低糖高脂肪支持治疗对呼吸科危重症患者疗效观察

目的:探讨低糖高脂肪类肠内营养(EN)治疗在呼吸系统危重症患者的应用价值.方法:呼吸科危重症患者60例,随机分为营养组和对照组.营养组采用高脂肪低糖EN液,对照组采用普通匀浆膳.于营养治疗前1d和治疗后第14d测定血清营养相关指标,二氧化碳分压(PaCO2)、氧分压(PaO2)、氧合指数(PaO2/FiO2)、无创通气时间及使用有创机械通气的病例数、住院时间等指标.结果:治疗第14d后,营养组患者TP、ALB、Hb均较对照组显著升高(P<0.05);两组患者治疗后PaC02、PaO2和PaO2/Fi02均较治疗前有明显改善(P<0.05);营养组患者的无创通气时间和住院时间与对照组相比有明显缩短趋势.结论:低糖高脂肪营养支持治疗能够有效的改善呼吸科危重症患者的营养状况及血气分析指标,有利于患者的恢复.     

肺病专用低糖类营养配方对呼吸衰竭病人的影响

目的:评价肺病专用低糖类营养配方(益菲佳)对呼吸衰竭病人的影响.方法:将60例符合入选标准的病人随机分为研究组和对照组,研究组给予益菲佳,对照组给予均衡经肠营养制剂(安素).于治疗前后分别检测病人的血脂、血清蛋白质和二氧化碳分压(PaCO2)、氧分压(PaO2)、氧耗量(VO2)、二氧化碳生成量(VCO2)和呼吸商(RQ)等指标,以评价其营养支持效果.结果:经过10天的营养治疗,研究组的血气分析指标与治疗前相比有显著性差异(P＜O.05或P＜0.01),而且与对照组同期相比也有显著性差异(P＜0.05或P＜0.01).结论:益菲佳能降低机械通气病人的VO2、VCO2、PaCO2和RQ,对改善呼吸衰竭病人的肺功能和营养状态具有一定的作用.     

高能低糖肠内营养液改善机械通气COPD患者的临床疗效

目的观察高脂肪(50%)、低碳水化合物(32%)肠内营养液对机械通气慢性阻塞性肺疾病(COPD)患者的临床疗效。方法我院32例机械通气COPD患者,平均年龄(70.4±17.4)岁,体重为(45.4±6.6)kg,均明显低于正常值(P<0.01);并伴有明显的营养不良。随机分为高能低糖肠内营养组(n=18)和传统肠内营养组(n=14)。两组均采用鼻饲肠内营养支持,每天供给热能125kJ(30kcal)/kg,蛋白质0.8~1.0g/kg,热氮比值为627.6kJ比1g。分别于营养治疗前一天及治疗后第10天测定血常规、电解质、呼吸商(RQ)、每分钟通气量(VE)、二氧化碳生成量(VCO2)、氧耗量(VO2)、二氧化碳分压(PaCO2)、氧分压(PaO2)、pH值以及血清总蛋白、白蛋白、血红蛋白、淋巴细胞比例等指标。结果治疗前两组患者的各项指标测定值相近,治疗10天后高能低糖组患者的VE、VCO2、VO2、RQ均较传统营养组显著降低(P<0.05)。传统营养治疗前后VE、VCO2、VO2、RQ无明显变化。两组患者的血气分析均有不同改善,高能低糖肠内营养组的PaCO2较传统肠内营养组降低,PaO2增高,但两组的差异无显著性。两组血液生化和血常规结果均无显著差异。结论高能低糖营养制剂能降低VCO2和RQ,减少VE和VO2,对于失偿期COPD患者有明显的临床治疗效果。     

肠内营养支持治疗在危重症机械通气病人中的临床应用

目的:探讨肠内营养(EN)支持治疗对危重症机械通气病人营养状态和预后的影响. 方法:采用随机对照法,将81例危重症病人分成治疗组和对照组.治疗组43例病人于机械通气后48 h内开始行EN支持治疗,对照组38例病人应用肠外营养(PN)支持治疗,并在肠功能改善后,逐渐过渡至流食和软食.观察两组病人的临床疗效,并监测治疗前和治疗后第7和第14天的血清清蛋白(ALB)、前清蛋白(PA)、免疫球蛋白(IgA)、血红蛋白(Hb)、氮平衡(NB)以及APACHEⅡ评分,呼吸机相关性肺炎发生率、2周内撤离呼吸机的成功率、机械通气时间以及入住ICU时间. 结果:治疗组病人治疗第14天后,血清PA水平与治疗前和对照组比均有显著性差异(P＜0.05).血清ALB、IgA、NB明显高于对照组(P＜0.05),APACHEⅡ评分显著低于对照组(P＜0.05).治疗组病人并发呼吸机相关性肺炎、机械通气时间和入住ICU的时间明显低于对照组(P＜0.05).2周内撤呼吸机成功率明显高于对照组(P＜0.05). 结论:EN支持治疗有助于改善危重症机械通气病人的营养状况和预后.     

