营养风险筛查2002的临床应用和分析

Objective To evaluate the clinical application of Nutritional Risk Screening 2002 (NRS 2002) in inpatients.Methods Totally 400 inpatients who were admitted to Tianjin Tianhe Hospital from Novem- ber 2008 to March 2009 were enrolled in this study.Physical examinations,including body height and body meas-urement,were performed the next morning after admission.The nutritional status was evaluated with NRS 2002.Results In all 400 inpatients.NRS 2002 was strongly practicable in 306 patients (76.5%) and weakly practica-ble in 94 patients (23.5%);Ninety-six patients (24.0%) had nutritional risks,which were most common in the department of internal medicine and the Department of neurology.The average age of patients with nutritional risks was (79.0±11.4) years,which was significantly higher than that of patients without nutritional risks [(58.1±15.8) years] (P<0.01).Conclusion NRS 2002 is effective and practicable in evaluating the nutritional status of inpatient.     

112例炎症性肠病患者的营养风险筛查

Objective To assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.     

急性白血病患儿治疗期人体组成成分的变化

Objective To investigate the changes of body composition in the children with acute leukemia during different treatment stages.Methods From January 2009 to April 2010,56 children with acute leukemia hospitalized in Shanghai Children's Medical Center for chemotherapy were enrolled.Meanwhile,56 healthy children with matched age and sex were enrolled as the control group.The body compositions of children in the control group and the children with acute leukemia at the end of the first course of each treatment stages ware detected by segmental multiple-frequency bioelectrical impedance analysis.The distribution of body compositions was recorded asthe percentage of each body composition to the body weighL Results Among 56 children with acute leukemia,41were with acute lymphoblastic leukemia and 15 with acute nonlymphoblasdc leukemia.Twenty-three cases were in remission-induction chemotherapy stage,15 in consolidation chemotherapy stage,and 18 in maintenance chemotherapy stage.Compared with children in the control group,children with acute leukemia showed a reduction in the percentage of intracellular fluid (P = 0.000), extracellular fluid (P - 0.005), protein (P = 0.000), mineral (P = 0.001), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000), while an increase in body fat mass [(26.2 ± 8.3)% vs.(20.3±3.8)%, P=0.000].The body weight (P = 0.001), the percentage of intracellular fluid (P = 0.005), protein (P = 0.004), body cell mass (P = 0.001), and active cell mass ( P = 0.020 ) in the children during remission-induction chemotherapy stage were significantly lower than those of the healthy children.However, the parameters of the consolidation chemotherapy stage were significantly lower than those of the control group, including the percentage of intracellular fluid (P = 0.000), extracellular fluid (P =0.000), protein (P = 0.000), mineral (P =0.001), body fat mass (P =0.000), non-fat mass (P = 0.000), skeletal muscle mass (P = 0.000), body cell mass (P = 0.000), and active cell mass (P = 0.000).Most body compositions in the maintenance chemotherapy stage were lower than those of the healthy children ( P < 0.05) except for body mass index (P = 0.127) and the percentage of extracellular fluid (P = 0.097).Conclusions Body compositions remarkably change in children with acute leukemia after chemotherapy.Therefore, the nutritional status of children with acute leukemia should be closely monitored, and proper nutritional support should be provided when necessary to improve the prognosis.     

学龄期儿童膳食钙与骨密度的关系

Objective To investigate the prevalence of overweight and obesity and the nutritional status of dietary calcium intake in school-age children in Shanghai and to analyze the relationship between dietary calcium and bone mineral density (BMD).Methods A cross-sectional study was conducted in the second and third grade students of 10 primary schools in Yangpu District and Baoshan District in Shanghai. Food frequency questionnaire was used tu estimate the relative intake of dietary calcium of students in 6 primary schools in Baoshnn District. Quantitative ultrasound bone density examination was used to estimate the calcaneal BMD.The relation-ship between calcium intake and BMD was analyzed.Results The average calcium intake was 647 mg/d among ested students.BMD was not significantly different among different age groups (F=1.595,P=0.173),while Z-score was significantly different among different age groups (F=16.02,P=0.000).The total calcium intake was not correlated with BMD or Z-score.The percentage of dairy calcium intake was positively correlated with BMD (r=0.097,P=0.015)and Z-score (r=O.117,P=0.003),the percentage of non-dairy calcium intake and the non-dairy calcium intake were negatively correlated with BMD (r=-0.097,P=0.015) and Z-score(r=-0.110,P=0.006).When the total dietary calcium intake was ≥600 mg/d,BMD and Z-score significantly higherin students with high dairy calcium intake than those with low dairy calcium intake (P<0.05).When the total dietary calcium intake was <600mg/d,BMD and Z-score were higher in students with high dairy calcium in-take than in those with low dairy calcium intake,although no statistical significance was noted (P>0.05).Conclusions BMD and Z-score increase along with the increase of dairy calcium intake.Such effect becomes even more obvious when the total dietary calcium intake is ≥600 mg/d.     

