全胃肠外营养在充血性心力衰竭病人中的早期应用

目的：探讨在充血性心血衰竭病人中，早期全胃肠外营养（TPN）的临床应用，方法：实验组（17例），早期应用TPN，经中心静脉导管24小时持续缓慢静滴，对照组（15例），采用普通饮食，为期1周，在治疗前后对心衰状况，心律失常、血清白蛋白、氮平衡情况进行监测，并分,:TPN上期应用心衰的效果显著提高，各项营养匀明显优于对照组。结论：在心衰病人中，早期应用TPN切实行，为抗心衰和心肌细胞功能的恢复创造有利条件。     

胃癌患者术后肠内、肠外营养的疗效观察

目的探讨胃癌术后早期经鼻空肠管行肠内营养的临床应用价值及可行性，并与全肠胃营养作一合理比较，选取近年来我院行胃癌及贲门癌30例分为两组，实验组（EN-PN组）术后24小时经鼻饲管饲能全素（13例），对照组（TPN组）术后行完全肠外营养（17例），对两组患者术前、术后进行营养状态评价。结果实验组（EN—PN组）患者术后体重营养状态均较对照组（TPN组）有明显改善。结论胃癌术后经鼻饲管肠内营养安全、可靠、经济、在临床上有实用价值。     

颅脑重症病人施行肠内营养的临床研究

目的探讨颅脑重症病人早期肠内营养(EEF)与早期完全胃肠外营养(TPN)在摄入同等热能、同等氮量的条件下的优劣. 方法颅脑重症病人40例随机分成EEF组和TPN组,予摄入同等热能、同等氮量,于入院后第1天、14天检测体重、 24 h排出氮、血清总蛋白,评估胃肠道功能(上消化道出血、返流、腹泻、拒食、淤胆等)及意识状态(GCS评分)的变化. 结果 EEF组的返流并无增加,腹泻、苏醒后拒食、淤胆、便秘的发生率显著减少,上消化道出血发生率显著减少,EEF组24 h排出氮明显少于 TPN组,血清总蛋白等营养指标优于TPN组. 入院后第14天,EEF组体重丢失[(-1.1±2.0) kg]显著少于TPN组[(-5.2±3.2) kg],GCS评分较TPN组显著改善(14.2±0.9 Vs 12.7±1.3). 结论颅脑重症病人在摄入同等热能、同等氮量的条件下肠内营养优于肠外营养.     

颅脑重症病人施行肠内营养的临床研究

目的　探讨颅脑重症病人早期肠内营养 (EEF)与早期完全胃肠外营养 (TPN)在摄入同等热能、同等氮量的条件下的优劣 .方法　颅脑重症病人 4 0例随机分成EEF组和TPN组 ,予摄入同等热能、同等氮量 ,于入院后第 1天、14天检测体重、2 4h排出氮、血清总蛋白 ,评估胃肠道功能 (上消化道出血、返流、腹泻、拒食、淤胆等 )及意识状态 (GCS评分 )的变化 .结果　EEF组的返流并无增加 ,腹泻、苏醒后拒食、淤胆、便秘的发生率显著减少 ,上消化道出血发生率显著减少 ,EEF组 2 4h排出氮明显少于TPN组 ,血清总蛋白等营养指标优于TPN组 .入院后第 14天 ,EEF组体重丢失[(- 1.1± 2 .0 )kg]显著少于TPN组 [(- 5 .2± 3.2 )kg],GCS评分较TPN组显著改善 (14 .2± 0 .9Vs 12 .7± 1.3) .结论　颅脑重症病人在摄入同等热能、同等氮量的条件下肠内营养优于肠外营养     

全肠外营养对免疫的影响

全肠外营养（TPN）是不能经胃肠营养的病人，包括新生儿获取所需营养以维持生长发育或维持细胞代谢、调节生理机能的必经途径。研究发现TPN在免疫器官、细胞、分子、基因各个水平影响机体免疫，其影响因素和作用机制复杂，其中长链多不饱和脂肪酸、个别氨基酸如谷氨酰胺等营养素对免疫的影响是目标研究的焦点，同时肯定了肠道微量喂养对免疫的促进作用。认识TPN对免疫的影响并合理使用TPN，使其不只是供给营养的途径，更重要的是作为治疗手段，以促进疾病康复。     

