Phosphate homeotasis in healthy subjects during prolonged periodic and continuous hypokinesia

OBJECTIVE: This study aimed to show that during hypokinesia (HK), phosphate (P(i)) imbalance increases more with higher than lower physical activity and that P(i) absorption reduces more with higher than lower P(i) imbalance in subjects with higher than lower muscular activity. METHODS: Studies were conducted on 30 healthy male subjects during 364 days of HK. They were equally divided in three groups: unrestricted active control subjects (UACS), continuously hypokinetic subjects (CHKS) and periodically hypokinetic subjects (PHKS). CHKS were kept under average walking distances of 0.5+/-0.2 km day(-1) PHKS were kept under average walking distances of 0.5+/-0.1 and running average distances of 8.7+/-1.2 km day(-l) for 5 days and 2 days per week, respectively. UACS were placed under average running distances of 8.7+/-1.2 km day(-l). RESULTS: P(i) imbalance, serum, urine and fecal P(i) levels, and urine and serum calcium (Ca(2+)) levels increased significantly (p<0.05) and P(i) absorption, and serum intact parathyroid hormone (iPTH) and 1,25-dehydroxyvitamin D (1,25 (OH)(2) D(3)) levels decreased significantly (p<0.05) in CHKS and PHKS compared with their pre-HK values and their respective active control (UACS). However, the P(i) imbalance, serum, urine and fecal P(i) levels, and serum and urine Ca(2+) levels increased more significantly (p<0.05), and P(i) absorption and serum iPTH and 1,25 (OH)(2) D(3) levels decreased more significantly in PHKS than in CHKS. CONCLUSIONS: Higher P(i) imbalance with higher than lower physical activity shows that the risk of higher P(i) imbalance is inversely related to the intensity of physical activity. Lower P(i) absorption with higher than lower P(i) imbalance shows that the risk of lower P(i) absorption is inversely related to magnitude of P(i) imbalance. In conclusion P(i) imbalance increases more with higher than lower physical activity and that P(i) absorption decreases more with higher than lower P(i) imbalance indicating that during HK the use of P(i) decreases more with higher than lower physical activity.     

PEG在神经重症患者中的应用

良好的营养支持以及正确的营养支持途径可以改善神经重症患者的预后.肠内营养途径是国内外公认的神经重症患者首选的营养支持途径.鼻胃管(NGT)作为传统给予肠内营养的方式常伴有误吸、导管移位及感染等并发症,且患者不适感严重.近些年来,经皮内镜下胃造口术(PEG)已经被逐渐接受并广泛应用于临床,对于长期需要应用肠内营养支持的患者较PEG营养支持途径有并发症少、患者不适感降低等优势.PEG是目前需要长期肠内营养支持的神经重症患者较理想的营养支持途径.     

早期肠内营养支持治疗对重症脑出血患者免疫功能和预后指标的影响

目的:探讨早期肠内营养(early enteral nutrition,EEN)治疗对重症脑出血患者免疫功能和预后指标的影响.方法:随机将173例重症脑出血伴吞咽障碍患者分为对照组(n=77)和EEN组(n=96),入院后12~48 h分别给普通鼻饲饮食和予肠内营养(EN).两组患者于入院第2和第14天后采用美国国立卫生院神经功能缺损量表(National Institutes of Health Stroke Scale,NIHSS)进行功能评分,并观察两组患者营养指标及免疫球蛋白(IgA、IgG、IgM),淋巴细胞计数(LYM)和细胞因子CD4+、CD8+、CD4+/CD8+值,并且比较两组患者预后并发症的发生情况.结果:入院14 d后,EEN组患者NIHSS评分显著低于对照组(P<0.05);两组患者入院后第2天各项营养指标无显著差异,第14天对照组TP、Alb、PA和Hb指标较第2天显著降低(P<0.05),EEN组患者的TP、Alb、PA和Hb均明显高于对照组,差异具有统计学意义(P<0.05);EEN组患者IgA、IgM、CD4+显著升高,LYM和CD4+/CD8+升高,IgG接近术前水平,CD8+降低;EN组患者并发症低于对照组组,但无统计学差异(P>0.05).结论:早期肠内营养支持治疗可以改善重症脑出血患者的神经功能、免疫功能、身体营养状态.     

早期肠内营养支持在神经外科的临床应用

颅脑损伤或颅脑手术患者,术后会出现明显高代谢过程,能量消耗大增,又因多数患者进食困难,长期静脉营养风险及并发症较高,故早期肠内营养(enteral nutrition,EN)十分必要。EN给予前需要认真评估患者营养需求及可行的管道给予方式和营养组分,建立个体化的EN给予模式。EN同样存在一定风险或并发症,常见如腹泻、便秘等胃肠道症状、误吸导致的感染性病变、管道阻塞及位置变化引起的梗阻症状等,因此需要及时发现、及时处理。总之,早期个体化EN给予可以使神经外科术后患者明显获益,需要临床医护人员高度重视。     

肠外营养支持应用于急性肠梗阻术后恢复的临床模式构建研究

目的：构建急性肠梗阻手术后恢复应用肠外营养支持的临床模式。方法：选取2015年1月至2015年12月在我院实施手术治疗的急性肠梗阻患者56例作为研究组,采用肠外营养支持方法,另选取2014年1月至12月在我院实施手术治疗的急性肠梗阻患者47例作为对照组,采用肠内营养支持,分析两组患者不同营养支持方式的恢复效果。结果：研究组患者胃肠减压量及肛门排气时间低于对照组患者,而术后7 d血浆白蛋白浓度高于对照组,而且研究组患者的住院费用和住院时间均少于对照组,与对照组数据比较差异较大,具有统计学意义(P<0.05)。结论：在急性肠梗阻手术后应用肠外营养支持能够促进患者肠功能的恢复,缩短患者的住院时间,减少住院费用,提高患者机体免疫力,值得在临床中推广应用。     

