危重病患者营养支持的研究进展

营养支持治疗危重病患者有着悠久的历史,早在300年前人们使用直肠内营养对危重病患者实施救治,到20世纪60年代末,肠内、外营养相继应用于临床,使许多危重病患者得到康复。人们逐渐认识到有效地调节危重病患者的代谢,对其进行合理、有效的营养支持,已经成为危重症病患者救治成功的关键。营养支持治疗亦存在不同时期对肠外营养支持及肠内营养支持治疗的认识。现就近年来危重病患者营养支持治疗方面的相关进展进行简要概述。     

Hearts and Minds Project: A breastfeeding curriculum intervention to improve the education outcomes for nutrition and dietetics graduates

Aim: Dietitian nutritionists play an important role in supporting and promoting breastfeeding. Improving undergraduate training to create a competent and motivated workforce to deliver these outcomes has been recommended. This study evaluated a breastfeeding curriculum intervention designed to improve knowledge, attitudes and beliefs, and increase graduates' motivation to support breastfeeding into the future. Methods: Final‐year students studying nutrition and dietetics were surveyed at baseline in 2005 and post‐intervention in 2010. Questions related to student profile, breastfeeding knowledge, attitudes and beliefs, perceived professional role in breastfeeding support, intentions to support breastfeeding in the future and perceptions of the breastfeeding curriculum. Curriculum interventions were based on relevant evidence including recommendations from the baseline survey report, a gap analysis of existing curriculum, previous literature identifying key barriers to the support of breastfeeding by health professionals and learning and behaviour change theories and approaches. Results: General improvements in knowledge and attitudes and beliefs were found over the intervention period, although knowledge gaps remained on the risks associated with not breastfeeding for mothers and infants and when to recommend the cessation of breastfeeding. A significant increase was found in the percentage of respondents agreeing that their studies had engendered a strong interest in work involving breastfeeding. Significant improvements were also seen in student perceptions of the degree to which breastfeeding was addressed in the dietetic course. Conclusion: Curriculum interventions can effectively influence new graduates' future intention to support and promote breastfeeding if they address knowledge gaps, attitudes, beliefs and perceived social concerns about breastfeeding promotion.     

危重病人幽门后置管早期空肠喂养误吸原因及预防

目的 探讨危重症患者幽门后置管实施早期空肠内营养返流、误吸的原因及预防措施.方法 选择2009年9月～2011年12月200例危重患者,于入院后24～48 h内床边徒手幽门后置管,置管后常规X线腹部平片证实营养管头端在空肠,血流动力稳定后实施早期空肠内营养,观察患者的返流、误吸、腹泻、腹胀、便秘等肠道耐受情况.结果 200例患者发生返流、误吸6例,误吸率为3％,腹泻47例占23.5％,便秘68例,占34％.结论 重症患者幽门后置管实施肠内营养并不能完全避免返流、误吸,空肠内营养仍可能发生误吸的风险.返流、误吸的原因与患者的基础疾病、胃动力、喂养方式、喂养配方有关,优化喂养环节可有效减低危重病人误吸的风险.     

Corn content of French fry oil from national chain vs. small business restaurants

Several issues, ranging from sustainability to health, may interest the consumers in the corn content of their food. However, because restaurants are excluded from the Nutrition Labeling and Education Act of 1990, national chain restaurants provide nonspecific ingredient information and small businesses supply none. We measured the carbon isotope composition of fry oil in French fries purchased from 68 (67%) of the 101 national chain fast food restaurants on Oahu (i.e., McDonald’s, Burger King, Wendy’s, Arby’s, and Jack in the Box), and paired this with a similar number of small businesses (n = 66) to calculate minimum percent contribution of corn to total fry oil. We found that the majority (69%) of the national chain restaurants served fries containing corn oil, whereas this was true for only a minority (20%) of the small businesses. Corn oil is more expensive than soybean oil (for example) when purchased from a small business supplier, suggesting that large-scale corporate agreements are necessary to make corn oil frying cost-effective. When considering French fry oil along with corn-fed beef and chicken, as well as high-fructose corn syrup–sweetened soda, we see the pervasive influence of corn as an ingredient in national chain fast food.     