B型脑钠肽对新生儿肺炎合并心力衰竭的诊断意义

目的通过检测并比较新生儿肺炎合并心力衰竭（心衰组）、肺炎新生儿（肺炎组）及正常新生儿（对照组）的B型脑钠肽（brainnatriuretic pep tide,BNP）水平,探讨其在肺炎合并心衰新生儿中的临床价值。方法选择肺炎合并心衰新生儿40例为研究对象,无心衰肺炎新生儿40例（肺炎组）,正常新生儿40例（对照组）,采用酶联免疫吸附试验进行定量检测B型BNP。结果心衰组BNP水平明显高于肺炎组及对照组,且心衰组心衰期与早期及恢复期之间均有显著差异（P〈0.05）,心衰早期与恢复期无显著差异,肺炎组与对照组无显著差异,提示BNP可作为早期诊断新生儿肺炎合并心衰及判断病情严重程度的指标。     

新生儿全静脉营养临床应用研究

全静脉营养又称全肠外营养（totalparenteralnutrition，TPN）。对长期不能经口喂养的患病新生儿及早产儿提供足够营养，达到正常生育发育，是近年来新生儿治疗学、营养学中的一个重要突破。对降低危重新生儿病死率，提高新生儿生存质量都具有重要意义。我科新生儿监护病房19941995年开展新生儿TPN；临床应用研究40例，效果满意，现报告如下。对象及方法一、研究对象；本组4O例，男26例，女14例，早产儿27例（67．5％），足月儿13例。体重＜1500glZ例，150o－2500g15例，＞2500913例，体重最低1例仅900g。开始TPN时的日龄＜7天22例，－…     

早期空肠内营养法降低重症急性胰腺炎大鼠死亡率和机制研究

目的：研究早期肠内营养疗法（EEN）和完全肠外营养疗法（TPN）对重症急性胰腺炎（SAP）大鼠急性期炎性反应程度及细胞免疫功能的影响，探讨SAP治疗过程中EEN对机体免疫的调节作用。方法:80只180-220 g雄性SD大鼠随机分为EEN组、TPN组及假手术（S）和重症胰腺炎（SAP）组，各20只，成模后分别行TPN过渡至EEN、TPN、正常喂养和正常喂养。检测术后2周时血清淀粉酶（Amy）、CRP、IL-6、TNF-α水平及外周血CD4+、CD8+淋巴细胞计数。结果:(1)术后2周S组大鼠无死亡, EEN组大鼠生存率为75%, TPN组生存率为70%, SAP组生存率为0。EEN和TPN组血清Amy差异无显著（P>0.05）。（2）术后2周EEN组和TPN组血淀粉酶、TNF-α、IL-6、CRP均明显高于S组（P<0.05, P<0.01）。（3）术后2周EEN组和TPN组CD4+、CD8+均明显高于S组，但CD4+/CD8+比值明显高于S组（P<0.05, P<0.01）。EEN组CD4+和CD4+/CD8+比值明显高于TPN组（P<0.01）。结论：EEN疗法可显著降低SAP大鼠死亡率，这可能与该疗法能有效地减轻病鼠急性期炎症反应和增强机体免疫力有关。     

危重早产儿静脉营养方法的探讨

目的 :旨在寻找一种有效的静脉营养 (TPN)供给方法。方法 :将 174例早产儿随机分成两组 ,综合组 (90例 ) :部分TPN 母乳 微生物疗法 ,对照组 (84例 ) :单纯TPN。比较两组每天体重、开奶时间、住院时间和治愈率。结果 :综合治疗组治愈率高于单纯TPN ;两种方法在供给热卡 ,增加体重方面无差异 ;综合治疗组开奶时间及平均住院天数均短于单纯TPN组。结论 :TPN期间 ,早期间断鼻饲活菌制剂及母乳 ,可更快过渡至肠内营养 ,有利于疾病的康复及正常生长发育     

