Comparison of Specialized and Standard Enteral Formulas in Trauma Patients

Study Objective . To compare selected nutrition and immunologic markers and infection in trauma patients receiving a specialized enteral formula with those receiving standard enteral therapy. Design . Prospective, randomized clinical trial. Setting . Level 1 trauma center at a county government hospital. Patients . Forty-one consecutive patients with major trauma who required enteral nutrition support. Thirty-seven patients completed the study. Four patients (two in each group) were excluded, as additional operative procedures prevented initiation of enteral feedings within 7 days of injury. Interventions . Nineteen patients fed the specialized enteral formula received supplemental arginine, linolenic acid, β-carotene, and hydrolyzed protein for up to 10 days. Eighteen control patients received standard enteral nutrition. Measurements and Main Results . After study entry, patients who received the specialized enteral formula had fewer infections than those receiving standard enteral nutrition (3/19 vs 10/18; p<0.05). The change in nitrogen balance was significantly better (p<0.05) from day 1 (−11.8 ± 1.8 g/day) to day 5 (−5.9 ± 2.0 g/day) for the group who received the specialized formula compared with the group who received standard enteral nutrition (-7.3 ± 1.7 g/day to −7.4 ± 2.8 g/day). Similarly, the change in C-reactive protein serum concentration was significantly better (p<0.05) from day 1 (18.0 ± 2.1 mg/dl) to day 5 (11.8 ± 1.5 mg/dl) in the group who received the specialized formula compared with the group who received standard enteral nutrition (17.6 ± 1.2 mg/dl to 14.4 ± 1.7 mg/dl). The CD4:CD8 ratio increased more in the group who received the specialized formula, although this difference did not reach statistical significance. Conclusion . Trauma patients who received the specialized enteral formula demonstrated a decreased incidence of infection and increased improvements in nitrogen balance and other indexes of stress. Additional clinical trials demonstrating positive patient outcomes are necessary before these specialized enteral formulas are used as the standard of practice in critically ill patients.     

39例新型冠状病毒肺炎重症患者营养干预及药学监护实践

目的：分析总结新型冠状病毒肺炎（COVID-19）重症患者营养支持现状及难点,从营养干预、营养药品使用及监护方面为COVID-19的救治提供参考。方法：纳入2020年1月28日至2月23日郑州大学第一附属医院重症隔离病房收治的39例COVID-19患者,含重型20例,危重型19例。营养药师对比分析了2组患者入ICU 7 d内的营养支持现状及难题,通过调整肠内营养制剂品种,制定肠外营养方案对COVID-19患者进行个体化营养支持及全程药学监护。结果：相对于COVID-19重型患者,危重型患者的营养风险筛查（NRS2002）评分≥5的占比更高、合并的基础疾病更多、消化道不良反应发生率也更高。入ICU第7天,经口进食及肠内营养补充为重型患者主要营养支持方式,平均能量和蛋白摄入量分别是（19.4±7.1）kcal·（kg·d）^-1和（0.6±0.2）g·（kg·d）^-1;全肠内营养及肠外营养为危重型患者主要营养支持方式,平均能量和蛋白摄入量分别是（15.5±6.3）kcal·（kg·d）^-1和（0.7±0.3）g·（kg·d）^-1。结论：COVID-19重症患者营养风险高,营养药师可协助其更快达到低热卡目标能量和氮量需求的75%以上,可为COVID-19的救治提供更多的临床营养支持经验及药学监护建议。     

Oral medications administration through enteral feeding tube: Clinical pharmacist-led educational intervention to improve knowledge of Intensive care units’ nurses at Jordan University Hospital

