重度烧伤患者早期肠内营养支持的经济学评价

目的研究重度烧伤患者早期肠内营养支持的疗效及费用。方法采用随机临床分组试验,将41例烧伤面积超过30%的患者分为肠内营养组(enteral nutrition,EN,n=21)和肠外营养支持为主的常规治疗组(conventionaltherapy,CONT,n=20)。治疗7天后观察两组内脏蛋白水平和预后炎症营养指数(prognostic inflammatory and nutritionalindex,PINI)等的变化及不良反应。结果治疗7天后EN组的前白蛋白水平显著高于CONT组[(115.8±31.0)mg/Lvs.(69.4±17.3)mg/L,P<0.01];PINI显著低于CONT组(162.9±89.4vs.343±149,P<0.01);EN组治疗7天的费用比CONT组节约382.06元(P=0.00)。结论早期肠内营养支持改善营养状况的疗效优于常规治疗,且费用低,具有良好的成本效果比。     

益生菌联合早期肠内营养支持对于胃癌病人术后康复的影响

目的:研究益生菌联合早期肠内营养支持治疗对于胃癌病人术后康复过程的影响.方法:回顾性分析2019年1月至2021年2月于无锡市第二人民医院接受胃癌根治术的病人共80例,分为对照组(n=40)和研究组(n=40).对照组予以单纯早期肠内营养支持,研究组予以益生菌联合早期肠内营养支持,观察比较两组病人术后营养与炎症指标、肠道菌群、肠道功能恢复情况之间的差异.结果:经过营养治疗后,研究组与对照组病人血清营养指标总蛋白、前白蛋白与白蛋白水平之间无明显差异(P＞0.05),但是研究组血清炎症反应指标C反应蛋白(t=3.924,P＜0.001)、白细胞介素6(t=5.269,P＜ 0.001)与肿瘤坏死因子α(t=3.251,P=0.002)水平均显著低于对照组;研究组营养治疗后肠道内双歧杆菌(t=4.048,P＜0.001)、乳酸杆菌(t=2.362,P=0.021)与肠球菌(t=2.412,P=0.018)水平均显著高于对照组.此外,研究组术后首次排气时间(t=5.589,P＜0.001),首次排便时间(=3.851,P＜ 0.001),恢复经口饮食时间(t=4.717,P＜0.001)均显著短于对照组.结论:益生菌联合早期肠内营养支持能够改善肠道菌群失衡,减轻术后炎症反应,同时促进肠道功能的恢复,有利于胃癌病人的术后康复.     

食管癌术后早期肠内营养的临床研究

目的 :探讨食管癌术后早期肠内营养的可行性、安全性和临床疗效。　方法 :食管癌病人 4 0例随机分为早期肠内营养组 (EEN)和传统肠内营养组 (TEN) ,每组 2 0例。所有病例在术后第 1、5、9天分别测定血清白蛋白(Alb)、前白蛋白 (PA)、转铁蛋白 (TF)和淋巴细胞计数 (TLC) ,临床观察生命体征、胃肠道功能恢复情况以及各种不良反应。　结果 :所有病人在研究期无死亡 ,无严重并发症 ,无明显肝肾功能改变。EEN组较TEN组PA和TF水平以及外周血TLC都明显升高 (P <0 .0 5 ) ;血清Alb水平未见明显改变 ;肛门排气时间较TEN组早 (P <0 .0 5 )。结论 :食管癌术后早期应用肠内营养支持安全可行 ,既能改善营养状态 ,维护和促进胃肠道功能 ,又能提高机体免疫功能     

贲门或食管癌病人术后早期序贯肠内营养支持的应用

目的:观察贲门或食管癌病人术后早期序贯肠内营养(ESEN)支持的临床效果.方法:将102例贲门或食管癌病人,随机分为ESEN组55例和常规肠内营养(EN)组47例.比较两组病人营养支持前后的营养状况和生化指标.结果:两组病人的血清总蛋白、清蛋白和前清蛋白在营养支持后均显著升高,ESEN组的前清蛋白升高较EN组更为显著(P《0.05).结论:ESEN支持与常规EN相比,可能更适合病人术后胃肠道功能的恢复.     