TPN添加丙氨酰谷氨酰胺在高龄胃癌患者术后治疗的应用

目的 观察全肠外营养（TPN）添加丙氨酰谷氨酰胺对高龄胃癌术后患者营养、免疫功能影响。方法高龄胃癌术后患者72例,随机分为对照组和研究组,对照组采用常规TPN,研究组在常规TPN基础上加用丙氨酰谷氨酰胺注射液。于术前及术后第3天、第8天分别抽取外周血测定IgG、IgA、IgM和T淋巴细胞亚群CD3、CD4、CD8,及CIM／CD8比值,及TP、ALB指标。结果术后第8天,研究组患者的IgG、IgA和IgM明显回升并高于术前水平,CD3、CIM和CD4／CD8比值与对照组有显著性差异（P〈0．05）,而TP、ALB指标明显高于对照组。结论TPN添加丙氨酰谷氨酰胺能有效改善和增强高龄胃癌患者术后免疫功能及营养水平。     

Parenteral Nutrition and preOp preparation in prevention of post-operative insulin resistance in gastrointestinal carcinoma

PurposeThe aim was to compare preventive effect of total parenteral nutrition (TPN) and oral nutrition (preOp) on the perioperative insulin resistance prevention in surgical gastrointestinal cancer patients.Material/MethodsThe study was conducted in a group of 75 elective gastric and large intestine cancer patients. Patients were randomly divided into 3 study groups, 25 patients each: group I (NIL) - no preparations influencing tissue sensitivity to insulin, group II (TPN) - total parenteral nutrition in its preoperative stage and group III (TPN + preOp) parenteral nutrition and preOp in the preoperative phase.ResultsImmediately after the surgery, no statistically significant differences in insulin resistance level between groups were observed. During the first 6 postoperative hours, a statistically significant decrease of insulin resistance level in the TPN+ preOp group in comparison to others, was observed. During the first 24 postoperative hours, the NIL group was the only one to keep the insulin resistance level the same as in the preoperative phase.ConclusionsApplication of TPN in the preoperative phase leads to shortening of perioperative insulin resistance time. Combining TPN with oral application of carbohydrate before surgical procedure is an effective and the best method in postoperative insulin resistance syndrome prevention.     

Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prosepective, randomized study

The benefits of early enteral feeding (EEN) have been demonstrated in gastrointestinal surgery. But, the impact of EEN has not been elucidated yet. We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy (PD) according to the postoperative nutritional method and compared the clinical outcomes of two methods. A prospective randomized trial was undertaken following PD. Patients were randomly divided into two groups; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition (TPN) management. Thirty-eight patients were included in our analyses. The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group. Prealbumin and transferrin were significantly reduced on post-operative day (POD) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group. EEN group rapidly recovered weight after POD 21 whereas it was gradually decreased in TPN group until POD 90. EEN after PD is associated with preservation of weight compared with TPN and impact on recovery of digestive function after PD.     

Psychiatric reactions to long-term intravenous hyperalimentation

The authors reviewed charts of 100 patients receiving total parenteral nutrition (TPN) and 100 control patients with similar diagnoses who did not receive TPN. In addition, 30 patients were studied with a structured interview and a psychiatric questionnaire. Organic brain syndromes and other confusional states were no more common in the patients on TPN than in the controls, and hyperalimentation did not appear to be a determining factor in the onset of psychosis or depression. Two dangers of TPN, apparently unreported previously, were noted. First, the use of hyperalimentation as primary treatment for anorexia nervosa (rather than as an adjunct to psychiatric therapy) can have serious consequences, such as cerebellar degeneration and suicidal ideation. Second, psychiatric disturbances in caretakers can endanger patients’ lives.     

