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目的 研究肠内营养（EN）和肠外营养（PN）支持对外科危重病人的治疗效果。方法 将80例不能进食的研究对象随机分成EN组和PN组,比较营养指标、免疫功能指标、病人耐受性指标的变化。结果在治疗10d后,两组病人均由负氮平衡转为正氮平衡,营养指标及免疫功能指标明显增高,且EN组免疫功能指标增高更显著;病人耐受性指标中,EN组无显著变化而PN组血糖明显增高。结果 EN和PN对外科危重病人均有营养支持和提高机体免疫功能的作用。耐受性强,且EN支持在提高机体免疫功能优于PN支持,病人耐受性较好。     

外科危重病人的营养支持

目的：总结外科危重病人应用肠外营养与肠内支持的方法及经验。方法：应用肠内营养（EN）支持26例,全部通过鼻肠管滴入安素或爱伦多溶液,通过中心静脉营养（CV－TPN）70例,周围静脉肠外营养（PV－TPN）52例,均应用3升营养袋匀速滴入全合一营养液（TNA）。结果：26例全胃切除术后病人应用EN,无死亡及其他严重并发症,应用TPN组有3例死亡,死亡原因与TPN无直接关系,病人恢复快,平均住院天数缩短。结论：由于外科危重病人存在独特的代谢特点,大部分病人存在营养不良,故营养支持对外科危重病人至关重要,直接影响病人的康得和预后,因此对外科危重病人应该进行积极的营养支持治疗。     

Preoperative risk assessment for gastrostomy tube placement in head and neck cancer patients

BACKGROUND: The presentation and definitive surgical treatment of head and neck malignancies have varying impact on postoperative recovery and return of swallowing function, which heretofore has not been well defined. METHODS: We performed a retrospective chart review of 142 patients who underwent extirpative surgery for head and neck cancer. RESULTS: Factors significantly associated with the need for long-term postoperative nutritional support (p < .05) included heavy alcohol use, tongue base involvement and surgery, pharyngectomy, composite resection, reconstruction with a myocutaneous flap, radiation therapy, tumor size, and moderately-to-poorly differentiated histology. Heavy alcohol users were at an absolute risk for gastrostomy tube dependence; patients who underwent radiation therapy, flap reconstruction, tongue base resection, and pharyngectomy were at a two to sevenfold increased risk for gastrostomy tube dependence, respectively. CONCLUSIONS: High-risk patients based on these criteria should receive a feeding gastrostomy at the time of their initial surgical therapy.     

早期肠内营养对烧伤后高代谢反应调节作用的研究

目的 观察早期肠内营养对烧伤高代谢反应的调节作用。方法 通过３０例烧伤患者用间接测热法监测静息能量消耗（ＲＥＥ）,监测血浆激素、脂类调节因子、细胞因子水平,并结合临床疗效和氮平衡变化来评价早期肠内营养的作用。结果 早期肠内营养（ＥＥＮ）组较延迟肠内营养（ＤＥＮ）组ＲＥＥ显著下降（Ｐ＜０.０５－０.０１）,升高的时间缩短（Ｐ＜０.０５）;ＥＥＮ组非蛋白呼吸商（ＮＰＲＱ）较ＤＥＮ组更接近生理状态,负氮平衡时间缩短。伤后第４天ＥＥＮ组血浆去甲肾上腺素（ＮＥ）、胰高糖素（ＧＬＵＣＡＧＯＮ）、前列腺素Ｅ２（ＰＧＥ２）、血栓素Ｂ２（ＴＸＢ２）、低于ＤＥＮ组（Ｐ＜０.０５）;伤后８－１２d肿瘤坏死因子α（ＴＮＦ－α）、白细胞介素－６（ＩＬ－６）显著低于ＤＥＮ组（Ｐ＜０.０５－０.０１）,胰岛素水平呈相反变化。结论 严重烧伤后尽早开始肠内营养对高代谢反应有重要的调节作用。     

精氨酸对全胃肠外营养肝硬化大鼠肝脏的保护作用

目的:观察精氨酸对肝硬化大鼠全胃肠外营养时的肝保护作用 。方法:13只肝硬化大鼠随机分成2组,A(TPN)组7只,B(TPN+精氨酸)组6只。观察大鼠生存情况,大鼠实验前后体重、肝重/体重比值的变化,大鼠氮平衡情况,肝功能、肝甘油三酯（TG）、胆固醇（CHO）含量、门静脉血胰岛素、C-肽、胰高血糖素浓度的变化及肝脏病理组织学改变情况 。结果:除TPN组一只大鼠因输液过快,肺水肿死亡外,其余大鼠均成活,实验前后体重无明显变化。与A组比较,B组血清TBIL、ALT、ALB、A/G比值差异无统计学性（P>0.05）,AST明显降低（P<0.01）,肝TG含量明显降低（P<0.01）,肝CHO含量明显降低（P<0.05）,门静脉血胰岛素、C-肽、胰高血糖素浓度明显升高（P<0.01）。肝脂肪变性程度,A组为Ⅳ级,B组Ⅱ级。电镜观察,A组肝细胞质内有多量的脂肪滴,但B组减少,两组肝细胞质内线粒体均轻度肿胀 。结论:精氨酸可以预防和治疗硬化肝TPN时进一步的肝损害,同时也需白蛋白强化。     