短肽型肠内营养制剂适用于老年脑卒中病人的营养支持

目的:评价短肽型肠内营养(EN)制剂对老年脑卒中病人营养支持治疗的疗效. 方法:将60例出现吞咽障碍需营养支持治疗的老年脑卒中病人,随机分为试验组(n =30,入院48 h内鼻饲给予短肽型EN制剂)和对照组(n=30,入院48 h内鼻饲给予匀浆膳).观察两组病人营养支持前后营养指标和不良反应的发生情况.结果:经过30 d的营养支持,试验组病人较对照组能更好地维持前清蛋白、清蛋白和血红蛋白水平;对照组病人前清蛋白、清蛋白和血红蛋白水平比入院时有显著降低(P＜0.01).试验组病人不良反应(腹胀、腹泻、呕吐、胃潴留、误吸和吸入性肺炎)的发生率(36.67％)显著低于对照组(56.67％),差异有显著性统计学意义(P＜0.05). 结论:短肽型EN制剂对老年脑卒中病人营养支持治疗的疗效和安全性均优于匀浆膳.     

食管癌病人术后早期肠内营养的疗效观察

目的:探讨食管癌病人术后早期肠内营养的可行性、安全性和临床疗效.方法:将58例食管癌病人随机分为早期肠内营养(EEN,n=30)组和全肠外营养(TPN,n=28)组,两组均行营养支持8 d.所有病人在手术前1d、术后第9天分别测定营养指标、免疫指标、肝功能、体重等,并观察肠功能恢复情况、术后并发症、住院费用和住院时间等...     

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.     

术后早期肠内营养在胃癌病人治疗中的临床观察

目的:运用快速康复理论,通过比较早期肠内营养(EEN)和常规肠内营养(EN)组间围手术期病人营养状况、炎症指标、免疫水平及临床指标,观察EEN对胃癌病人术后恢复的影响。方法:前瞻性分析65例胃癌术后病人,按照不同时间EN支持分为EEN组(n=33)和EN组(n=32)。比较两组病人术前1天、术后第3天和术后第7天的血清总蛋白、血清白蛋白、前白蛋白、白细胞总数、C反应蛋白以及T淋巴细胞亚群、免疫球蛋白(Ig G),同时观察病人早期胃肠道恢复时间、住院天数及平均住院费用等指标。结果:EEN组病人术后第7天营养指标和细胞免疫指标大多高于EN组,EEN组病人术后第3天炎症指标低于EN组,两组间有显著差异(P0.05)。EEN组在术后短期内免疫水平和临床恢复及住院时间方面都优于EN组(P0.05)。结论:胃癌术后早期肠内营养支持,对早期提高术后病人营养状况、免疫功能及减轻炎症反应具有显著作用,促进了胃肠功能的恢复,缩短了住院时间。     

肠外瘘合并胆或胰外瘘时的营养支持研究

目的 :研究肠外瘘合并胆或胰外瘘时的营养支持方法及其作用。　方法 :2 3例肠外瘘合并胆或胰外瘘病人行TPN→PN +EN→TEN→EN +口服饮食序贯营养支持。收集各阶段的营养物质供给量、天数、所占比例及各营养支持阶段末期的肝酶谱 ;统计肠内营养给予途径、全组病例的预后及并发症发生情况 ;比较TPN支持前、TEN支持后 1 5天病人的体重、上臂中点周径、血清总蛋白、白蛋白和前白蛋白浓度。　结果 :2 3例病人住院总天数为 1 498天 ,使用TPN 90 1天 (60 1 % ) ,供给非蛋白质热量 (1 35 .9± 2 3 .4)kJ/(kg·d) ,氮 (0 .2 1± 0 .0 6) g/(kg·d) ;使用PN +EN 445天 (2 9.7% ) ,供给非蛋白质热量 (1 2 3 .4± 1 4 .2 )kJ/(kg·d) ,氮 (0 .1 8± 0 .0 3) g/(kg·d) ;使用TEN 1 52天 (1 0 .2 % ) ,供给非蛋白质热量 (1 1 6 .3± 1 9.6)kJ/(kg·d) ,氮 (0 .1 7± 0 .0 4 ) g/(kg·d) ,肠内营养途径依次是鼻肠管1 3例 ,空肠造口管 5例 ,堵瘘 3例 ,鼻胃管 2例。全组死亡 4例 ,治愈 1 9例 ;中心静脉导管感染 2例 ,肝酶谱改变 6例 ,腹胀、腹泻 3例 ;TEN支持后阶段营养指标明显改善。　结论 :TPN→PN +EN→TEN→EN +口服饮食的序贯营养支持模式是肠外瘘合并胆或胰外瘘病人的合理、有效营养支持方法 ,其中PN是主要手段     