IntroductionMedication administration through enteral feeding tubes is a practice that is commonly encountered in hospital settings, particularly in critically ill patients. This study aims to evaluate the knowledge of intensive care unit nurses regarding enteral medication administration and evaluate the effect of an educational intervention led by a clinical pharmacist that would improve nurses’ knowledge regarding the subject.MethodsA pre/post interventional study was conducted. Improvement in nurses’ knowledge regarding medication administration through an enteral feeding tube was assessed using a validated questionnaire.ResultsData were coded, entered, and analyzed using the Statistical Package for Social Sciences (IBM SPSS statistics 22). Independent samples t-test and paired t-test were used to detect any statistically significant differences in the mean total knowledge scores both between and within each group respectively. A P-value of <0.05 was considered statistically significant. The mean total knowledge score for nurses in the intervention and control group at the pre-interventional phase of the study was inadequate. There was a statistically significant improvement in the mean total knowledge score for the interventional group at the post-interventional phase of the study, while that of the control group remained inadequate (Intervention group total mean knowledge score at baseline 12.11 ± 3.75, post-intervention 21.50 ± 2.36, p-value <0.001; Control group total mean knowledge score at baseline 12.05 ± 3.12, post-intervention 12.60 ± 3.76, p-value 0.96).ConclusionIncorrect drug preparation and administration for patients with feeding tubes can affect patients. The knowledge of nurses regarding the subject can be improved significantly via an educational intervention. The activation of clinical pharmacists’ role and collaboration between pharmacists, physicians, and nurses is highly recommended in this clinical setting.     

QT Interval Prolongation and Torsades de Pointes Due to Erythromycin Lactobionate

Study Objectives . To discern the frequency of torsades de pointes and QT prolongation in patients receiving intravenous erythromycin lactobionate; to examine the degree of QT prolongation and QT dispersion due to intravenous erythromycin in a typical clinical setting; and to identify any concurrent factors that might predispose patients to excessive QT prolongation or torsades de pointes while receiving intravenous erythromycin. Design . Retrospective cohort trial. Setting . A university teaching hospital. Patients . All inpatients who received intravenous erythromycin lactobionate during a 1-year period. Measurements and Main Results . The records of 278 consecutive patients were analyzed, of whom 49 had 12-lead electrocardiograms while receiving and not receiving erythromycin. The dosages of erythromycin ranged from 18–83 (42 pL 18) mg/kg/day. Of the 49 patients, the baseline QTc was 432 ± 39 msec, compared with 483 ± 62 msec during erythromycin therapy (p<0.01). In 30 of 49 patients with heart disease, the increase in QTc due to erythromycin was 15 ± 11%, compared with 8.6 ± 10% in the 19 patients without heart disease (p<0.05). The degree of QTc dispersion was 34 ± 16 msec at baseline, compared with 80 ± 35 msec with erythromycin (p<0.01). Overall, 19 (39%) of 49 patients had a moderate to severe delay in ventricular repolarization (QTc ≥ 500 msec). Of the 278 patients prescribed intravenous erythromycin over the year, it caused torsades de pointes in just one (≤ 0.4%). Conclusion . Erythromycin lactobionate-induced torsades de pointes is rare, although QT prolongation is common. Some patients may be at risk for suffering torsades de pointes due to this agent, particularly if heart disease or other factors that may further delay ventricular repolarization are present.     

神阙灸防治ICU肠内营养并发腹泻的临床疗效观察

目的：观察艾灸神阙穴防治ICU肠内营养并发腹泻的临床疗效。方法将120例患者随机分为试验组和对照组,每组60例,所有患者在积极治疗原发疾病同时,给予百普力采用持续输注的鼻饲方式进行肠内营养,试验组在肠内营养第1天开始给予神阙穴温和灸。结果在肠内营养治疗第7天时观察患者的腹泻发生率,发现试验组、对照组腹泻发生率分别为16.7%、36.7%,试验组明显低于对照组,经x2检验,P＜0.05,差异有统计学意义。结论神阙穴艾灸用于防治ICU危重患者肠内营养并发的腹泻疗效显著,且操作简便,成本低廉,值得推广应用。     

Early postoperative gastric enteral nutrition improve gastric emptying after cardiac surgery