贲门癌患者围术期肠内营养的临床研究

目的研究贲门癌患者围术期肠内营养的实施方法、效果。方法对209例贲门癌患者依据术后给予不同的营养支持方法随机分为两组,肠内营养组146例,术后施行早期肠内营养;静脉营养组63例,贲门癌术后给予全静脉营养支持;比较两组患者术后并发症发生情况,术后恢复情况,检测手术后理化指标。结果两组患者术后均未发生吻合口瘘。术后并发症发生率肠内营养组明显低于静脉营养组(P<0.01),而肠内营养组腹泻发生率高于静脉营养组(P<0.01),两组腹胀发生率差异无统计学意义(P>0.01)。术后肠鸣音恢复时间,肛门排气、排便时间和住院时间,肠内营养组较静脉营养组短(P<0.01)。术后白蛋白、球蛋白、总蛋白量肠内营养组高于静脉营养组(P<0.01),而血尿素氮、肌酐和中性粒细胞低于静脉营养组(P<0.01)。结论贲门癌患者围术期肠内营养是安全、有效、可行的,较静脉营养组有明显的优势。     

Menorrhagia: a synopsis of management focusing on herbal and nutritional supplements, and chiropractic

Introduction

To make chiropractors more aware of menorrhagia and how they can serve a role in their patient’s care and education since women make up 60% of the population seeking chiropractic care.

Method

A review of the biomedical literature on menorrhagia was conducted. Items that were retrieved were synthesized and interpreted in order to give the best information to practicing chiropractors.

Discussion

Most of the information available relative to menorrhagia is medically oriented. Other treatment options can include: chiropractic, various types of herbs, and nutritional supplements.

Conclusion

Knowledge of medical treatment, nutritional supplements, along with chiropractic treatment options may be beneficial to doctors in their practice.     

微生态肠内营养在结直肠癌患者围手术期的应用

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。     

早期肠内营养对肝胆手术患者胃肠功能的恢复效果分析

目的：探讨早期肠内营养对肝胆手术患者胃肠功能的恢复效果。方法选取2010年6月～2013年6月我院收治的肝癌、肝血管瘤、肝硬化、门脉高压,共85例作为研究对象,随机分为研究组43例及对照组42例。比较两组患者的临床疗效,治疗前后胃肠功指标变化,包括血清白蛋白（ALB）,前白蛋白（PA）,预后营养指数（PNI）等功能指标。并对胃肠道功能改善时间和术后住院接受恢复治疗时间进行比较。结果研究组治疗后的ALB,PA及PNI皆明显高于对照组,两组比较,差异有统计学意义（P＜0.05）。研究组的胃肠道功能改善时间和术后住院接受恢复治疗时间明显短于对照组,两组比较,差异有统计学意义（P＜0.05）。研究组的总有效率为95.35%,明显高于对照组的83.33%,两组比较,差异有统计学意义（P＜0.05）。结论早期肠内营养对肝胆外科术后患者胃肠功能恢复影响有着积极作用,且给药方便、费用低廉,值得临床广泛推广。     

Soin nutritionnel et amélioration clinique dans un service de néphrologie : une approche pilote multidisciplinaire

Malnutrition is an independent factor associated with morbi-mortality in chronic kidney disease. It is particularly common and may increase during hospitalization.ObjectivesTo measure nutritional and physical performance evolution as well as patients’ physical autonomy during a hospitalization in a university hospital renal ward. Treatments were adjusted according to different diagnoses (nutritional care, body composition, physical activity) along with a multidisciplinary approach. In this way, it can show the impact of this care on nutritional status of the patient.DesignRegardless of their nutritional status and kidney disease (acute or chronic kidney disease, chronic hemodialysis), patients were included at day 0, within 2 days from admission; nutritional interventions and measurements were assessed on day 7, day 14 and day 21. The study was run from December 2011 till June 2012, and 48 patients were included.ResultsOn admission, patients had a low energy intake (20.9 ± 8.6 kcal/kg/day). This intake was improved by means of a dietetic intervention (28.1 ± 6.5 kcal/kg/day after two weeks of hospitalization, 29 ± 6.1 kcal/kg/day after three weeks and 29 ± 8.4 kcal/kg/day after four weeks). Seventy-three percent of the hospitalized patients were malnourished, among them 91% had a decreased serum albumin (26.8 ± 6.6 g/L). Weight and muscle mass (measured by impedancemetry) were maintained, prealbumin increased by 16.5 mg/L after two weeks (n = 48; P = 0.61), 27.8 mg/L after three weeks (n = 31; P = 0.018), 52.3 mg/L after four weeks (n = 13; P = 0.002) and albuminemia by 1.8 g/L (n = 13 patients monitoring four weeks; P = 0.13). Both physical autonomy (assessed with Test moteur minimum) and muscle strength (Hand Grip Test) were significantly improved.ConclusionA systematic screening of wasting and a multidisciplinary care improved nutritional status and physical ability of patients hospitalized in a renal ward.