术后早期肠内营养对胃肠肿瘤患者体液免疫的影响

目的探讨术后早期肠内营养对胃肠肿瘤患者体液免疫的影响。方法将2003年6～12月本科收治的30例胃肠道肿瘤患者均分为肠内营养(EN)和肠外营养(PN)两组。EN组术后24小时内经鼻空肠管输注肠内营养液,PN组经外周静脉输注营养液,两组热卡、氮量相同。于术前(营养支持前)、术后第7天(营养支持后)检测体液免疫指标IgA、IgG、IgM、C3、C4和CH50。结果EN组体液免疫指标较营养支持前差异无显著性(P>0.05)。PN组IgA、IgG、IgM差异无显著性;但C3、C4、CH50营养支持前分别为(1.091±0.227)、(0.221±0.051)和(40.950±11.400)g/L,营养支持后分别为(0.782±0.233)、(0.162±0.058)和(32.440±9.355)g/L,支持后较支持前明显降低,差异具有显著性(P=0.002,0.009,0.049)。结论胃肠肿瘤术后早期肠内营养对改善机体体液免疫有一定作用。     

老年重症肺炎病人营养支持治疗的疗效观察

目的:探讨两种不同的营养支持治疗对老年重症肺炎病人临床治疗疗效的影响。方法:将我院收治的老年重症肺炎病人84例随机分为两组,每组各42例。一组肠内营养(EN)组病人给予EN以鼻饲营养液治疗;另一组采用EN+肠外营养(PN)治疗为EN+PN组。治疗第4周,比较两组病人的营养指标改善情况、肺炎治愈率以及治疗期间并发症的发生率。结果:EN+PN组病人治疗后血红蛋白和清蛋白明显高于EN组,两组比较差异有显著性统计学意义(P0.05)。两组病人治愈率分别为92.86%和95.24%,无显著性差异(P0.05)。EN组病人的不良反应发生率明显高于EN+PN组(16.67%vs 7.14%),差异有显著性统计学意义(P0.05)。结论:采用EN+PN治疗的方法更加容易改善老年重症肺炎病人的营养指标,且不良反应发生率较低。     

肠外瘘病人肠内营养支持临床应用研究

目的：观察肠内营养在肠外瘘病人应用的时机、条件、途径及肠内营养制品的选择,研究肠内营养在肠外瘘病人中的作用。方法：收集１７０例肠外瘘病人诊断、住院总天数及全肠外营养（ＴＰＮ）、全肠内营养（ＴＥＮ）、肠内＋肠外营养（ＰＮ＋ＥＮ）、经口饮食的天数,计算不同营养支持方法期间,非蛋白质热量、蛋白质的供给量和并发症的发生率。收集ＴＰＮ、ＴＥＮ支持前和支持后满１５天病人的血清白蛋白浓度。另对４０例肠外瘘病人进行为期１５天的前瞻性观察,了解肠内营养对白蛋白、前白蛋白、转铁蛋白、纤维连结蛋白、总蛋白、球蛋白和肝酶谱的影响。结果：１７０例病人的总住院天数为１３５５３天,其中１６４人曾使用ＴＰＮ６０４０天（４４．６％）;１２９人使用ＴＥＮ３６７６天（２７．１％）;８３人使用肠内＋肠外营养４８９天（３．６％）;１２８人经口饮食２３３     

Enteral nutritional support in acute alcoholic pancreatitis.

The experience to date with total enteral nutritional (TEN) support in acute alcoholic pancreatitis patients admitted to the University of Kentucky affiliated hospitals was reviewed.

Standard enteral formulas sufficient to meet patient's needs were administered into the small bowel via endoscopically placed nasoenteric feeding tubes in five patients. Feedings were administered for a mean of 28.4 days. Pancreatitis was mild to moderate in severity by Ranson's criteria in four patients, and severe in one.

Four patients developed complications of pancreatitis before initiation of TEN, representing the most common indication for nutritional support. Nutritional status was maintained by TEN with no significant complications from this nutritional support identified. Diarrhea that did not limit tube feeding developed in a single patient.

This experience further supports the safety of TEN in acute pancreatitis and suggests that adequate nutritional support can be delivered by this route.     

