早期全肠外营养及肠内、外混合营养对神经外科危重患者免疫功能的影响

目的探讨早期给予全肠外营养（TPN）及肠内营养（EN）、肠外营养（PN）混合支持对神经外科危重患者免疫功能的影响。方法采用前瞻性对照研究将神经外科危重患者按入院顺序随机分为TPN组及EN＋PN组,并对比营养支持前后两组CD3、CD4、CD8、CD4／CD8、CD3／CD25、IgA、IgG、IgM、血清白蛋白的变化。结果给予神经外科危重患者两种营养支持均可提高其CD3、CD4、CD8及CD3＋／CD25＋比值（P〈0．05,P〈0．01）;两种营养支持方式均可显著升高IgA、IgG、IgM、（P〈0．05）及血清白蛋白浓度（P〈0．01）。与TPN组比较,EN＋PN组CD3、CD4、CD8、CD4／CD8比值、IgA、IgG、IgM浓度及血清白蛋白水平均显著升高（P〈0．05,P〈0．01）。结论早期TPN及EN＋PN支持均可促进神经外科危重患者免疫功能的恢复及提高,EN＋PN的作用优于TPN,对于神经外科危重患者应早期给予营养支持治疗。     

肠内营养联合肠外营养对结肠癌手术后患者免疫功能的影响

目的比较结肠癌术后肠内营养(EN)联合肠外营养(PN)与全肠外营养(TPN)对患者术后应激和免疫指标的影响。方法将64例结肠癌患者随机分成两组,术后分别接受肠内外联合营养(EN+PN)和全肠外营养(TPN),所有患者分别于术前1d和术后第1、第7d测定补体C3,IgA,IgM,IgG,CD3,CD4,CD8,CD4/CD8。结果 6d后补体C3,IgA,IgM,IgG,CD3,CD4,CD8,CD4/CD8的恢复程度,EN+PN组与TPN组差异有统计学意义(P0.05)。结论与TPN对比,联合使用EN和PN更能有效促进结肠癌术后机体免疫功能的恢复。     

Inflammatory mediators and immune function are altered in home parenteral nutrition patients

OBJECTIVES: Patients who used home parenteral nutrition (HPN) and healthy, volunteer control subjects were examined to assess relative immune potential and inflammatory marker expression and to investigate the association between HPN and immune parameters. METHODS: Subjective Global Assessments were performed on all subjects. The peripheral blood concentration of C-reactive protein was determined by enzyme-linked immunosorbent assay. The peripheral blood concentration of systemic inflammatory mediators that included tumor necrosis factor-alpha (TNF-alpha), soluble TNF-alpha receptors p55 and p75, and interleukin-6 were similarly determined. Peripheral blood lymphocytes were isolated and the percentage of circulating CD4+ and CD8+ lymphocytes was determined by flow cytometry. In addition, peripheral blood lymphocytes were cultured in the presence of the T-cell mitogen, phytohemagglutinin, and the proliferative response of the CD3+ population was assessed by flow cytometry. Results of these experiments were obtained for 10 clinically stable patients who had used HPN longer than 2 y and these results were compared by Student's t test with data obtained for 12 normal, volunteer control subjects. RESULTS: Of the 10 patients who used HPN and were examined, seven had short bowel syndrome, two had dysmotility, and one required HPN due to radiation enteritis. Based on Subjective Global Assessments, all patients were well nourished. No difference was observed in TNF-alpha level between groups and C-reactive protein levels were within normal limits (1.2 mg/L in patients, 0.99 mg/L in controls). Soluble TNF-alpha receptors p55 and p75 were significantly increased (P < 0.001), but serum interleukin-6 was not (P = 0.07). The percentage of CD8+ cells and the CD4+/CD8+ ratio were not statistically different between groups. In contrast to this result, the percentage of CD4+ cells and the proliferative T-cell response to phytohemagglutinin were significantly depressed in patients who used HPN versus control subjects. CONCLUSIONS: These data suggest the presence of an underlying inflammatory process and subsequent abnormal T-lymphocyte function in patients who use HPN.     

精氨酸强化肠外营养对外科危重病人免疫功能影响的研究

目的观察精氨酸强化肠外营养对术后外科危重病人免疫功能的影响。方法选择危重病人30例，随机分为实验组采用精氨酸强化肠外营养和对照组应用常规的肠外营养。营养支持前后分别检验T细胞亚群(CD3^ 、CD4^ 、CO8^ )，NK细胞活性，IL-2受体浓度。结果营养支持后9天实验组CD4^ 、CO4^ ／CO8^ 、NK细胞活性、IL-2受体浓度较营养支持前明显升高，统计学差异显，而对照组所有指标改善无明显统计学意义。结论精氨酸强化肠外营养可以改善外科危重病人的免疫功能。     