全胃切除术后3种不同空肠构建贮存袋与保持十二指肠连续性消化道重建患者生活质量的比较

Objective To compare the short-term quality of life after total gastrectomy in patients with gastric cancer with three recontructive methods of stamoch storage function. Methods Totally 62 cases underwent jejunal interposition afar total gastrectomy from March 2000 to December 2007. Patients were divided into three groups according to the procedures: functional jejunal interposition (FJI-type) group ( n = 23 ), modified jejunal interposition ( Ⅲ -type) group ( n = 20), and P-type jejunal interposition (P-type) group (n = 19). In each group,the patients' general conditions, the nutritional status at month 3 and 12, and gastrointestinal symptoms were evaluated. Results The durations of procedures were significantly different among three groups (P ＜0. 01 ). The intraoperative bleeding volume, postoperative complications, and food intake of each meal at month 3 were not significantly different ( P ＞ 0. 05 ). Compared with the data at month 3, the levels of hemoglobin and serum calcium at month 12 were significantly higher in all three groups (P ＜ 0. 01 ). Compared to the level at month 3, the level of serum albumin at month 12 significantly increased in FJI-type group (P ＜ 0. 05 ) but showed not significant difference in Ⅲ-type group and P-type group ( P ＞ 0. 05 ). The incidence of reflux esophagitis in three groups and the comparative parameters among the three groups at month 12 were not significantly different ( P ＞ 0. 05 ). Conclusions The jejunal interpositions after total gastrectomy will not increase the complexity and risk of the surgical procedure. In fact, they can reduce the reflux esophagitis and improve quality of life by keeping the storage function and restoring food passage through the duodenum. FJI-type is simpler than the other two types, and P-type is preferred for operations that need to open the pectoral cavity.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

饮食、C反应蛋白与2型糖尿病颈动脉内膜厚度的关系

Objective To compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.     

亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.     

两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [slower plasma exchange (PE) combined with continuous veno-venous hemofiltration (CWH), and coupled plasma exchange filtration adsorption (CPEFA)] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CWH based on the conservation medical therapy (group A). 43 patients were treated with CPEFA based on the conservation medical therapy (group B). 43 patients received PE with conservative medical therapy (group C). The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates (within 6 months after the treatment) were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups (χ2=0.10,P>0.05), the survival rates(6 months) were 45.45% and 46.51% respectively and there was no statistical difference (χ2 = 0.08, P > 0.05). In group C, patients' hyponatremia did not change, the effective rate (51.16%)was obviously lower than those in group A and B (χ2 = 7.55,9.31, P < 0.01) and the total survival rate(6 months) was 30.23% also lower than those in group A, B (χ2 = 4.80,6.10, P < 0.05). Conclusions Being combined slower PE and CWH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.     

不同血浆靶浓度的普鲁泊福对鼻内镜手术应激反应的影响

Objective To observe the effect of propofol target controlled infusion with different blood plasma target concentration on stress reaction during the nasal endoscope operation. Methods Sixty patients with ASA Ⅰ - Ⅱ scheduled for the nasal endoscope operation were divided into three groups by random digits table: each group was 20 patients, group A, B, C was given propofol target controlled infusion with blood plasma target concentration 3,4,5 μ g/mi respectively. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), blood glucose, serum cortisol, bispectral index ( BIS ), extubation time were recorded before anesthesia,at 30 min after the operation starting and 60 min after the extubation.Results The descent degree of HR and MAP at 30 min after the operation starting were group C ＞ group B ＞ group A (P = 0.024,0.010 );the descent degree of MAP at 60 min after the extubation were group C ＞group B ＞ group A (P = 0.011 ). BIS and extubation time were 65 ± 8 and (25 ± 7) min in group A, 53 ± 11 and( 36 ± 13 ) min in group B, 45 ± 12 and(45 ± 9 ) min in group C, there were significant differences among three groups(t = 2.476,P= 0.023;t = 2.657,P= 0.012). The blood glucose was increased at 30 min after the operation starting and 60 min after the extubation, the ascensus degree were group A ＞ group B ＞ group C (P= 0.000、0.000);the serum cortisol was decreased at 30 min after the operation starting, the descent degree was group C ＞ group B ＞ group A (P= 0.000), increased at 60 min after the extubation, the ascensus degree was group A ＞ group B ＞ group C (P= 0.001 ). Conclusions Propofol target controlled infusion with blood plasma target concentration 4-5 μ g/ml can ensure eligible depth of anesthesia, decrease pain stimulus, remain stable vital sign,depress the stress reaction caused by nasal endoscope operation efficiently,with short extubation time. It is an eligible blood plasma target concentration.