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。     

Vitamin a cost-effectiveness model

To assist in the selection of a preferable vitamin A deficiency control policy, a model has been developed to organize information on program costs and program-related effects. The model was designed to compare three approaches: (1) diet modification; (2) fortification of processed foods; and (3) periodic large doses. Health effects projected are rates of specific eye pathologies associated with vitamin A deficiency (xerophthalmia), and mortalities within age cohorts. Effectiveness is calculated as a function of coverage, biological efficacy, and incidence of vitamin A deficiency. The model was applied to data from the Province of West Java in Indonesia. The results of this application suggest that funding level considerations are an important factor in selecting a preferred control strategy. In addition to determining the relative resource requirements of alternative interventions aimed at reducing the morbidity and mortality effects of vitamin A deficiencies, the model, using marginal cost and marginal effectiveness information, can serve as a guide to the most efficient allocation of resources for each type of intervention.     

COPD患者营养状况与生活质量的关系

观察５６例男性慢性阻塞性肺病（ＣＯＰＤ）患者的体检营养指标，并分析其与生活质量的关系，实测体重占理想体重的百分比和生活质量测评表中的日常生活能力，社会活动情况，抑郁心理障碍等项评分有显著相关性（Ｐ〈０．０５），上臂中点肌肉臂围与日常生活能力和社会活动情况的评分的相关也有统计学意义（Ｐ〈０．０５）。提示改善ＣＯＰＤ患者的营养状况对提高生活质量有重要意义。     

直肠癌全直肠系膜切除术后直肠阴道瘘原因与防治

本文通过分析近5年来我院18例女性直肠癌全直肠系膜切除术后直肠阴道痿的临床资料。发现直肠阴道痿多发生于中低位直肠癌行全直肠系膜切除保肛手术的患者。痿的发生与肿瘤的位置、肿瘤的分期、肿瘤距肛门口的距离．以及手术技巧、手术难度、引流方法有关。而与是否进行预防性造口，以及是否采用腹腔镜手术无关。预防上强调应重视术中直肠前壁的锐性分离、结肠直肠吻合以及术后盆腔的负压引流。治疗上应首先进行保守治疗，即肠内营养，阴道冲洗。早期配合肠外营养、及全身或局部抗炎治疗，大部分直肠阴道痿通过保守治疗可以治愈。保守治疗无效时考虑结肠或回肠末端造口。若长期不愈应考虑吻合口肿瘤复发的可能。     

Artificial nutrition support in intensive care units in Spain

Objective A multicenter survey to study the use of nutritional support in patients admitted to the ICU in Spain.Design The survey was announced during the annual Spanish Society of Intensive Care Medicine and Coronary Units (SEMIUC) congress meeting.Setting Questionnaires designed to determine current clinical practice concerning artificial nutrition were sent to the 27 ICU who accepted to participate.Patients and participants In each center the 235-question form was filled out individually for each patient admitted to the ICU during the month of March, 1992.Interventions To validate the study a preliminary pilot surveys were conducted to ensure that there was a correct interpretation of the questions. The replies were entered into a database for analysis.Results A total of 1261 patients were studied; 33.9% received artificial nutrition (AN). The administration of AN was significantly higher in the medical group (44%), than in the surgical (37%) and the trauma group (19%). AN was significantly lower in patients admitted to private clinic than public institutions (26.7% versus 34.7%). Among the patients who received AN, enteral nutrition (EN) was administered to 59.7% of the patients, total parenteral nutrition (TPN) to 38.5%, and peripheral parenteral nutrition (PPN) to 18.2%. Medical patients received significantly more EN than surgical and trauma patients. Surgical patients received more PN than medical and trauma groups.Conclusions Nutritional support is a common practice in the treatment of ICU patients in our country. All information concerning its use is necessary to optimize it.     

Does Low FEV1 in Addition to Fixed Ratio and/or Lower Limit of Normal of FEV1/FVC Improve Prediction of Mortality in COPD? The NHANES-III-linked-mortality Cohort

Purpose

There is presently an ongoing debate on the relative merits of suggested criteria for spirometric airway obstruction. This study tests the null hypothesis that no superiority exists with the use of fixed ratio (FR) of forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.7 versus less than lower limit predicted (LLN) criteria with or without FEV1 <80% predicted in regards to future mortality.