高脂肪肠内营养液改善脑卒中病人营养状况和预后

目的:评价高脂肪EN液对脑卒中病人营养状况和预后的影响.方法:将56例脑卒中病人随机分为高脂肪营养液(瑞能)组和标准营养液(Nutrison Fiber)对照组,每组28例.于住院营养支持前,营养支持第1 、10 和21天分别检测两组病人的血糖、Hb、血清ALB、TG、TC、HDL和LDL水平以及美国国立卫生院卒中量表(NIHSS)评分.观察病人EN支持过程中胃肠道不良反应的发生情况.入院30 d时,进行日常生活能力量表(ADL)评定.结果:两组病人EN支持第1天各项指标与营养支持前相比无显著性差异.EN支持第10和21天时,对照组病人各项营养指标除Glu外均有下降;高脂肪营养组病人仅血清ALB水平有一定程度的下降,血脂维持在正常水平.两组病人胃肠道并发症无显著性差异.第21天时,高脂肪营养组病人NIHSS评分改善较对照组更为显著(P<0.01),第30天高脂肪营养组ADL评分明显好于对照组(P <0.01).结论:早期高脂肪EN支持可明显改善重症脑卒中病人的营养状况,改善预后,不会升高血脂.     

危重症病人肠内与肠外营养支持的对比观察

目的:对比研究危重症病人EN与PN支持的效果.方法:将48例危重症病人随机分为EN组和PN组,对比观察营养支持后两组病人的Hb、PA、血清总蛋白(TP)、ALB等营养指标以及腹泻、腹胀、胃肠道出血、肝功能损害、高血糖等并发症的发生率.结果:经EN支持后,病人的Hb、TP和PA明显升高(P<0.05);而PN组与营养支持前比较,病人各指标无显著性差异.PN组并发症的发生率高于EN组.结论:EN支持可较好地改善病人的营养状况,并发症少,是危重症病人较好的营养支持方式.     

不同营养途径对危重症病人营养和免疫功能的影响

目的:观察比较不同营养支持途径对危重症病人的治疗效果.方法:选择ICU危重症病人45例,分为A组(PN支持) 、B组(EN支持)和C组(PN+EN支持),每组各15例.分别于营养支持前和连续营养支持治疗8 d后测体质指数(BMI)、血清总蛋白(TP)、ALB、Hb、淋巴细胞总数(TLC)、IgA、IgG和 IgM、 T细胞亚群(CD3、CD4、CD8)百分比,并进行临床营养指标和免疫指标的分析对比.结果:给予营养支持8 d后,42例(93.3%)病人康复,3例(6.7%)死于原发病.三组病人的Hb均明显升高,EN组和PN+EN组的TP、ALB较PN组有显著升高,EN组TCL和IgM、PN+EN组IgG和IgM均较PN组升高.结论:三种途径营养支持均可改善危重症病人的营养状况和免疫功能,EN或联合EN的效果更加明显.在危重症病人的治疗中,可根据病人的不同情况,合理地选择营养支持方式.     

低糖高脂营养膳食对慢性阻塞性肺疾病急性发作并发呼吸衰竭病人疗效的影响

目的:探讨自配低糖高脂营养膳食对慢性阻塞性肺疾病急性发作(AECOPD)并发呼吸衰竭病人疗效的影响. 方法:将78例COPD急性发作(AECOPD)并发呼吸衰竭进行机械通气病人,随机分为试验组(n=38)和对照组(n=40).两组病人均采用鼻饲肠内营养(EN)治疗,试验组采用自配低糖高脂膳食,对照组采用整蛋白营养制剂(瑞素),具体能量摄入依据病人实际情况而定,分别于营养治疗第1天和治疗后第14天测定病人二氧化碳生成量(VCO2)、氧耗量(VO2)、肺活量(FVC)和1 s用力呼气容积占最大肺活量的比值(FEV1/FVC)、二氧化碳分压(PaCO2)、氧分压(PaO2)、pH值以及第14天脱机成功率、机械通气时间、病死率和营养支持费用等指标.结果:治疗前,两组病人的各项指标测定值无显著性差异(P＞0.05).治疗第14天,两组病人的各项指标均较治疗前有所改善,且差异有显著性统计学意义(P＜0.05).试验组较对照组改善更加明显,差异有显著性统计学意义(P＜0.05). 结论:自配低糖高脂营养膳食对AECOPD并发呼吸衰竭病人有明显的临床治疗效果.     

