老年病人肠内营养的并发症及预防

肠内营养（ＥＮ）自７０年代末开展至今，已在外科营养学领域展示出其与众不同的优势。它是目前普遍认为简单、经济、安全和有效的营养补给方法，具有符合生理状态、监护操作方便、有助于胃肠道功能和形态的恢复等特点。对于有功能的消化道，不论年轻病人还是老年病人采用...     

颅脑损伤昏迷患者早期胃肠内营养并发症的预防

由于胃肠道内供给营养是人类固有的消化吸收利用营养素的最佳途经,尤其在疾病状态下,尽早采用胃肠内营养对恢复和维持胃肠道的生理功能较静脉法有益[1].因此,应尽可能应用胃肠内营养(enteral nutrition,EN).颅脑损伤昏迷病人胃肠内营养的优越性日渐显著,由于伤后病人呈高代谢、高分解状态,能量消耗急增,尤其是蛋白质高分解代谢,使病人处于负氮平衡,增加颅脑损伤的病死率和病残率[2].胃肠外营养往往不能满足颅脑损伤后的能量高消耗,所以主张EN为主要营养方式.临床应用最多的是鼻胃管插管,适用于要素饮食、匀浆饮食、混合奶的EN支持[3].此类病人病情均很严重,因此,由EN引起的各种潜在的并发症也不应忽视.回顾我院2002～2003年共收治117例重型颅脑损伤病人,总结其鼻饲情况,报告如下.     

外科病人肠内营养并发症的预防及护理

目的采用有效的护理方法减少使用肠内营养出现的并发症。方法收集我科2006年6月-2011年7月实施肠内营养的65例患者,年龄18-83岁。结果 5例发生了腹泻、腹胀,3例发生了恶心、呕吐,3例发生了堵管。1例发生了误吸,经处理后患者的症状好转。结论肠内营养并发症是多方面的,应以预防为主,并及时处理,才能降低并发症的发生率。     

肠内营养对于特重型颅脑外伤并发上消化道应激性溃疡出血的预防作用

0　引　　言近年来 ,营养支持尤其是肠内营养支持 ,在手术及创伤病人中的应用越来越受到重视 ,其必要性得到广泛的认同。我科对特重型颅脑外伤病人治疗中应用肠内营养预防上消化道应激性溃疡出血的作用进行初步观察 ,现报告如下。1　资料与方法1 1　对象　病例均来自我科近 7年来的住院病人 ,共 138例。其中男 94例 ,女 4 4例 ,男性平均年龄(38.2 4± 6 .4 7)岁 ;女性平均年龄 (37.83± 7.6 4)岁。全部病例格拉斯哥 (Ｇｌａｓｇｏｗ)评分 3～ 5分 ,诊断为特重型颅脑外伤。1 2　方法　 138例病人诊断明确 ,随机分为三组 :①无抑酸药物和肠内…     

86例危重症患者肠内营养相关并发症分析

目的探讨危重症患者肠内营养相关并发症的发生原因及防治措施。方法回顾性分析医院重症监护科收治的86例危重症患者,观察肠内营养相关并发症的发生情况。结果观察发现危重症患者肠内营养相关并发症主要有:腹泻、腹胀、高血糖、吸入性肺炎。结论重视肠内营养相关并发症的发生,及早预防,可使患者的营养支持治疗取得最佳效果。     

重型颅脑损伤后早期肠内营养相关并发症分析

目的:观察重型颅脑损伤后早期肠内营养(EN)相关并发症的发生特点、相关因素及防治措施.方法:360例接受早期肠内营养支持的重型颅脑损伤病人,入住ICU后进行GCS评分,置鼻胃(肠)管,48 h后开始EN,观察伤后第7 d EN最大输注量(mL/d)、过渡至完全肠内营养(TEN)的时间(d)、伤后第7 d实现TEN的病例数及血糖和血清清蛋白(ALB)和谷丙转氨酶变化,记录各种肠内营养并发症的发生率.结果:颅脑损伤后早期EN并发症发生特点:伤后1周内以腹胀、呕吐、反流和误吸为主,1周后以腹泻为主;腹胀和呕吐的发生与鼻饲管所在位置有关,腹泻发生与GCS评分和ALB水平呈负相关;GCS评分越低,EN耐受的最大输注量越低、过渡至TEN的时间越长、相关并发症的发生率亦增加.结论:重型颅脑损伤后早期肠内营养相关并发症与其损伤程度、血清清蛋白水平等因素呈负相关;使用鼻肠管可降低腹胀和呕吐的发生率.     

胃肠内营养的感染并发症

胃肠内营养支持是营养治疗的主要手段，但其感染性并发症，特别是吸入性肺炎，严重威胁病人生命。本文介绍３例老年男性胃肠内营养支持病例Ｌ（１）例１，食管修补术后多脏器衰竭伴肺部感染，试用胃造瘘管滴入营养液维持未成功，控制感染后改由空肠造瘘滴入营养液成功，病人康复；（２例２，胆囊切除术后多脏器功能衰竭伴重度肺部感染，鼻饲胃管维持营养后出现吸入性肺炎，行胃造兼输注营养液出现腹泻、全复水肿后死亡；（３）例３，     

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。     

肠内营养并发症的防治体会

目的 总结全胃切除术后肠内营养支持中常见并发症发生的原因及预防措施.方法 对127例全胃切除病人实施肠内营养过程出现的并发症进行回顾性分析.结果 肠内营养常见的并发症可分为三类:胃肠道并发症、机械性并发症和代谢性并发症.结论 积极预防和及时处理并发症是肠内营养支持成功的关键.     