肠瘘病人在确定性手术前行家庭肠内营养支持的效果分析

目的:探讨肠瘘病人在确定性手术前实行家庭EN支持的效果. 方法:58例肠瘘病人在病情平稳,恢复TEN后分为家庭EN支持组(家庭组,n=31)和住院EN支持组(住院组,n=27),由营养支持小组成员对两组病人进行指导、监测和随访.前瞻性观察记录两组病人EN支持天数、住院天数、住院费用以及营养支持前后体质量、体质量指数、血浆ALB、Hb和白细胞、淋巴细胞水平的变化,比较EN并发症的差异. 结果:营养支持前后,两组病人营养指标均明显改善,组间差异无统计学意义(P>0.05),两组间并发症发生率的差异无统计学意义.两组营养支持时间,差异均无统计学意义(P<0.05).家庭组家庭EN支持时间为(61.11±27.71)d.家庭组和住院组住院天数为[(60.79±17.11)d vs(119.38±46.70)d]、总治疗费用为(14.21±6.12)万元/vs(18.92±7.22)万元,P<0.01. 结论:在严格的指导和监测下,肠瘘病人在确定性手术前实行家庭EN安全可行,可达到住院营养同样的营养效果,同时能缩短住院天数,降低医疗费用.     

Total artificial nutrition is associated with major changes in the fecal flora

Summary Background Animal studies have demonstrated dramatic changes in the intestinal flora during total enteral (TEN) or parenteral (TPN) nutrition. Aims of the study To assess the impact of TEN and TPN on human intestinal microflora. Methods Eight patients on fiber-free TEN, five patients on TPN, and ten controls were studied. Fecal bacteria were identified and numbered (logCFU/g feces), and fecal short-chain fatty acids (SCFAs) were measured in stool samples, by gas-liquid chromatography. Results In TEN patients, compared to controls (P<0.01), aerobes were increased (8.46±0.24) while anaerobes were decreased (5.79±0.84). In TPN patients, both aerobes and anaerobes were decreased compared to controls (5.64±0.27 and 5.31±1.09 respectively, P<0.01). Total SCFAs were lower in TPN patients than in TEN patients (48.3±16.6 vs 118.6±24.1 mmol/kg, P<0.05). Conclusions Both TPN and TEN induce modifications in the intestinal microflora. During TPN, a homogeneous decrease occurs in both aerobic and anaerobic bacteria. TEN decreases only anaerobic bacteria, while aerobic bacteria are increased. This imbalance may play a role in the pathophysiology of TEN-induced diarrhea. Received: 24 February 2000, Accepted: 5 September 2000     

Changes in liver function tests in patients with inflammatory bowel disease on enteral nutrition

Morphologic and functional hepatic changes occur in inflammatory bowel disease (IBD). Patients with this disease often require the administration of artificial nutritional support. Liver function tests (LFT) derangement is a widely recognized side-effect of total parenteral nutrition (TPN). Therefore, the use of this modality of nutritional support may be an additional factor to cause hepatic damage in IBD patients. However whether or not the same occurs in patients receiving total enteral nutrition (TEN) is not well-established. The aim of the present study was to evaluate the effect of TEN upon LFT in patients with moderate to severe acute attacks of IBD, by means of a prospective, controlled, and nonrandomized design. Forty-nine patients were included; 29 (11 patients with ulcerative colitis and 18 with Crohn's disease) received TEN, and 20 (11 with ulcerative colitis and 9 with Crohn's disease) did not. Both groups were homogeneous regarding age, sex, disease activity index, nutritional status, and length of the study (24.8 +/- 1.3 vs 23.9 +/- 16.8 days). In all cases, weekly measurements of serum alkaline phosphatase, GOT, and GPT were performed. There were no significant differences in LFT at the beginning of the study between groups. The percentage of patients showing derangement of some LFT during the study did not differ between both groups: six of 29 (20.6%) in TEN group vs three of 20 (15%) in control group. Six out of the nine patients (in both groups) who developed LFT derangement had one or more causes, other than TEN for explaining hepatic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)     

严重烧伤患者外周血高迁移率族蛋白B-1水平的检测及其临床意义

目的 检测严重烧伤后患者血浆高迁移率族蛋白B-1 (HMGB1)水平的变化并探讨其临床意义.方法 用酶联免疫吸附试验法检测77例严重烧伤患者血浆HMGB1水平,同步检测肿瘤坏死因子-α(TNF-α)含量,并与30名健康对照组进行比较.结果 77例严重烧伤患者按烧伤面积分为3组,A组31例,烧伤总面积30％～49％,B组25例,烧伤总面积50％～69％,C组21例,烧伤总面积70％～95％；烧伤患者血浆HMGB1及TNF-α水平在A组为(22.15±6.34) ng/ml、(89.26±21.41)pg/ml,B组为(26.24±9.71)ng/ml、( 132.45±76.32)pg/ml,C组为(36.45±11.63)ng/ml、(213.61±87.45) pg/ml,对照组为(2.17±1.13)ng/ml、(45.32±13.84)pg/m1,烧伤各组HMGB1及TNF-α水平明显高于对照组(P＜0.01);24例特大面积烧伤患者根据预后情况分为生存组和死亡组进行动态观察,两组患者血浆HMGB1水平在伤后第1天即显著升高(P＜0.01),在伤后3～21 d,死亡组明显高于生存组(P＜0.05),而TNF-α含量在伤后第3～7 d达高峰,以后逐渐下降,到21d时生存组与死亡组相比已差异无统计学意义.结论 严重烧伤后HMGB1的表达异常升高,HMGB1作为重要的晚期炎症介质和TNF-α相互诱生相互作用,参与严重烧伤后全身炎症反应综合征的病理生理过程,动态观察其水平变化有助于烧伤患者病程监测及预后判断.     