危重症病人早期肠内营养联合新斯的明疗效观察

目的:探讨早期肠内营养(EEN)联合新斯的明足三里注射对危重症病人救治的效果。方法:80例危重症病人随机分为EEN组和EEN+新斯的明组,每组40例。两组均给予等热量、等氮量的EN支持。EEN+新斯的明组病人同时行双侧足三里穴位注射新斯的明各0.5 mg,每2 d一次,连用14 d。病人分别于EN支持前和EN支持后第1、7、14和21天检测血清清蛋白(ALB)、血红蛋白(Hb)、淋巴细胞计数(PLT)、氮平衡(NB);EN支持后第14和21天测定免疫学指标(lgM,lgG,lgA)和T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8比值)。并记录EN使用期间达TEN时间、EEN达标率和EN并发症的发生率等临床指标。结果:两组病人EN治疗后各项营养指标均较治疗前改善。EEN+新斯的明组病人第14天时ALB、TLC、NB以及第21天时ALB、Hb、TLC、NB改善均明显优于EEN组(P<0.05)。EEN+新斯的明组第14和21天时lgA水平明显低于EEN组(P<0.05),且CD4、CD4/CD8比值较亦EEN组明显升高(P<0.05)。EEN+新斯的明组病人对EN的耐受性显著高于EEN组[(4.8±0.7)d vs(6.7±1.3)d](P<0.05),EEN达标率亦明显升高(63.33%vs 48%,P<0.05),EN相关并发症发生率明显减低。结论:EEN支持联合新斯的明足三里注射治疗能改善危重症病人的营养状况,增强病人对EN的耐受,降低并发症,增强病人免疫功能。     

危重症病人胰岛素强化治疗时不同肠内营养制剂的影响

目的:观察危重症病人胰岛素强化治疗时对不同肠内营养(EN)制剂的影响。方法:选择机械通气的高血糖危重症病人40例,随机分为对照组和治疗组。对照组病人用EN制剂能全力,治疗组病人用EN制剂瑞代。第3～10天内给全量EN支持,达到完全EN[83.68 kJ(20 kcal)/(kg.d)],观察两组病人EN治疗后的胃肠道不良反应、第10天的24 h平均血糖、总热量、总胰岛素用量和血浆清蛋白(ALB)水平。结果:两组各有2例病人出现胃肠道潴留和腹泻而被剔除本研究,其余均能达到目标热量供给。两组病人EN治疗后第10天的平均血糖、总热量、血浆ALB均无显著性差异(P0.05)。治疗组病人EN治疗后第10天总胰岛素用量明显小于对照组(P0.05)。结论:危重症病人胰岛素强化治疗时不同EN制剂的选择对胰岛素的需要量有明显影响。     

Fatigue of the respiratory muscle and respiratory insufficiency

Recent results on respiratory muscle function are reviewed, with special regard to the muscle fatigue theory of respiratory failure. In this respect diagnostic measures and clinical symptoms are reported. Therapy is directed to reduce the work of respiratory muscles and temporarily rest them. Within this special role is given to the treatment with respirator and positive pressure breathing.     

Continuous respiratory therapy of newborn and premature infants with respiratory disorders

2216 newborns and prematures with respiratory distress of different underlying diseases were treated with long term respiratory therapy from 1. Jan. 1975 to 31. Dec. 1985. One part of the patients were born in our hospital, the other part of them were transported from outside. The rate of prematures was 81.2%. The respiratory therapy was applied in 1813 cases because of pulmonary diseases (group 1.), while in 403 cases the respiratory troubles were extrapulmonary in origin (group 2.). The diseases in the first group were as follows: hyaline membrane disease in 482 cases (27.30%), intrauterine pneumonia in 634 cases (34.64%), postnatal pneumonia in 291 cases (15.90%), meconium aspiration syndrome in 110 cases (6.01%), severe RDS-II in 158 cases (8.63%), pulmonary immaturity in 116 cases (6.35%), persistent fetal circulation in 21 cases (1.15%) and pulmonary aplasia on the left in 1 case (0.021%). In the second group the greatest part of the cases were treated for neurological disturbances. We discuss the indications of different types of respiratory therapy and the complications as well. The survival rate was in the first group 59.3%, while in the second only 16.9%. Therefore the respiratory therapy seems to be more effective in the pulmonary diseases of the newborns. The mortality rate and the rate of severe complications were lower among inborn babies because of the early application of the respiratory therapy.     

