全肠外营养液不同存放方式对稳定性的影响

目的 探讨全肠外营养(TPN)液不同存放方式对稳定性的影响.方法 将两种配方药物配制成TPN液,分别在不同温度条件下观察其外观性状、pH值、渗透浓度、脂肪颗粒直径、细菌生长情况.结果 两种配方TPN液在不同温度条件下不同时间点均为白色、乳浊液,类似于脂肪乳,观察期内未见分层、沉淀以及絮状凝集.两种配方TPN不同温度条件下在不同时间点的pH值及渗透压与配液即刻比较均差异无统计学意义(P>0.05).两种配方TPN的脂肪颗粒直径在4℃条件下放置1 d、2 d与即刻比较差异无统计学意义(P>0.05);放置3 d后平均直径与即刻、1 d、2 d时比较差异有统计学意义(P<0.05);20～25℃、37℃条件下放置1 d时脂肪颗粒平均直径与配液即刻时比较差异无统计学意义(P>0.05);在放置2 d、3 d时直径与配液即刻、1 d比较差异有统计学意义(P<0.05).两种配方TPN液细菌培养结果均为阴性.结论 存放条件对TPN液稳定性具有重要影响,只有保证TPN液在各个环节都遵循质量控制的原则才可配置出符合要求的TPN液.     

Fractured pediatric central venous catheters — Repair or replace?

Introduction

Central venous catheter (CVC) fracture is a common complication. The aim of this study is to examine risk factors resulting in CVC fracture and compare outcomes of children undergoing CVC repair versus replacement.

营养支持对危重病人免疫功能的影响

目的：探讨肠外加肠内营养支持与全肠外营养支持对危重病人免疫功能的影响。方法：将40例危重病人按就诊顺序分为2组，每组20例．试验组接受肠外＋肠内营养（PN＋EN）,对照组接受全肠外营养（TPN），2组等氮等热量供给。于治疗前后检测血浆总蛋白、白蛋白、血红蛋白和转铁蛋白浓度，外周血IgA、IgG、IgM、淋巴细胞总数（TLC）及T细胞亚群CD2、CD4百分率和CD4／CD8比值。结果：试验组TLC和IgG营养支持前后及与对照组相比其差异均有统计学意义（P〈0．05）；CD4和CD4／CD8比值也有升高，其差异有统计学意义（P〈0．05）；其余指标差异无统计学意义（P〉0．05）。结论：PN＋EN较TPN更能改善危重病人机体的免疫功能。促进患者康复，为危重病患者提供较好的营养支持方案。     

谷氨酰胺在胃肠道术后患者全胃肠外营养中的疗效评价

目的：探讨在胃肠术后予加入谷氨酰胺的TPN的疗效。方法：32例胃肠道手术患者随即均分为对照组和Gin组,对两组病人胃肠功能恢复情况、术前术后蛋白质合成、氮平衡及等情况进行比较。结果：Gin组患者的并发症发生率及住院时间均较对照组低,并有显著性差异（P〈0．05）;同时,肠功能恢复时间Gin组（58．7±8．7）h短于对照组（60．3±6．7）h,但两组间差异无统计学意义;两组术后12d血清白蛋白、前白蛋白均有回升,但对照TPN组均明显低于Gln组,差异有统计学意义（P〈0．05）;术后第8dGin组氮平衡的改善明显优对照组（P〈0．05）。结论：加用谷氨酰胺的TPN的疗效是有利于改善胃肠道术后患者营养状况和促进胃肠功能的恢复。     

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Purpose

To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery.

Primary versus secondary anastomosis in intestinal atresia

Purpose

Neonates with intestinal atresia (IA) undergo either primary anastomosis (PA) or ostomy creation with secondary anastomosis (SA). Our purpose was to compare outcomes for PA and SA and to assess factors influencing procedure selection.

Altered equilibrium between cortisol and cortisone in plasma in thyroid dysfunction and inflammatory diseases

The radioactivities of cortisol and cortisone in plasma were determined following simultaneous injection of ¹⁴C-cortisol and ³H-cortisone. The plasma concentrations of ¹⁴C-cortisol and ³H-cortisone decreased as a first-order function of time after an initial rapid drop, while there was a prompt appearance of ¹⁴C-cortisone and ³H-cortisol in plasma, which also decreased as a first-order function. The biologic half-lives of these four isotopic steroids were essentially identical. The ratio of ¹⁴C-cortisone to ¹⁴C-cortisol and that of ³H-cortisone to ³H-cortisol in plasma were constant after 60 min following injection and were identical, which suggested that cortisol and cortisone in plasma were at dynamic equilibrium. This ratio was 0.36 ± 0.01 (SE) in normals; it was decreased in patients with hypothyroidism (0.21 ± 0.03) and inflammatory diseases (0.18 ± 0.01) and was variable in hyperthyroid patients (0.42 ± 0.11). The ratio of the metabolic clearance rate of cortisone to that of cortisol was significantly increased in hypothyroid patients and in patients with inflammatory diseases, while urinary 11-ketonic metabolites of cortisol are known to decrease relative to its 11-hydroxy metabolites in these patients. These data and the decreased cortisone-to-cortisol ratio at equilibrium were consistent with the altered equilibrium between cortisol and cortisone, favoring cortisol, in these patients. It was suggested that the altered equilibrium between these steroids may be an important factor in determining the effectiveness of secreted or exogenously administered cortisol and the plasma concentration of cortisone in several disorders.     

术后早期肠内营养对老年食管癌患者免疫功能和预后的影响

目的：研究术后早期肠内营养对老年食管癌患者免疫功能和预后的影响。方法：选取2011年1月至2013年12月期间收治的100例食管癌患者作为研究对象,将100例患者随机分为两组,其中观察组50例,采取早期肠内营养（EEN）;对照组50例,采取胃肠外营养（TPN）,比较两组患者的临床指标、胃肠功能和术后并发症、营养状态和免疫功能。结果：两组患者术中出血量、手术时间、术后48h的液体引流量无统计学差异（ P＞0．05）,患者术后的住院时间和住院花费具有统计学差异（ P＜0．05）。两组患者的术后首次排气时间和排便时间具有统计学差异（ P＜0．05）,患者的胃肠道反应和并发症发生率无统计学差异（P＞0．05）。观察组患者的体重损失（－0．24±0．87）kg,对照组患者体重损失（0．79±1．23）kg,无统计学差异（P＞0．05）。两组患者术后1周的ALB和PA水平具有统计学差异（P＜0．05）。术后1周,两组患者的血清免疫球蛋白和CD3＋、CD4＋和CD4＋／CD8＋具有统计学差异（ P＜0．05）。结论：早期的肠内营养可以促进患者营养状态和免疫功能的恢复,缩短住院时间。