Oxalate Metabolism after Intestinal Bypass Operations

Hyperoxaluria and kidney stones are frequent following intestinal bypass operations. The urinary oxalate excretion was studied for 10-13 days during enteral and parenteral nutrition in six patients operated on because of massive obesity with a jejunoileostomy. The oxalate excretion in urine was higher than normal in all patients on normal diet. The excretion decreased on low-oxalate diet. Further decrease was observed during total parenteral nutrition (TPN). The oxalate excretion was stabilized at a low level within 48 h after the start of TPN and was unchanged during the rest of the study. This included a period of 2 days when a load of the oxalate precursor glycine (10 and 20 g) was given parenterally to five patients, resulting in increased serum glycine concentration. A slight decrease in oxalate excretion was found when the amino acid part (Vamin® with 10% glucose) of the TPN solution was given enterally instead of parenterally in two patients. This study has indicated that the main reason for hyperoxaluria in patients with intestinal bypass operations is hyper-absorption of dietary oxalate. It seems likely that these patients have a normal endogenous oxalate production.     

唾液腺乳腺样分泌癌的研究进展

唾液腺乳腺样分泌癌(MASC)是一种近年来才被描述的唾液腺肿瘤新类型,因其存在与乳腺分泌性癌类似的特异性的E-二十六变异基因6-神经营养酪氨酸受体激酶3融合基因而得名.MASC在病理形态上非完全特异,与诸多唾液腺肿瘤有重叠,所以在病理诊断中经常将其诊断为腺泡细胞癌或黏液表皮样癌等.本文就MASC的临床表现、病理特点、分子生物学特征、鉴别诊断、预后和治疗等研究进展作一综述.     

早期要素肠内营养与肠外、肠内阶段性营养治疗急性重症胰腺炎的对比研究

目的:探讨早期肠内要素营养(early enteral elemental nutrition,EEN)与肠外营养(parenteral nutrition,PN)、肠内营养(enteral nutrition,EN)阶段性营养支持对急性重症胰腺炎(Severe acute pancreatitis,SAP)的疗效及临床价值.方法:将45例临床SAP患者随机分为两组,分别接受早期肠内营养(EEN)和阶段性营养支持治疗.观察其血清白蛋白、淀粉酶水平、胃肠功能,比较其并发症、感染率、住院时间和住院费用.结果:两组血清白蛋白水平变化和淀粉酶水平比较无统计学意义(P＞0.05),EEN组肠道蠕动恢复较早,且并发症、感染率、住院时间和费用低于阶段性营养支持组(P＜0.05).结论:在SAP的治疗中,72 h之内行EEN能减少并发症,改善患者预后.     

肠内生态免疫营养对重症胰腺炎大鼠炎症反应和肠屏障损害的影响

目的: 探讨早期应用生态免疫肠内营养对重症急性胰腺炎大鼠炎症反应和肠屏障损害的影响.方法:60只SD大鼠随机分为对照组(C组)、传统肠内营养组(EN组)和生态免疫型组(EIN组),每组20只.采用5%牛磺胆酸钠逆行注射法建立重症急性胰腺炎模型.于第12、24、48、72小时处死大鼠留取标本,检测血清巨噬细胞移动抑制因子(MIF),观察小肠组织病理学改变及运用免疫组化法和RT-PCR方法检测小肠组织中MIF的表达、Toll样受体4(TLR4)mRNA的相对含量.结果:(1) 建模12 h,EN组和EIN组MIF水平较C组明显升高(P ＜ 0.01);建模72 h,3组的指标呈不同程度下降趋势,其中EIN组明显低于EN组 (P ＜ 0.05).(2) C组大鼠小肠组织MIF表达弱,EIN组和EN组阳性细胞数增加,EIN组较EN组阳性表达率低(P ＜ 0.05).病理学观察显示72 h EIN组病变程度较EN组轻.(3)大鼠给予肠内营养干预后72 h,EIN组TLR4 mRNA的相对含量较EN组显著降低(P ＜ 0.01).结论:生态免疫型肠内营养能缓解重症急性胰腺炎大鼠炎症反应,减轻肠道屏障损害,缩短病程.     

合并糖尿病消化道肿瘤患者术后早期肠内营养支持的护理研究

目的:探讨消化道肿瘤合并糖尿病患者在术后早期肠内营养过程中的护理方法。方法:37例消化道肿瘤合并糖尿病患者术后24h经鼻空肠营养管重力滴入肠内营养糖尿病专用制剂,检测治疗前后各项营养、生化及免疫指标变化。通过一系列相关护理措施,监测和控制血糖,预防并发症的发生。结果:在输注肠内营养过程中患者无1例发生严重并发症,仅有5例出现腹胀腹泻症状,2例出现咽喉炎,均对症治疗后缓解。81.08%患者血糖稳定,控制在(7.8±1.1)mmol/L范围内。治疗后血清白蛋白、前清蛋白、转铁蛋白等营养指标水平显著增高(P0.05),体重、血红蛋白、丙氨酸氨基转移酶、总胆红素无明显改变,IgG、IgA、IgM免疫指标水平比术前有明显升高(P0.01)。结论:对消化道肿瘤合并糖尿病患者术后早期应用糖尿病专用制剂是营养支持的有效手段。治疗期间应采取科学有效的护理方法,加强基础护理,监测血糖变化,预防糖尿病和手术相关并发症的发生。