Clinical and epidemiological aspects of respiratory syncytial virus lower respiratory tract infections

This paper has analyzed respiratory syncytial virus lower respiratory tract infections in 201 hospitalized children. In children with wheezing, erythrocyte sedimentation rate (ESR) was significantly higher in those with pneumonia than with syndroma pertussis, while the white blood cell (WBC) count was significantly lower in patients with bronchitis than in those with bronchiolitis and syndroma pertussis. Bronchodilatators were applied in 75.6% and corticosteroids in 20% of patients. Ten patients were ventilated. Fatal disease outcome was observed in one infant. Twelve consecutive-year study of respiratory syncytial virus (RSV) infections showed that 27.3% of these diseases were bronchiolitis and pneumonia.     

Nutrition and respiratory disease

Weight loss is a frequently occurring complication in patients with chronic obstructive pulmonary disease (COPD) and is a determining factor of functional capacity, health status and mortality. Weight loss in COPD is a consequence of increased energy requirements that are not balanced by dietary intake. Both metabolic and mechanical inefficiency contribute to an elevated total daily energy expenditure. Alterations in anabolic and catabolic mediators resulting in a dysbalance between protein synthesis and protein breakdown may cause a disproportionate depletion of fat-free mass in some patients. Nutritional support is indicated for depleted patients with COPD because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance. A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism. The efficacy of anti-catabolic modulation requires further investigation.     

新生儿呼吸合胞病毒下呼吸道感染临床分析

目的探讨新生儿呼吸合胞病毒下呼吸道感染的临床特点。方法选取2008年5月-2011年4月,在医院进行治疗的呼吸合胞病毒下呼吸道感染260例新生儿为研究对象,对其采用氧疗、雾化吸入及抗病毒、抗菌药物治疗,后将其治疗有效率、住院时间及治疗前后的血清IL-4、IL-6、IL-12、CRP、IgE及外周血T淋巴细胞亚群水平进行统计比较。结果 260例患儿痊愈239例,好转20例,无效1例,总有效率为99.62%,住院时间为(12.8±2.8)d,治疗后IL-4、IL-6、IL-12分别为(7.55±2.69)、(16.69±7.14)、(56.48±13.39)ng/L,CRP为(6.88±2.39)mg/L,CD8+为(26.52±5.69)%均高于治疗前;治疗后IgE为(808.34±205.30)μg/L,CD3+、CD4+分别为(63.12±5.20)%、(45.58±5.20)%,CD4+/CD8+为(1.68±0.43)%,均高于治疗前,治疗前后差异有统计学意义(P<0.05)。结论经合理治疗,新生儿呼吸合胞病毒下呼吸道感染治疗效果较佳,可显著改善炎性因子及免疫状态。     

Control and prevention of healthcare-associated tuberculosis: the role of respiratory isolation and personal respiratory protection

Although the prevalence of tuberculosis continues to decline in most developed countries, the risk of healthcare-associated tuberculosis, remains for patients or healthcare staff. Outbreaks of healthcare-associated tuberculosis are usually associated with delays in diagnosis and treatment, or the care of patients in sub-optimal facilities. The control and prevention of tuberculosis in hospitals is best achieved by three approaches, namely administrative (early investigation diagnosis, etc.), engineering (physical facilities e.g. ventilated isolation rooms) and personal respiratory protection (face sealing masks which are filtered). Recent guidelines on the prevention of tuberculosis in healthcare facilities from Europe and the USA have many common themes. In the UK, however, negative pressure isolation rooms are recommended only for patients with suspected multi-drug resistant TB and personal respiratory protection, i.e. filtered masks, are not considered necessary unless multi-drug resistant TB is suspected, or where aerosol-generating procedures are likely. In the US, the standard of care for patients with infectious tuberculosis is a negative pressure ventilated room and the use of personal respiratory protection for all healthcare workers entering the room of a patient with suspected or confirmed tuberculosis. The absence of clinical trials in this area precludes dogmatic recommendations. Nonetheless, observational studies and mathematical modelling suggest that all measures are required for effective prevention. Even when policies and facilities are optimal, there is a need to regularly review and audit these as sometimes compliance is less than optimal. The differences in recommendations may reflect the variations in epidemiology and the greater use of BCG vaccination in the UK compared with the United States. There is a strong argument for advising ventilated facilities and personal respiratory protection for the care of all patients with tuberculosis, as multi-drug tuberculosis may not always be apparent on admission, and these measures minimise transmission of all cases of TB to other patients and healthcare staff.