全胃切除术后早期肠内营养护理及并发症的预防

0引言 胃癌病人常伴有中度以上的营养不良,肿瘤根治术后的营养支持对病人的预后显得尤为重要.EN在经历了临床的考验和不断发展后,其重要性已重新得到认识和肯定[1].     

A Comparison of Postoperative Early Enteral Nutrition with Delayed Enteral Nutrition in Patients with Esophageal Cancer

We examined esophageal cancer patients who received enteral nutrition (EN) to evaluate the validity of early EN compared to delayed EN, and to determine the appropriate time to start EN. A total of 208 esophagectomy patients who received EN postoperatively were divided into three groups (Group 1, 2 and 3) based on whether they received EN within 48 h, 48 h–72 h or more than 72 h, respectively. The postoperative complications, length of hospital stay (LOH), days for first fecal passage, cost of hospitalization, and the difference in serum albumin values between pre-operation and post-operation were all recorded. The statistical analyses were performed using the t-test, the Mann-Whitney U test and the chi square test. Statistical significance was defined as p < 0.05. Group 1 had the lowest thoracic drainage volume, the earliest first fecal passage, and the lowest LOH and hospitalization expenses of the three groups. The incidence of pneumonia was by far the highest in Group 3 (p = 0.019). Finally, all the postoperative outcomes of nutritional conditions were the worst by a significant margin in Group 3. It is therefore safe and valid to start early enteral nutrition within 48 h for postoperative esophageal cancer patients.     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月-2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组（观察组）19例和全肠外营养支持组（对照组）19例。观察组早期肠内营养（enteral nutrition,EN）和肠外营养（parenterl nutrition,PN）结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组（P〈0．05）,观察组并发症少于对照组。观察组10天后病死率为（15．79％）明显低于对照组（31．58％）。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月～2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组(观察组)19例和全肠外营养支持组(对照组)19例。观察组早期肠内营养(enteral nutrition,EN)和肠外营养(parenteral nutrition,PN)结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组(P<0.05),观察组并发症少于对照组。观察组10天后病死率为(15.79%)明显低于对照组(31.58%)。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。     

Home Parenteral and Enteral Nutrition

While the history of nutrition support dates to the ancient world, modern home parenteral and enteral nutrition (HPEN) has been available since the 1960s. Home enteral nutrition is primarily for patients in whom there is a reduction in oral intake below the amount needed to maintain nutrition or hydration (i.e., oral failure), whereas home parenteral nutrition is used for patients when oral-enteral nutrition is temporarily or permanently impossible or absorption insufficient to maintain nutrition or hydration (i.e., intestinal failure). The development of home delivery of these therapies has revolutionized the field of clinical nutrition. The use of HPEN appears to be increasing on a global scale, and because of this, it is important for healthcare providers to understand all that HPEN entails to provide safe, efficacious, and cost-effective support to the HPEN patient. In this article, we provide a comprehensive review of the indications, patient requirements, monitoring, complications, and overall process of managing these therapies at home. Whereas some of the information in this article may be applicable to the pediatric patient, the focus is on the adult population.     

肠内营养在克罗恩病治疗中的应用

目的探讨肠内营养在克罗恩病（CD）治疗中的作用。方法随机选取39例综合确诊的CD患者，依据是否行肠内营养治疗分为肠内营养组（n=31）和对照组（n=8），记录其临床表现、实验室检查结果和CD活动指数（CDAI）。结果（1）临床表现：肠内营养治疗2周和4周后，肠内营养组在发热、腹部包块、腹泻和肠外表现等临床症状方面，以及活动性病变人数和需肠外营养支持的人数方面，均较治疗前和对照组有明显好转（P〈0．05）；在肠梗阻、腹痛和便血等临床症状上也较治疗前明显好转（P〈0．05）；患者体重亦较治疗前明显增加（P〈0．05），而对照组却较治疗前显著下降（P〈0．05）。（2）实验室检查：肠内营养治疗2周和4周后，肠内营养组在γ球蛋白、α2球蛋白、CRP和ESR等方面均较治疗前显著下降（P〈0．05）；在H曲和血白蛋白方面较治疗前明显增加（P〈0．05），而对照组却较治疗前明显下降（P〈0．05）。（3）CDAI：肠内营养治疗2周和4周后，肠内营养组和对照组的CDAI均较治疗前明显下降（P〈0．05），但肠内营养组CDAI下降的幅度较对照组大。（4）皮质激素使用方面：肠内营养组和对照组无统计学上的显著差异（P均〉0．05），肠内营养组15例在观察期内均开始激素减量。结论肠内营养是CD患者充分有效的营养支持方式，有助于CD活动期病情的改善，可以作为激素的替代治疗选择。对于疾病的治疗具有重大意义。     