AN ELECTRON MICROSCOPIC EXAMINATION OF AGE-RELATED CHANGES IN THE RAT LIVER. The Influence of Diet

The influence of age and diet on the ultrastructure of hepatocytes is reported. The following dietary manipulations were investigated: Group 1, fed ad libitum a diet containing 21% protein; Group 2, fed a similar diet but restricted to 60% of the intake of Group 1 from 6 weeks of age onwards; Group 3, restricted from 6 weeks to 6 months of age and thereafter fed ad libitum; Group 4, restriction started at 6 months of age; Group 5, fed ad libitum a diet containing 12.6% protein. In all groups the size of hepatocytes was found not to increase during adult life. The size of hepatocytes in Groups 2 and 4 was the same as or larger than that of the other groups; thus food restriction resulted in a decreased number of hepatocytes. Changes in the structure of some organelles and the accumulation of lipofuscin granules occurred with advancing age and the extent of these age-related changes was less in Groups 2 and 4 than in the other groups. These morphologic findings in conjunction with our previously reported metabolic findings provide a new view of the action of food restriction on the aging process. ACTA PATHOL JPN 38: 1119∼1130, 1988.     

营养和激素对家蝇卵黄发生的影响

本实验通过对家蝇取食量的测定，对家蝇进行不同饲料饲喂后，对其不同发育期的血淋巴、脂肪体及和卵巢的发育及卵黄蛋白含量进行观察测定，结果表明，取食蛋白组家蝇血淋巴、脂肪体和卵巢卵黄蛋白含量均高于奶粉组和对照组；羽化４８ｈ后的血淋巴和脂肪体中卵黄蛋白含量为７．３μｇ／μｌ、３１．９μｇ／头；卵巢卵黄蛋白含量为５５．０μｇ／头；在羽化后７２ｈ血淋巴和脂肪体中卵黄蛋白含量分别为２．９μｇ／μｌ、３２．０μｇ／头；卵巢卵黄蛋白含量为８０．０μｇ／头；脉冲式饲喂家蝇后，体内卵黄蛋白含量明显高于对照组，说明蛋白质饲料在家蝇卵黄发生中起重要作用。激素处理结果证明，ＪＨＡ单独处理及ＪＨＡ和蜕皮素协同处理均能促进卵黄蛋白的合成和摄取，而蜕皮素单独处理没有促进作用。最后对营养和激素对生殖的调控作用进行了讨论。     

老年髋部骨折患者围术期“2P-3R”营养管理模式构建

目的构建老年髋部骨折患者围术期营养管理模式,促进患者早手术、早下地、早康复。方法针对老年髋部骨折患者营养管理现状,采用课题研究型品管圈活动进行改进。经过科学循证、专家指导等,从术前、术后及家庭三个环节,骨科、营养科、家庭三个维度,人员、制度、材料设备、方法、信息五个方面,制定三大对策群组并予以实施,包括组建营养支持团队、构建营养管理策略、搭建多维信息交互平台等。结果老年髋部骨折患者首次下地时间缩短为26.7 h,平均住院日缩短为5.6 d,实现了早手术、早下地、早康复的目标。结论对老年髋部骨折患者实施个性化、全流程的序贯性营养干预具有重要意义。后续还需开展大样本多中心研究以进一步验证成效,数据自动采集与智能反馈也是今后研究重点。     

青海省少数民族地区老年人营养知信行调查分析

目的 了解青海省少数民族地区老年人营养知信行现状,为开展老年人健康教育提供理论依据。方法 采用问卷调查青海省四县共1 174名60岁及以上老年人。采用秩和检验分析营养知识得分的影响因素,采用logistic回归分析营养知识和行为得分是否合格的影响因素。结果 本次调查老年人营养知识知晓率为28.15%,营养态度积极率为57.93%,营养行为正确率为42.38%。秩和检验显示,男性、60～65岁、汉族、居住在湟源县、初中及以上学历、已婚、无业、非建档立卡户、近一年内参加过健康教育活动者营养知识得分高;logistic回归结果显示,居住地区（称多县:OR = 0.035,95%CI:0.007～0.161）、婚姻状况（丧偶:OR = 0.504,95%CI:0.316～0.805）是营养知识得分合格的影响因素;民族（撒拉族:OR = 3.550,95%CI:1.522～8.282）、居住地区（称多县:OR = 28.313,95%CI:9.843～81.440）、居住方式（与子女同住:OR = 1.501,95%CI:1.038～2.171）、职业（农民:OR = 2.058,95%CI:1.013～4.181）是营养行为得分合格的影响因素。结论 青海省少数民族地区老年人营养知识知晓率和营养行为正确率较低,应针对不同地区、民族实施相应的营养健康教育。