心力衰竭患者血浆sTRAIL和sDR5的水平及培哚普利对其影响

目的 :探讨充血性心力衰竭 (CHF)患者血浆可溶型TNF相关的凋亡诱导配体 (sTRAIL)和死亡受体DR5水平的变化及与培哚普利对心脏保护的关系。方法 :用ELISA法检测治疗前后 30例服用培哚普利的CHF患者、2 8例常规治疗的CHF患者及 2 0例健康人对照血浆中sTRAIL及sDR5的水平。结果 :① 5 8例CHF患者血浆sTRAIL的平均含量为 (1.4 3± 0 .4 7)μg/L ,健康人为 (0 .93± 0 .12 ) μg/L ,两者无显著性差异(P >0 .0 5 ) ;sTRAIL水平与心功能损害程度亦无明显关系。CHF患者血浆sDR5的平均含量为 (39.6 7± 6 .78)ng/L ,较健康人 (<6ng/L)明显升高 ,且随着心功能损害程度的加重而升高。②培哚普利组与常规心衰治疗组治疗后 ,血浆中sTRAIL的水平均有所降低 ,但无显著性差异。治疗前后培哚普利组血浆sDR5的平均水平 ,分别为 (31.2 3± 10 .16 )ng/L和 (8.5 0± 2 .14 )ng/L(P <0 .0 5 ) ;常规治疗组分别为 (48.81± 8.74 )ng/L和 (2 6 .6 4± 6 .2 7)ng/L(P <0 .0 5 )。培哚普利组与常规治疗组相比较 ,前者降低更明显 (分别下降 72 .7%和 4 5 .4 % )。③与其他病因所致CHF患者相比较 ,高血压心脏病所致CHF患者血浆sDR5的水平明显升高。结论 :sDR5可能在CHF患者心肌细胞凋亡的发生、发展中起着重要作用。培哚普利可降低C     

Mucositis after allogeneic hematopoietic stem cell transplantation: a cohort study of methotrexate- and non-methotrexate-containing graft-versus-host disease prophylaxis regimens.

Oral mucositis occurs in up to 75% of recipients of high-dose chemoradiotherapy conditioning regimens used for allogeneic hematopoietic stem cell transplantation (HSCT). As a result of mucositis, narcotic analgesia and total parenteral nutrition (TPN) are commonly required after HSCT. Methotrexate, an antiproliferative graft-versus-host disease (GVHD) prophylaxis agent, impairs mucosal regeneration and worsens and prolongs mucositis. We assessed the effect of substituting sirolimus for methotrexate as GVHD prophylaxis on outcomes associated with mucositis. Two patient cohorts undergoing allogeneic HLA-matched related donor peripheral blood stem cell transplantation with cyclophosphamide/total body irradiation conditioning were prospectively analyzed for mucositis severity and retrospectively reviewed for correlative outcomes. GVHD prophylaxis consisted of sirolimus/tacrolimus (ST) in the study group and tacrolimus/methotrexate (TM) in the control group. Thirty patients received ST and 24 patients received TM as GVHD prophylaxis between October 2000 and May 2003. Mild, moderate, and severe mucositis was noted in 37%, 57%, and 7% of the ST group and 8%, 42%, and 50% of the TM group (P = .0002). Less TPN was used in the ST group than the TM group (17% versus 43% of posttransplantation hospital days; P = .02). The total number of narcotic days was lower in the ST group in comparison with the TM group (median, 13.5 versus 17 days; P = .08). The time to first hospital discharge was shorter in the ST group compared with the TM group (median, 18 versus 22 days; P = .07). The substitution of sirolimus for methotrexate as GVHD prophylaxis is associated with a reduction in mucositis severity. As a result, TPN and narcotic use are reduced, and hospitalization duration is shortened. Less toxic GVHD prophylaxis regimens without methotrexate may have a significant effect on patient quality of life, patient outcomes, and economic outcomes associated with allogeneic stem cell transplantation.     

The comparative effects of abrupt vs. stepwise discontinuation of TPN in rats.

