,p<0.05;在术后感染率显著并发症发生率上,观察组低于对照组,p<0.05;在肛门排气与住院时长上,观察组短于对照组,p<0.05。结论：胃癌术后通过肠内营养支持护理可以有效的提升患者恢复效果,加快术后恢复,减少术后并发症。     

肠内肠外营养的并发症

文中阐述了肠内、肠外营养的并发症。胃肠道外营养的并发症主要有:(1)导管并发症;(2)感染并发症;(3)代谢并发症。肠道内营养的主要并发症是腹泻、恶心呕吐、倾倒综合征及代谢并发症。依靠健全的营养支持来管理肠外、肠内营养是减少各类并发症的中心环节。特别对长期需要肠外营养的家庭TPN病人营养支持组的管理和指导更属重要。     

Perioperative nutrition: parenteral versus enteral

Malnutrition has been shown to have an adverse effect on the clinical outcome of surgical patients. During the past 25 years, investigators have sought to determine whether clinical outcome can be improved by the administration of pre- or postoperative (perioperative) nutritional support. We conclude that the clinical outcome of severely malnourished surgical patients is improved by perioperative nutritional support and that this should be administered whenever possible via the enteral route. The clinical outcome of less severely malnourished surgical patients, including those who are normally nourished, can be improved by the administration of oral dietary supplements at a time in the postoperative period when patients are ingesting free fluids. Some of these patients may also benefit from early postoperative enteral tube feeding, but further work is required to determine the effects following different types of surgery before this is adopted for routine use. Parenteral nutrition is only indicated in the postoperative period when major complications occur in association with intestinal failure.     

Modern parenteral and enteral nutrition in critical care

With both enteral and parenteral feedings, the amount of nutrients required depends on the degree of nutritional depletion, level of hypermetabolism, and the phase of the patient's response to illness or injury. Protein requirements are significantly increased in the critically ill. In skeletal trauma, energy needs are increased approximately 25%, in sepsis, 50%, and in severe burns, 75-100%. Energy requirements increase also but in part are met by body fat reserves. While D5W solutions were once thought to spare body proteins by reducing gluconeogenesis, it is now known that such semi-starvation regimes are deficient by omitting protein intake. Enteral and parenteral feeding techniques have developed as precise methods for administering a balance of required protein and calories. A comprehensive nutritional assessment will determine patient nutrient requirements. The marasmic patient without significant stress will generally require 30-40 kcal/kg and 1.5 g protein/kg of ideal body weight. Such support should lead to a slow weight gain and positive nitrogen balance of 2-6 g nitrogen. In the hypoalbunemic patient with concomitant stress, nitrogen retention will be limited until the stress, i.e. acute injury or infection, is relieved. Nitrogen (g):calorie (kcal) intake will average 1:80. During therapy, nutritional assessment parameters must be measured periodically to evaluate the effectiveness of the nutritional regime.     

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.     

Neonatal nutrition: a focus on parenteral nutrition and early enteral nutrition.

No population has benefited more from the development and advancement of specialized nutrition support than pediatric patients. Today, neonates comprise the largest group of pediatric patients receiving parenteral nutrition (PN). Nutrient needs of neonates differ substantially from other populations, presenting unique challenges in optimizing nutrition care. Neonates are highly susceptible to catabolic stress because of reduced energy stores and markedly increased energy needs. Immature organ systems and metabolic pathways further complicate the delivery of adequate nutrition in the preterm neonate. Early nutrition support is essential to improve survival, reduce catabolism, promote growth, and limit developmental complications. This article discusses feeding strategies for PN and early enteral nutrition in neonates, particularly the preterm neonate.     

老年机械通气病人肠内肠外营养支持的比较

目的:观察老年机械通气病人肠内肠外营养支持的效果.方法:将60例老年机械通气病人随机分为全肠内营养(TEN)组和全肠外营养(TPN)组,每组30例,在摄入同等热量和氮量的条件下进行比较.结果:TEN组血清清蛋白、血红蛋白、氮平衡方面明显优于TPN组(P＜0.05).机械通气时间和临床费用低于TPN组(P＜0.05).两组并发症的发生率无显著性差异(P＞0.05).结论:老年机械通气病人肠内营养较肠外营养能更好的提供营养,缩短机械通气时间,而且费用低.     

论胃气学说与肠外和肠内营养

试论医学胃气学说与现代医学临床营养支持(肠外和肠内营养)的异同.胃气学说和临床营养支持虽理论异曲,发展各殊,途径有别,但功用雷同,应用广泛,若相互结合,取长补短,定相得益彰.     

肠内营养与肠外营养支持的代谢效应

对比术后病人应用肠外(parenteral　nutrition,PN)与肠内(enteral　nutrition,EN)营养支持的代谢效应。20例病人,随机分为肠外营养组(对照组)及肠内营养组(研究组)。于手术后第5～11天给病人以传统的标准肠外营养或肠内营养剂爱伦多(Elental)支持。结果:(1)对照组病人的体重下降2.8±0.2kg,研究组病人的体重下降2.1±0.3kg,两组之间有差异(P=0.09)。(2)对照组的累积氮平衡 105.2±9.2mg·kg~(-1)/7d,研究组的累积氮平衡 184.8±33.2mg·kg~(-1)/7d。研究组明显优于对照组(p=0.03)。(3)血清谷氨酰胺(glutamine)的变化,对照组术前为630±20mmol/L,术后为594±26mmol/L,术后无显著性差异(P=0.55)。(4)血清亚油酸(linolicacid)的变化,对照组术前为101.4±37.7ug/ml,术后116.1±11.2ug/ml,术后血清亚油酸无显著性差异(P=0.65)。研究组术前为151.9±31.2ug/ml,术后101.2±16.5ug/ml,术后有降低,但没有显著性差异(P=0.11)。本研究结果表明,手术后肠功能恢复时,给予肠内营养爱伦多支持比传统的标准肠外营养支持有较好的代谢效应,但必需脂肪酸的补充量尚嫌不足。     

全胃切除术后早期肠内肠外营养的对比研究

目的：探讨全胃切除术后早期肠内营养（EEN）与全肠外营养（TPN）对患者营养状况的改善及并发症发生率的影响。方法：将86例接受根治性全胃切除的胃癌患者随机分为EEN组和TPN组。EEN组手术后第1天开始分别给予营养支持,于术前1天、术后8天检测体重、血常规、肝功能、前白蛋白和C-反应蛋白,并观察并发症的发生率和平均住院费用。结果：EEN组体重、白蛋白、前白蛋白下降幅度和白细胞、转氨酶、C-反应蛋白升高幅度均少于TPN组。EEN组患者吻合口瘘、肺部感染、切口愈合不良等并发症发病率低于TPN组。EEN组的平均住院费用低于TPN组。结论：术后EEN较TPN能改善全胃切除术后患者的营养状况,降低并发症发生率,减少经济费用。     

肠外、肠内营养支持的并发症及其管理与平衡监测

一、肠外、肠内营养支持的主要并发症1．机械性并发症：肠内、肠外营养置管失败、异位、阻塞、机械性损伤等。2．感染性并发症：营养制剂及配制、输入系统的污染，肠外营养导管感染、内源性感染，肠内营养误吸性肺炎等。