Beverage intake improvement by high school students in Saskatchewan,Canada

Certain beverages contribute energy, protein, vitamins, and minerals. North American adolescents have shifted their beverage intake from predominantly milk to predominantly sugary beverages. Intake of these sugary beverages, in sufficient quantity, may increase the risk of bone fractures, may contribute to obesity, and may lead to tooth decay. This study evaluated the effectiveness of a school-nutrition education program (Fluids Used Effectively for Living) on nutrition knowledge, attitude, and self-reported behavior of grade 9 students in Saskatchewan, Canada. Two classes of grade 9 students, 1 (n = 33) in a high school in Saskatoon (n = 33) and 1 (n = 24) in a large high school in Prince Albert, Saskatchewan, received the peer educator intervention. Two other classes in the 2 cities (n = 24 and n = 24, respectively) were controls. Six sessions of Fluids Used Effectively for Living nutrition education were delivered by using 2 peer educator models (multiple and single), and the intervention was delivered in a 45-minute weekly class session over a 6-week period. After the intervention, students in these 2 peer educator classes decreased their sugary beverage intake significantly, which was sustained for 3 months. Students in the control self-taught class increased their juice intake at the end of the year. The significant decrease of juice and sugary beverage intakes in the single model peer educator class disappeared after Bonferroni correction. Carbonated sugary beverage intake of students in the control self-taught classes declined, but it was not sustainable at the 3-month follow-up. A peer educator school-based nutrition education approach can lead to a decrease in sugary beverage intake in high school children.     

Dietary intervention with emphasis on folate intake reduces serum lipids but not plasma homocysteine levels in hyperlipidemic patients

Hyperlipidemia and hyperhomocysteinemia are regarded as major risk factors for cardiovascular disease. Medical nutrition therapy (MNT), which involves a combination of nutritional diagnosis, therapy, and counseling for at-risk patients, has been proposed as a protocol to control these risk factors. The purpose of this study was to investigate the effect of an intensive MNT, specifically tailored to Korean hyperlipidemic patients, on levels of serum lipids and plasma homocysteine. Forty hyperlipidemic patients with blood levels of total cholesterol ≥200 mg/dL or triacylglycerol ≥150 mg/dL were recruited from the Kyung Hee University Medical Center (Seoul, Korea). They were randomly divided into control (no treatment) or experimental (MNT treatment) groups. A registered dietitian performed MNT, emphasizing dietary folate intake based on the guidelines for Korean hyperlipidemic patients; this was performed 5 times during the 12 weeks of the experiment. After the MNT period, we observed that body mass index (P < .001) and fat percentage (P < .05) was significantly decreased in the experimental group but not in the control group. Daily energy consumption, as well as carbohydrate, fat, and cholesterol intakes, all decreased significantly (P < .05) in the MNT group, whereas folate intake increased (P < .05). Blood levels of triacylglycerol (−30.8%), total cholesterol (−20.9%), low-density lipoprotein cholesterol (−14.5%), and ratio of low-density lipoprotein/high-density lipoprotein (−17.1%) were significantly lower in the experimental group after MNT (P < .001) compared with the control group. Plasma homocysteine levels were unchanged (P = .98); however, the levels of folate (P < .01), vitamin B₆ (P < .01), and vitamin B₁₂ (P < .05) increased significantly in the experimental group. These results indicate that MNT, with an emphasis on folate intake, can be effective at reducing blood levels of lipids and improving the blood levels of folate, vitamin B₆, and vitamin B₁₂ in Korean hyperlipidemic patients.     

中药汤剂在胃癌患者术后早期肠内营养中的应用

目的：探讨在胃癌患者术后早期肠内营养的过程中应用中药汤剂是否有利于改善患者术后的营养状态。方法：将67例行胃癌根治术后的患者随机分为单纯早期肠内营养组（EN组）和早期肠内营养＋中药汤剂组（EN＋中药组），观察在患者术后早期恢复过程中胃肠道功能恢复时间、腹腔引流量、吻合口瘘、伤口感染、肺部感染、腹胀、呕吐、腹泻等临床指标、营养指标和肝功指标的变化，并进行对比分析。结果：单纯EN组患者胃肠道功能恢复时间要长于EN＋中药组，前组患者的腹腔引流量以及腹胀、呕吐发生的例数均要多于后组患者，差异具有统计学意义（P〈0．05）；而吻合口瘘、伤口感染、肺部感染等并发症的发生率两组间无显著性差异；对比营养、肝功指标的变化发现EN组的患者术后早期纠正负氮平衡的能力明显弱于EN＋中药组（P〈0．05），并且前组患者血浆PALB以及ALB的浓度均显著低于后组患者（P〈0．05），体重下降值、HGB浓度、ALT、AST等其他指标的变化方面，两组患者间无统计学差异。结论：在胃癌患者术后早期肠内营养支持治疗过程中应用一定量的中药汤剂能够有效地减少术后部分并发症的发生并提高肠内营养支持的效率。     

用肠内营养预防胃癌患者胃次全切除术后胃瘫综合征

目的:探讨运用肠内营养预防胃癌患者胃次全切除术后胃瘫综合征的作用。方法:200例胃次全切除术后的胃癌患者随机分为实验组105例,术后早期开始实施肠内营养;对照组95例,术后采用传统静脉输液支持。结果:术后实验组有1例(0.9%)出现术后胃瘫综合征。对照组有7例(7.3%)出现术后胃瘫综合征。两组间有明显差异。(P<0.05)。结论:肠内营养预防胃癌患者胃次全切除术后胃瘫综合征效果良好,有助于康复。