Postoperative intragastric enteral feeding in cardiac surgery patients is frequently complicated by delayed gastric emptying. The aim of the study was to evaluate how early postoperative gastric enteral nutrition affects the gastric emptying in coronary artery by-pass graft (CABG) surgery patients. In the prospective, randomized study 40 patients treated at intensive care unit after CABG surgery were studied. Patients were divided in two groups: enteral feeding group E (20 patients: age 59±8 yr.; male 70%) and control group C (20 patients: age 58±10 yr.; male 80%), respectively. Paracetamol absorption test was used to evaluate gastric emptying. In the group E postoperative gastric supply of enteral formula begun 18 hours after surgery and after 6 hours the supply was stopped and paracetamol solution was administrated by nasogastric tube. The patients in group C for.rst 24 hours received only crystalloid solutions intravenously and paracetamol solution by nasogastric tube. Blood samples were obtained at 0 (t₀), 15 (t₊₁₅), 30 (t₊₃₀), 60 (t₊₆₀) and 120 (t₊₁₂₀) min after administration of paracetamol. The values of plasma paracetamol concentration (PPC) at 15 and 120 min were significantly higher in group E vs. group C: (t₊₁₅) 3.3_±2.5 vs. 1.7±1.9 and (t₊₁₂₀) 5.2_−2.8 vs. 3.3_±1.6 (p <0.05). The PPC values at 30 and 60 min were higher, but not signi.cantly, in group E vs. group C: (t₊₃₀) 3.7±2.0 vs. 2.9±2.7 and (t₊₆₀) 5.1±3.2 vs. 3.9±3.5 (p = NS). The area under the PPC curve was 429 ± 309 in the E group vs. 293 ± 204 in the group C (p < 0.05). In conclusion an early postoperative gastric administration of nutritients after CABG surgery stimulates the gastric emptying.     

Health-related quality of life in patients after the acute myocardial infarction

Introduction

Acute myocardial infarction has a negative impact on patient’s quality of life. The aim of this paper was to evaluate the health-related quality of life in patients one month after the acute myocardial infarction.

Material and method

The study involved 160 patients of both sexes, 30 to 79 years of age. The health-related quality of life in patients was assessed at the admission at the coronary care unit, and one month after. The following questionnaires were used: EuroQuolVAS and EuroQuol 5 Dimension. Angina pectoris was ranked according to the Canadian Cardiovascular Society Classification. Results: Men and women evaluated their health condition in a similar way (60.48±11.98 vs 60.55±12.24). Patients who (have) undergone primary coronary intervention had significantly higher average scores on EuroQuolVAS than the patients who were treated with thrombolytic therapy (68.69±9.67 vs 52.31±7.87, p<0.001). Modest and severe problems were the most presented in answers to those questions: pain/discomfort, anxiety/depression and self-care. Both men (0.92±0.43 vs 3.27±0.59, p<0.001) and women (0.89±0.46 vs 3.19±0.55, p<0.001) had significiantly lower average marks of angina pectoris one month after the acute myocardial infarction than at the admission to the hospital.

Conclusion

One month after the acute myocardial infarction the quality of life in patients was very impared. Patients who undergone to the primary coronary intervention evaluated their health condition as better than the patients who were treated with thrombolytic therapy. Those patients also had the lower average marks of angina pectoris and the higher health-related quality of life.     

肠内营养在食管癌手术中胸导管结扎病例的应用

目的 了解胸导管结扎后肠内营养治疗对胸腔引流情况的影响。方法将116例食管癌手术患者分成肠内营养组（A组）和非肠内营养组（B组）。两组均在手术同期行低位胸导管结扎。A组病例术中置空肠营养管,从术后第1天开始肠内营养至术后第7天。B组患者术后肠外营养。两组病例分别统计胸腔引流量及胸管置留天数。结果两组病例的胸腔引流量和引流天数的差异无统计学意义。A组病例平均引流量（1087±98）ml,引流天数：（4．53±1．19）d。B组病例平均引流量（1268±103）ml,引流天数：（4．34±1．37）d。结论食管癌手术中胸导管结扎后可以施行早期肠内营养,不会引起胸腔引流量的增加和置管时间延长。     