The comparative effects of discontinuing total parenteral nutrition (TPN: caloric ratio of glucose:fat:amino acid = 50:30:20) abruptly or in a stepwise manner on spontaneous food intake were investigated in two studies. Study 1: In 16 rats, TPN was given for 4 days, then stopped abruptly in eight rats. In the other eight rats, TPN was tapered; they received TPN at 75%, 50%, and 25% of their mean daily energy requirements per day for 3 consecutive days, and then switched to normal saline. Total parenteral nutrition induced a significant 60% reduction in spontaneous food intake (SFI) in both groups during the first TPN day. After 4 days of TPN, an 80% decrease in SFI had occurred in both groups. Resumption of SFI was significantly sooner in the abruptly-stopping group than in the stepwise-stopping group. But, in the latter group, there was a significantly greater cumulative caloric intake during the entire study. Study 2: In 32 rats, TPN providing either 100%, 50%, or 25% of their mean daily caloric requirements was given to three groups each of eight rats, for 3 days, then abruptly changed to normal saline; control rats received normal saline throughout. The TPN-induced decrease in SFI was proportional to the caloric density of the solution infused. Three days of 100%, 50%, or 25% TPN infusion led to an approximate 85%, 60%, or 35% decrease in SFI, respectively. Spontaneous food intake recovery was independent of the caloric density of TPN.(ABSTRACT TRUNCATED AT 250 WORDS)     

Catheter-induced superior vena cava thrombosis-lysis with streptokinase and apsac (Anisoylated plasminogen streptokinase activator complex BRL 26921)

Ten patients were given thrombolytic therapy for obstructive thrombi in the superior vena cava (SVC) following catheterisation for total parenteral nutrition (TPN—8 cases) or chemotherapy (2 cases). Seven of the TPN patients were given intravenous APSAC (Beecham, BRL 26921); the other 3 were given streptokinase (SK). Five of the caval occlusions treated with APSAC cleared after between 1 and 5 doses; one of those given SK cleared after 3 days continuous infusions during which active thrombolytic potential was maintained.Intravenous APSAC should be considered for the relief of major SVC occlusive thrombosis secondary to central venous catheters.     

依那普利联合美托洛尔治疗充血性心力衰竭的远期疗效研究

目的了解依那普利联合美托洛尔对充血性心力衰竭(CHF)的远期疗效.方法82例CHF患者,分为2组,研究组42例,使用依那普利联合美托洛尔治疗,疗程24个月;对照组40例,使用常规治疗,比较两组的疗效及超声心动图变化.结果研究组治疗2年的总有效率90.5%,明显高于对照组47.5%(p<0.05),心功能持续性改善,死亡率较常规治疗组明显降低(p<0.05).结论依那普利联合美托洛尔不仅持续改善心衰症状,提高生活质素,还能明显降低远期病死率.     

Asymptomatic fungemia caused by Acremonium sp associated with colonization of a central venous catheter

BACKGROUND: Microorganisms considered saprophytes have emerged as invasive or indolent pathogens among immuno-compromised patients. MATERIAL AND METHODS: We detected an initial case of catheter-related Acremonium sp fungemia on a previously asymptomatic patient. We diagnosed a second case five weeks later. Both patients had a non-tunneled central venous catheter (CVC) that had been cared for following routine protocol by nurses in the Intravenous Therapy Team on a weekly basis. The sole risk factor that both patients shared was that they had received total parenteral nutrition (TPN) by a CVC 5 months prior to the date the catheter-related fungemia was detected. We retrospectively studied all patients who had received TPN during this period. RESULTS: We found two cases ofAcremonium fungemia, patients had gastric adenocarcinoma and received TPN for an average of 19 days. Infection was resolved with catheter removal and antifungic therapy. Another eight patients received TPN from the same commercial firm during this period; average administration was 9.5 days (range, 6-20). Neither blood cultures nor tip-catheters culture reported Acremonium sp. CONCLUSIONS: Patients with CVC for TPN should be closely monitored to identify colonization with a low pathogenic microorganism that could be mistakenly diagnosed as asymptomatic.