Objective To observe the effect of parenteral nutrition (PN) on the protein storage and immunofunction in patients with liver cirrhosis. Methods PN regimes consisted of nonprotein calories (NPC) 20-25 kcal/(kg·d) and nitrogen 0.15-0.20 g/(kg·d), the energy ratio of the glucose and fat emulsion was 2∶1. The PN solution was infused by total nutrition admixture (TNA), 12-16 hours per day for 7 days in 21 liver cirrhosis patients. Perior to the surgery and at 1st, 4th, 7th postoperative day, serum pre-Alb, transferrin (TSF), immunofunction (IgG, IgA, IgM, IgE, CH50, C3, C4, CD3, CD4, CD8, NKC), and nitrogen balance were tested. Results Serum pre-Alb, TSF, nitrogen balance and IgG, IgE, CH50, CD3, CD4, NKC were significantly decreased (Ｐ＜0.05), but the foregoing indices were higher than those of postoperative 1, 4d as compared with postoperative 7d. Conclusion These results bly indicated that postoperative nutritional support is safe and useful, and improve the patient’s nutritional status and immunofunction.
ObjectiveTo explore the role of nutritional support in adjuvant therapy for respiratory failure. MethodsWe took 72 patients with respiratory failure who were treated in our hospital from August 2011 to January 2013 as the research objects. They were divided into two groups:control group and trial group, with 36 patients in each group. The division of the groups was in accordance with the state food and drug administration clinical trial institution ethics committee standard operating procedures. In the control group, 36 patients were provided with regular treatments according to their condition, like maintaining the respiratory tract unobstructed, oxygen therapy, mechanical ventilation and anti-infection. In the trial group, we offered nutritional support in addition to the normal treatment. Consecutive 20 days was a course of treatment. After four courses, we inspected and put down two groups' respective clinical features, and made a contrast of their treatment conditions. We analyzed the treatments through observational indexes including assessment of eutrophication, treatment efficiency, pulmonary function and arterial blood gases. ResultsBoth groups had obvious therapeutic effects. The observational indexes in the trial group were better than those in the control group. The total effective rate was 91.7% in the trail group after treatment, significantly higher than that in the control group (66.7%) (χ2=8.692, P=0.003); the lung capacity, the ventilation flow ratio and arterial blood gas analysis values in the trial group was better than those in the control group. ConclusionThe effect of the nutritional support for the respiratory failure treatment is much better than the regular treatment. The total effective rate is improved while the death rate is lower than before and the patients recover quickly.
临床营养支持自1968年Dudrick与Wilmore创用静脉营养(intravenous hyperalimentation)后，解决了肠道功能发生障碍时无适合途径供给营养的难题，带动了营养支持的发展。 在其后40年营养供给的方法、制剂与基础理论都在不断地改进，对临床疾病的代谢改变也都有深入的研究，使临床营养支持的理论、策略都有很大进步， 也取得了很多共识，制定了很多指南。有各国、各地、各个系统，各个疾病都有指南与共识的制定，并且随着理论与技术的发展，对营养支持的作用、输注的方法有深入的认识，各种指南、共识也都在不断地更新、修正……
目的:探讨益生菌联合营养支持对胃肠外科术后患者肠功能和肠道菌群的影响。方法:36例胃肠道中等以上手术的患者,随机分为研究组和对照组,每组18例。两组术后均接受等氮等能量的营养支持,研究组患者于术后第3天开始每天加用益生菌制剂(6.6 × 10.7 colony forming units),共7天。监测治疗期间患者的胃肠道症状、生命体征、腹泻情况和菌群比例等。结果:两组患者术后腹痛、腹胀、肠鸣音异常等胃肠道症状均无显著差异 (Pgt;0.05),两组患者在术后第8和9天的腹泻比例和腹泻评分差异有显著性意义(Plt;0.05)。治疗结束后,研究组患者肠道双歧杆菌和乳酸杆菌计数均较对照组高,两组间差异有显著性意义(Plt;0.05)。 结论:在胃肠外科术后患者中应用益生菌可改善胃肠道症状、减轻腹泻程度和纠正肠道菌群失调。
Continuous renal replacement therapy (CRRT) is the treatment of choice for critically ill patients with hemodynamic instability who require renal replacement therapy. This review summarizes the impact of CRRT treatment on nutritional support in critically ill patients, including: energy increase caused by citrate-based anticoagulants, energy loss caused by glucose-free replacement fluid and dialysate, a large amount of amino acids loss in the effluent, and the influences on the way of lipid emulsion administration, capacity, electrolyte, vitamins, and trace elements. It is hoped that the intensive care unit doctors, nephrologists, and nutritionists can fully cooperate to determine the CRRT prescription and the nutritional support prescription.
ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
ObjectiveTo investigate the guidance of preoperative nutritional risk screening in perioperative nutrition support for colon cancer, in order to provide evidence for the rationally clinical application of nutrition support. MethodsNutritional risk screening was carried out in 95 hospitalized patients with colon cancer who were treated in the Liao He Oil Center Hospital from Jul. 2012 to Jul. 2014, with the nutritional risk screening 2002 score summary table. Patients were divided into nutritional risk group and non-nutritional risk group according to the screening results, and postoperative bowel function recovery and nutritional indicators were compared between patients who received perioperative nutrition support according to the screening results and those who did not. ResultsThere were 29 patients received perioperative nutrition support among 53 patients at nutritional risk and 19 patients received perioperative nutrition support among 42 patients without nutritional risk. Among 53 patients at nutritional risk, the time to first flatus, time to first defecation, hospital stay, postoperative complications rate, and postoperative recurrence/metastasis rate of patients who received perioperative nutrition support were shorter or lower than those of patients who didn't receive perioperative nutrition support (P<0.05), but there was no significant difference in mortality (P≥0.05); in addition, the levels of albumin, prealbumin, and transferring on 7-day after surgery were all higher in patients received perioperative nutrition support (P<0.05). Among 42 patients without nutritional risk, there was no significant difference in time to first flatus, time to first defecation, hospital stay, postoperative complications rate, postoperative recurrence/metastasis rate, and levels of albumin, prealbumin, and transferring on 1- and 7-day after surgery between patients received perioperative nutrition support and those who did not (P>0.05). ConclusionsIt is important to evaluate the nutritional risk in hospitalized patients with colon cancer. Nutritional support is benefical to the patients with nutritional risk, but it isn't necessary to patients without nutritional risk.
自20世纪60年代中期，发现仅从静脉给予机体所必需的营养物质，就可以维持幼体动物的生存发育与成长以来，古老的营养支持疗法开始了一个新的辉煌时期。经过近30多年的研究与实践，其内涵得到更大的发展，80年代以后，营养支持在我国普外临床也有较快的进展，当前已成为临床重要的治疗手段。在提高危重患者的治愈率，降低外科手术后并发症，加速术后患者的恢复和减少住院时间起到了很重要的作用，无论在营养支持的基础理论或临床实践都有了更深入的认识。因此，它的应用范围在不断地扩大，其临床地位也日益显得重要。