强化低热量肠外营养对重型颅脑损伤病人营养和免疫功能的影响

目的: 探讨丙氨酰谷氨酰胺双肽(Ala-Gln,丙谷双肽)强化的低热量PN支持对早期重型颅脑损伤病人免疫功能和营养代谢的影响. 方法: 将60例病人随机分为试验组和对照组,每组30例.试验组给予强化丙谷双肽的低热量PN支持;对照组给予标准的PN支持,共8 d.观察两组病人营养支持期间IgA、IgG、IgM、CD4、CD8、血糖、血清ALB、TF、Hb和氮平衡等. 结果: 试验组病人IgA、IgG、CD4和CD4/CD8比值均高于对照组(P<0.05,P<0.01).试验组病人营养支持第5和第8天后,血糖水平显著低于对照组(P<0.01). 结论: 丙谷双肽强化的低热量PN能增加早期重型颅脑损伤病人免疫功能,控制其应激性高血糖.     

含精氨酸的肠外营养对胃肠道肿瘤病人术后免疫功能的影响

目的:探讨添加精氨酸(arginine,Arg)的胃肠外营养(PN)支持对胃肠道肿瘤病人术后免疫功能的影响.方法:将我院应用含Arg的PN的胃肠道肿瘤病人52例作为PN组,未应用PN的胃肠道肿瘤病人50例作为对照组.于手术前、术后第1天和第8天分别测定病人的T淋巴细胞亚群CD3 、CD4 、CD8 和免疫球蛋白IgM、IgA、IgG的含量.结果:手术前、术后第1天两组病人的免疫功能无明显差异(P＞0.05),术后第8天,PN组病人的体液免疫和细胞免疫功能均高于对照组,差异有显著性意义(P＜0.05,P＜0.01).结论:含精氨酸的胃肠外营养支持可促进胃肠道肿瘤病人术后免疫功能的恢复.     

Balance study of twenty trace elements during total parenteral nutrition in man.

1. Balances of twenty trace elements (silver, arsenic, gold, bromine, cadmium, cobalt, chromium, caesium, copper, iron, mercury, lanthanum, molybdenum, rubidium, antimony, scandium, selenium, samarium, tungsten and zinc) have been determined in four male patients during total parenteral nutrition incliding fat emulsion and a special solution for addition of Fe, Zn, manganese, Cu, fluorine and iodine, besides calcium and magnesium, to the infusion solutions. 2. The analyses for trace elements were made with the aid of an ion-exchange technique based on neutron activation, and combined with subsequent gamma spectrometry. 3. The intended intravenous supply of trace elements correspond approximately to the analysed supply. However, all the other trace elements determined were found to be unintentionally administered in small amounts. 4.There was a substantial retention of Fe. Other elements retained were Ag, Co, Cr, Cu, Sb, Sc, and W. 5. Particularly Br and Rb were lost by the patients, but negative balances were also found for As, Au, Cd, Cs, Mo, Se and Zn. However, Zn was retained by one patient with short bowel syndrome. 6. The serum concentrations of thirteen (Ag, Br, Co, Cs, Cu, Fe, Hg, Mo, Rb, Sc, Se, W and Zn) of the trace elements were found to have some decrease during the period of total parenteral nutrition, mostly in accordance with the corresponding balance values, Fe, in particular, was found to have the derectional change in concentration. 7. The administration of trace elements is recommended in long-term total parenteral nutrition.     

Liver function tests in patients receiving parenteral nutrition

A 5-year prospective study was performed to monitor liver function tests (LFTs) in patients receiving total parenteral nutrition (TPN). A gradual and progressive rise was seen in the plasma concentration of bilirubin, aspartate transaminase, and alkaline phosphatase. The rate of rise was not increased in patients with LFT abnormalities before the start of TPN. Half of the patients had an episode of sepsis during TPN, but overall abnormal LFTs did not appear more common in these patients than in those without obvious sepsis. Patients with malignant disease, those requiring long-term TPN, and those requiring a nonstandard TPN regimen were more likely to develop raised LFTs.     

脂肪乳剂对红细胞免疫功能的影响

对30例胃癌根治术患者手术前后及脂肪乳剂支持前后的红细胞免疫指标进行了观察。结果显示：胃癌根治术后实施含有脂肪乳剂的TPN较单纯胃癌根治术有更强的刺激红细胞免疫功能恢复作用。     

肠外营养对肝癌手术患者胃肠功能恢复与免疫功能及感染的影响

目的 探讨肠外营养对肝癌手术患者胃肠功能恢复、免疫功能及感染的影响。方法 选取2019年11月-2020年11月南阳医学高等专科学校第一附属医院收治的96例肝癌患者,随机分为研究组和对照组各48例,对照组予以肠内营养支持,研究组在对照组的基础上加以肠外营养支持。比较两组患者治疗后临床指标、感染并发症的发生情况,治疗前后免疫功能指标水平、营养状态以及生活质量。结果 研究组患者治疗后肛门排便时间、肛门排气时间、住院时间短于对照组(P<0.05),出入院体质量差优于对照组(P<0.05);研究组患者治疗后CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺水平高于对照组(P<0.05),CD₈⁺低于对照组(P<0.05);研究组患者治疗后总蛋白、白蛋白、前白蛋白、转铁蛋白水平高于对照组(P<0.05);研究组患者治疗后社会功能、心理功能、躯体功能、物质生活评分...     

