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31.
微生态肠内营养在结直肠癌患者围手术期的应用 总被引:2,自引:2,他引:0
目的:探讨微生态肠内营养在结直肠癌患者围手术期应用中的疗效。方法:将90例结直肠癌患者随机分为3组:常规治疗组(RT)、肠内营养组(EN)及添加微生态制剂肠内营养组(EMN)。观察患者术中肠道清洁度以及术后排气时间、吻合口漏、感染情况以及菌群失调情况,并监测手术前后内毒素、CRP、TNF水平变化及淋巴细胞计数改变。结果:术后排气时间EN组及MEN组均早于RT组(P<0.05),而EMN组早于EN组(P<0.05);第1次排便后细菌油镜计数结果示EN组及MEN组均明显低于RT组(P<0.05),而EMN组低于EN组(P<0.05)。术后外周血内毒素及CRP水平EN组及MEN组均低于RT组(P<0.05),而EMN组低于EN组(P<0.05);外周血淋巴细胞计数EMN组较术前有所增加(P<0.05),其他两组无明显变化;TNF水平各组均高于术前水平(P<0.05)。肠腔清洁度、吻合口漏、切口感染率及腹腔感染率差异均无统计学意义(P>0.05)。结论:添加微生态制剂肠内营养能有效防治患者肠道菌群失调,增强机体免疫力,促进肠道功能恢复。 相似文献
32.
This study aimed to identify risk factors for type 2 diabetes (T2D) in Korea, a rapidly changing country. Data of 5,132 adults aged 20-85 were used from the 2001 Korean Health and Nutrition Examination Survey. Multiple logistic regression was carried out to identify risk factors for T2D. Three models were specified: (i) socioeconomic and demographic factors (model 1: age, gender, education, poverty income ratio, employment), (ii) behavioral risk factors and covariates (model 2: obesity, physical activity, smoking, alcohol drinking, dietary quality, family history of T2D, co-morbidity) and (iii) socioeconomic, demographic, and behavioral factors (model 3). The prevalence of T2D was 7.4%. Less education (OR 1.41, 95% CI 1.08-1.84), age (OR 2.19, 95% CI 1.56-3.08 in 40-59 yrs, OR 4.05, 95% CI 2.76-5.95 in 60 yrs + comparing to 20-39 yrs) and abdominal obesity (OR 2.24, 95% CI 1.79-2.82) were risk factors for T2D even after controlling for other factors simultaneously. There was a significant association of T2D with ever smoking (OR 1.34, 95% CI 1.06-1.67). The relationship of age with T2D was modified by gender in model 1 and the relationship of smoking with T2D was modified by obesity in model 2. Less educated, older, obese or ever smokers were more likely to have T2D. Gender mediated the relationship of age, and obesity mediated the relationship of smoking, with T2D. Intervention programs for T2D in Korea should take the interactions among risk factors into account. 相似文献
33.
34.
将32例肝脏外科疾病患者随机分为Ⅰ组(单能源TPN组10例);Ⅱ组(双能源TPN组11例,其中脂肪乳剂用量为1g·kg-1·d-1);Ⅲ组(双能,TPN组11例,其中脂肪乳剂用量为2g·kg-1·d-1)。术后按组别给予TPN支持共6天,术前1天、术后第1和第6天测定肝功,糖代谢及蛋白质合成代谢指标。结果:①Ⅱ、Ⅲ组术后第6天肝脏酶学指标明显下降(P<0.05),而Ⅰ组仍高于术前水平(P<O.05);②Ⅱ、Ⅲ组术后糖代谢基本恢复正常,而Ⅰ组出现高血糖症及高胰岛素血症(P<0.05);③Ⅱ组肝脏蛋白质合成水平恢复术前水平或略有提高(P<0.05),而Ⅰ和Ⅲ组术后蛋白质合成功能仍低(P<0.05)。结果提示:含脂肪乳剂的TPN支持对肝脏外科患者术后的肝功恢复有益,能促进蛋白质合成及肝细胞再生,并且在进行TPN支持时按1g·kg-1·d-1给予脂肪乳剂较为安全合理。 相似文献
35.
Edward W. Lipkin M.D. Ph.D. Susan M. Ott Gordon L. Klein Leonard J. Deftos 《Calcified tissue international》1990,47(2):75-81
Summary Bone gamma-carboxyglutamic acid containing protein (BGP) has been utilized effectively as a serum marker of bone turnover
in healthy normals and in individuals with a variety of metabolic bone disorders including postmenopausal osteoporosis and
Paget's disease. The utility of this serum marker in other bone disorders, including that associated with the maintenance
of patients on long-term parenteral nutrition, still requires definition. Because of our interest in this clinical syndrome
and the availability of serum and of bone formation rates (BFR) measured directly from double tetracycline labeling in 11
long-term parenteral nutrition patients, we measured BGP levels in these patients and attempted to correlate this measure
with BFR. Serum vitamin D metabolites, immunoreactive parathyroid hormone (PTH), and alkaline phosphatase (alk phos) were
also measured. Serum BGP was only weakly and not significantly correlated (r=0.24, p=NS) with bone formation rate for the
group as a whole. However, in a subgroup of 10 patients without hyperparathyroidism, there was strong and significant correlation
(r=0.81,P<0.01) between BGP and BFR. There was also a strong correlation between bone formation rate and serum 1,25 dihydroxyvitamin
D [1,25(OH)2D] levels (r=0.89,P<0.01, n=11). The mechanism of this association could not be established. A correlation of borderline significance was observed
between bone formation rate and serum alk phos (r=0.60,P=0.05, n=11). The current data suggest that additional studies may help to more fully define the utility of serum measurements
in quantifying bone dynamics in parenteral nutrition patients, and that measures of vitamin D metabolites, BGP, and alk phos
may prove useful. 相似文献
36.