Immediate enteral nutrition following multisystem trauma: a decade perspective.

Metabolic support is an integral component of surgical critical care. Although prompt restoration of oxygen availability is clearly essential, the timing, composition, and route of nutritional support may also be decisive factors. The ensuing discussion will focus on: (a) timing of substrate delivery and (b) route of administration based on our clinical investigation over the past decade. The acutely injured patient was selected as a model of ICU hypermetabolism because of relative homogeneity with respect to age, comorbid factors, and stress level. Our first study hypothesis was that early nutritional support would improve outcome in the severely injured, but previously well-nourished patient. During an 18-month period, all patients undergoing laparotomy with a abdominal trauma index (ATI) greater than 15 were randomized to a control or total enteral nutrition (TEN) group. The control patients were given total parenteral nutrition (TPN) after POD 5, whereas the TEN cohort had a needle catheter jejunostomy (NCJ) inserted at laparotomy and received an elemental diet within 12 hours. The control (n = 31) and TEN (n = 32) groups were otherwise comparable with respect to risk stratification. The TEN patients, of course, shared improved nitrogen balance (p less than 0.001), but also had significantly (p less than 0.025) less septic morbidity. Nine (29%) of the controls developed major infections, contrasted to three (9%) of the TEN patients. Acknowledging the benefit of early nutrition, the next issue we addressed was the optimal route of substrate delivery; i.e., TEN vs TPN. The hypothesis was that TEN, compared to TPN, would reduce the injury stress response as reflected by the prioritization of hepatic protein synthesis. TEN given via NCJ and a nutritionally matched TPN solution were administered during the same postoperative period. Indeed, the TEN patients (n = 23) had significantly (p less than 0.05) higher constitutive proteins and lower acute-phase proteins, whereas the TPN patients manifested the opposite protein profile as measured by crossed immunoelectrophoresis. In view of these findings, we continued the study to ascertain clinical impact. Ultimately, 75 patients were randomized, providing groups with equivalent risk factors. Eleven (37%) of the TPN patients developed septic complications compared to five (17%) of the TEN group, and the incidence of major infection was six (20%) following TPN vs one (3%) with TEN. Thus, immediate TEN provided an additional clinical benefit compared to early TPN in these high-risk surgical patients.     

消化道肿瘤-T-术后早期肠内营养疗效研究

目的评价消化道肿瘤手术后早期肠内营养的安全性,比较手术后短期应用要素制剂爱伦多的肠内营养与标准肠外营养支持的疗效。 方法62例消化道恶性肿瘤手术患者,随机分为对照组、肠外营养组和肠内营养组。手术后第一天开始等热卡、等氮量的肠外或肠内营养支持一周。检测体重、机体测量指标、血浆各内脏蛋白浓度及氮平衡等营养指标,外周血T细胞亚群、NK细胞和NK细胞活性等免疫指标及血清氨基酸谱。 结果三组病人术后体重下降分别为4．26±1．03ks、2．04±0．65ke和2．12±o．72kg,对照组与肠外营养组、肠内营养组之间差异有显著性(P<0．05),后两组之间无差异。术后各内脏蛋白浓度均低于术前,对照组降低最明显,与肠外或肠内营养组之间差异有显著性(P<0．05),而后两组之间无差异。三组病人平均氮平衡为—8．6±3．12g／d,—4．22±2．02g／d及—3．88±2．35g／d,对照组与肠外或肠内营养组之间差异有显著性(P<0．05),而后两组之间无差异。手术后各组病人外周血T细胞亚群、NK细胞和NK细胞活性均不同程度下降,但三组之间差异无显著性意义。三组病人血清谷氨酰胺水平明显下降,术后1周对照组和肠外营养组血清谷氨酰胺水平仍处于低水平,而肠内营养组却有一定程度恢复。 结论消化道肿瘤手术后早期肠内营养支持是安全、有效的方法,短期肠内营养和肠外营养支持的临床效果基本相同。