Visual function in patients undergoing long-term total parenteral nutrition

To evaluate the effects of long-term total parenteral nutrition (TPN) on eye function, 27 adults and 12 children in the UCLA Home TPN Clinic underwent ophthalmoscopic examination and visual-function testing. Direct inspection of the fundus showed a marked granularity of the retinal pigmented epithelium in some patients. About one-half of the children and one-third of the adults tested had at least one and usually two abnormalities in their electroretinogram. Determination of blood nutrients thought to affect vision revealed that zinc and vitamin E were within normal range. Vitamin A concentrations were above normal in 10 of 19 adults and selenium concentrations were below normal in 10 of 10 children and 17 of 21 adults tested. Linoleic and linolenic acid concentrations were low; plasma, platelet, and urine taurine concentrations were significantly lower than normal. Despite these diffuse nutrient abnormalities, only zinc and vitamin E concentrations correlated significantly with any index of visual function.     

Total parenteral nutrition tamponade.

When Aubaniac first introduced the central venous catheter to clinical medicine he stated 'Elle est strictement sans danger'. Subsequently, central venous catheters have been used for monitoring, medicating and feeding intensive care patients of all ages. Complications are infrequent, but can, however, sometimes be fatal. Cardiac tamponade is a rare complication, and in this report prompt recognition and treatment prevented the death of a neonate.     

围手术期谷氨酰胺强化全肠外营养对胃肠道肿瘤病人免疫功能的影响

目的:研究围手术期谷氨酰胺强化的全肠外营养(TPN)对接受术前化疗的胃肠道肿瘤病人免疫功能的影响.方法:将60例胃肠道肿瘤病人随机分为TPN组、谷氨酰胺强化TPN(Gln-TPN)组和对照组,每组20例病人.对照组给予常规术前准备和术后治疗,TPN组和Gln-TPN组分别给予术前5 d和术后5 d营养支持,两组给予等氮0.20g/(kg·d)和等热量104.6 kJ/(kg·d),同时接受为期5 d的术前化疗.Gln-TPN组中25%～35%的氮源由谷氨酰胺双肽提供,其余的氮源及TPN组的氮源由乐凡命提供.检测术前、术后病人的外周血淋巴细胞总数、T淋巴细胞亚群(CD3 、CD4 、CD8 )及NK细胞数量等免疫指标及前列腺素E2、C反应蛋白(CRP)浓度等炎性反应指标.结果:研究期间三组病人无严重并发症发生.三组病人术后CD3 细胞和CD8 细胞百分比均较术前明显下降,术后水平三组间比较差异无显著性意义.Gln-TPN组CD4 和NK细胞数量及CD4 /CD8 明显高于其他两组,术后Gln-TPN组淋巴细胞总数高于TPN组,而前列腺素E2和C反应蛋白浓度则低于TPN组.结论:谷氨酰胺强化的TPN可降低血浆中前列腺素E2和CRP浓度,促进淋巴细胞增生,调节机体的炎性反应,增强机体的细胞免疫功能.     

肠内和肠外营养对食管癌病人术后免疫功能影响的系统评价

目的:系统评价肠内营养(EN)和肠外营养(PN)对食管癌病人免疫功能的影响。方法:采用系统评价方法,计算机检索PUBMED、MEDLINE和CNKI、重庆维普等数据库,对食管癌病人建立的随机对照试验(RCT)进行收集,并分析病人在手术治疗后行PN和EN对其机体免疫功能影响情况,按照纳入和排除标准选择RCT,进行质量评价后提取数据,并应用Rev Man 5.3软件进行Meta分析。结果:共纳入11项研究,合计754例食管癌病人,各项研究均采用随机分组方法。Meta分析对病人细胞免疫的影响结果显示,治疗1周后,EN组病人CD3+、CD4+、CD4+/CD8+水平均高于PN组,而CD8+水平相反,两组间比较差异有显著性统计学意义(P0.01)。对病人体液免疫影响的结果显示,治疗1周后,EN组病人Ig G、Ig A和Ig M水平均高于PN组,两组间比较差异有显著性统计学意义(P0.01)。结论:与PN比,EN治疗能显著提高食管癌病人术后的细胞和体液免疫功能。