ROSS W SHEPHERD 《Journal of gastroenterology and hepatology》1996,11(5):S7-S10
Orthotopic liver transplantation (OLT) is now a definitive treatment option for most cases of endstage liver disease (ESLD) in children. Efforts now focus on active supportive treatment to maintain, if not improve, the patient's clinical status before OLT and to ensure normal patterns of growth and development after OLT. Malnutrition adversely affects the outcome of OLT and is probably the single area in pre-operative management where the largest potential improvement can be made. Our studies indicate significant abnormalities of protein energy metabolism and body composition in children referred for OLT. We have shown that the use of enteral formulae, enriched with branched-chain amino acids, have significant advantages. Other adjunctive therapy, such as growth hormone, is the subject of current investigation. Following transplantation, catch-up weight and growth does occur with the advent of normal liver functioning, but patients at continuing risk for undernutrition, such as those with rejection and/or chronic infection, need to be targeted for specific nutritional therapy. 相似文献
37.
普通外科危重患者围手术期的营养支持 总被引:6,自引:1,他引:5
目的:研究普通外科危重患者围手术期营养支持的临床疗效。方法:对1995年以来147例普通外科危重患者围手术期营养支持应用情况进行了分析,腹部手术138例(93.9%),颈部手术9例(6.1%),采用以全胃肠外营养(TPN)为主的阶段性营养支持方法补充营养。深静脉置管方法:经颈内静脉置管132例(89.8%)、腋静脉11例(7.5%)、股静脉4例(2.7%),使用单腔导管127例(86.4%),双腔20例(13.6%),41例(27.9%),放置肠内营养(EN)管。106例(72.1%)为TPN→PN 口服饮食→口服饮食,41例(27.9%)为TPN→PN EN→EN→EN 口服饮食→口服饮食。结果:本组营养支持期间无置管和代谢并发症。142例(96.6%)康复,5例(3.4%)死于原发病。结论:普通外科危重患者围手术期营养支持是重要辅助治疗方法,可保证手术安全,促进术后康复。 相似文献
38.
Background: There appears to be an emerging consensus that early postoperative nutritional support benefits the high-risk patient by decreasing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associated with serious complications, with a reported mortality rate as high as 10%. while total parenteral nutrition has also been associated with a wide variety of complications. Methods: Ninety-seven patients undergoing oesophagectomy or gastrectomy underwent pre-operative nutritional assessment and were randomized to receive either total parenteral nutrition (47 patients) or enteral nutrition (50 patients). Results: There was no significant difference in the number of catheter-related complications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in two patients) requiring active intervention. Conclusions: This study demonstrates enteral nutrition to be safe and associated with mainly reversible minor complications. It is probable that immediate postoperative enteral feeding conserves the gut's integrity. Whether this leads to a reduction in postoperative septic complications has not been demonstrated by this study although there appears to be a trend in this direction, supporting the concept of enteral feeding as ‘primary therapy’. This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time of surgery. 相似文献
39.
AJK WILLIAMS R FRASER DP CHORLEY J DENT 《Journal of gastroenterology and hepatology》1996,11(5):500-505
Safe placement of nasogastric tubes requires reliable positioning of the tip of the tube within the stomach. Radiology and aspiration are currently used to confirm tube position, but suffer from significant problems of cost and efficacy, respectively. We have developed a novel method to locate the position of a catheter tip within the body, using the detection of a low energy electromagnetic field generated in a coil located in the catheter with an external hand-held unit (Cathlocator). In vitro, the unit detected the distance of the coil from the detector with an accuracy of 0.1 cm over a range of 4–12 cm. In vivo studies were performed in 11 healthy volunteers using a purpose-built manometric assembly that incorporated the signal generating coil in its tip. In all subjects the Cathlocator showed the position of the signal generating coil to be cranial to the xiphisternum when manometric and transmucosal potential difference criteria showed it to be located above the lower oesophageal sphincter. When the coil was within the stomach, the Cathlocator identified its position within the epigastric, umbilical and left hypochondrial regions of the abdomen. The distance of the coil from the surface was significantly greater when in the duodenum mean (±s.e.m. 7.6±0.3 cm; P<0.001) and oesophagus (8.6±0.2 cm; P<0.002) than the stomach (5.0±0.4 cm). In one subject studied twice there was a close correlation between the location and depth measured by the device on each occasion. The Cathlocator is a novel non-radiological device that has the potential to be useful in the placement of gastrointestinal catheters. 相似文献
40.