肠内营养支持重型颅脑外伤患者的临床护理

目的探讨肠内营养支持重型颅脑外伤患者的临床护理。方法根据患者的生理,病理情况和个人经济条件制定营养计划。采用匀浆膳食和新鲜流质饮食联合使用。结果 68例重症颅脑外伤患者中并发症出现率,腹泻31.0%,呕吐19.1%,消化道出血16.1%,误吸13.2%,脱管7.4%,堵管7.4%,采用匀浆膳食和新鲜流质饮食联合使用,患者的体重、握力显著增加。结论肠内营养支持能促进术后患者的蛋白质合成,尽快达到正氮平衡,降低感染性并发症的发生率,并增进患者的神经功能恢复,降低病死率和伤残率。     

肠内营养支持重型颅脑外伤患者的临床护理

目的探讨肠内营养支持重型颅脑外伤患者的临床护理。方法根据患者的生理,病理情况和个人经济条件制定营养计划。采用匀浆膳食和新鲜流质饮食联合使用。结果68例重症颅脑外伤患者中并发症出现率,腹泻31．0％,呕吐19．1％,消化道出血16．1％,误吸13．2％,脱管7．4％,堵管7．4％,采用匀浆膳食和新鲜流质饮食联合使用,患者的体重、握力显著增加。结论肠内营养支持能促进术后患者的蛋白质合成,尽快达到正氮平衡,降低感染性并发症的发生率,并增进患者的神经功能恢复,降低病死率和伤残率。     

Influence of Age and Type of Underlying Disease on Complications Related to Home Enteral Nutrition

Background: No data about the influence of age and underlying diseases on home enteral nutrition (HEN)–related complications are reported in the literature. Herein, we retrospectively investigated this issue by analyzing HEN‐related complications in a cohort of consecutive patients grouped according to the underlying disease and age. Material and Methods: We reviewed the medical records of 101 patients referring to our team in 2007–2010 to obtain patients’ demographic data, age, nutrition status, duration of HEN treatment, and type of HEN‐related complications. They were divided in cancer and neurologic patients and subgrouped on the basis of their age. HEN‐related complications were expressed as complication rates. Results: Patients with neurological diseases suffered a significantly higher number of complications as compared with cancer patients (P = .04). Age did not significantly influence complication rates. The mechanical complications were the most frequent. The majority of HEN‐related complications were resolved at home. Conclusion: Our data strongly suggest that HEN‐related complications are influenced by underlying diseases and not by age. In neurologic patients, dementia, loss of autonomy, and the different therapies administered by PEG probably play an important role in increasing the number of HEN‐related complications as compared with cancer patients. The most frequent complications can be managed at home, reducing the costs of hospitalizations and discomfort for the patient.     

早期肠内营养预防特重型颅脑损伤并发上消化道出血

目的：探讨早期肠内营养预防特重型颅脑损伤并发上消化道出血的机制和效果。方法：回顾性分析采用早期肠内营养（观察组）与晚期肠内营养（对照组）的特重型颅脑损伤患者的临床资料。结果：两组入院后第1、2、3周并发应激性溃疡出血的发生率比较,差异有统计学意义（P〈0.05）,其中入院后第1周并发应激性溃疡出血的发生率最高。结论：对特重度颅脑损伤患者进行早期肠内营养,可有效预防并发应激性溃疡出血的发生率、减少并发症、改善预后。     

Effects of Enteral Nutrition on the Barrier Function of the Intestinal Mucosa and Dopamine Receptor Expression in Rats With Traumatic Brain Injury

Background: Impaired intestinal mucosal barrier (IMB) function is common in traumatic brain injury (TBI), but dopamine receptors (DRs) change in intestinal mucosa after TBI, and effects of enteral nutrition (EN) and supplements on IMB function remain unclear. Our purpose was to study the effects of EN and supplements on intestinal mucosal permeability (IMPB) and the expression of DRs DRD1 and DRD2 in the intestinal mucosa of rats with TBI. Methods: Forty‐eight rats were divided into 8 groups; control, animals with TBI, dopamine group, animals with TBI treated with dopamine antagonist, EN alone, or EN combined with glutamine, probiotics, or a combination of probiotics and glutamine daily after TBI. Results: The IMPB was improved in the glutamine, probiotics, and combination groups. Including probiotics improved IMPB more than adding glutamine, and bacterial translocation in the intestines after TBI was reduced in the probiotics and combination groups (all Ps < .01). TBI led to elevated DRD1 and DRD2 mRNA and protein levels, which were reduced in the DA antagonist, glutamine, probiotics, and combination groups. DRD2 mRNA and protein levels in the probiotics and combination groups were decreased more than in the DA antagonist group (all Ps < .01). The increased IMPB after TBI correlated with increased DRD1 and DRD2 levels in the rat intestinal mucosa. Conclusion: EN supplemented with probiotics or combining glutamine and probiotics lowers the increased IMPB, bacterial translocation, and DRD1 and DRD2 mRNA and protein expression in rat intestinal mucosa caused by TBI.