对611例喉癌术前营养评价和术后肠内营养支持效果观察

目的：对喉癌患者进行术前营养评价及术后肠内营养支持的效果观察。方法选择1996年1月-2012年12月解放军白求恩国际和平医院收治的喉癌择期手术患者611例,对术前营养状况进行评价,术后经鼻胃管给予高能高蛋白全营养粉剂,每日能量125.4~146.3 kJ（30~35 kcal）/kg理想体重,蛋白质1.2~1.5 g/kg理想体重。分别于术前、管喂第1天、管喂第7天和管喂停止日测量体重和血清白蛋白、前白蛋白、血红蛋白、淋巴细胞总数,观察消化道症状和切口愈合情况。结果16.0%的患者术前体重过低,10.8%存在低白蛋白血症。除体重外,管喂停止日患者血清白蛋白、前白蛋白、血红蛋白、淋巴细胞总数均较管喂第1天明显升高（P〈0．05,P〈0．01）,达到术前水平。95.7%的患者手术切口一期愈合。仅4.3%的患者发生咽瘘,经积极处理瘘口均愈合。结论术后积极进行科学的肠内营养支持可改善喉癌患者的营养状况,促进切口愈合,降低并发症的发生率。     

Effect of Sustained Endotoxemia on α1-Adrenergic Responsiveness in Parenterally Fed Rats

We investigated the effect of endotoxemia on α₁-adrenergic receptor-mediated smooth muscle contraction as measured by mean arterial pressure (MAP) in response to incremental doses of a vasopressor. Twelve male Sprague-Dawley rats were randomized to receive parenteral nutrition alone (PN) or in combination with a continuous infusion of endotoxin (PN-LPS) for 48 hours. Incremental doses of phenylephrine were given and peak MAP response was recorded. The endotoxin group had a decreased rise in MAP with the same dose of phenylephrine compared with the control group (59 ± 14 and 99 ± 12 mm Hg, respectively, p<0.001). However, the baseline MAP was higher in the endotoxin group (102 ± 18 and 71 ± 7 mm Hg, respectively, p<0.002). The overall maximum effect was the same for both groups (161 ± 16 and 170 ± 8 mm Hg, respectively, p=NS). These data indicate that sustained endotoxemia does not result in desensitization of α₁-adrenergic responsiveness. Other mechanisms are responsible for the ineffectiveness of vasopressors during advanced sepsis.     

结肠癌术后早期肠内营养的应用价值

目的探讨结肠癌术后早期肠内营养（EN）的临床应用价值。方法93例结肠癌患者按入院单双号分为EN组（57例）和肠外营养组（PN组,36例）,EN组于结肠癌术后24h内开始经空肠营养管滴人肠内营养制剂并逐步减少静脉营养支持,PN组于结肠癌术后每日行完全肠外静脉营养支持,直到经口进食。观察两组胃肠功能恢复时间、营养状况及血清C-反应蛋白水平变化情况。结果两组术后营养状态指标均较术前明显下降,但两组间差异无统计学意义（P〉0．05）;EN组肛门排气时间、排便时间分别为（52．9±17．6）h和（67．2±9．3）h,与PN组的（71．4±13．8）h和（83．6±10．1）h相比较,差异均有统计学意义（t=2．58、3．56,均P〈O．05）;术后7dEN组C-反应蛋白水平（19．3±2．2）mg／L明显低于PN组的（27．8±2．3）mg／L（t=4．12,P〈0．05）。结论早期EN能降低结肠癌术后应激反应,促进胃肠功能的早期恢复。     

Altered Protein Binding of Quinidine in Patients with Atrial Fibrillation and Flutter

Study Objectives . To determine if α₁-acid glycoprotein (AAG) concentrations are altered in patients with atrial fibrillation and flutter (AFF), and to establish if fluctuations in AAG change the free fraction of quinidine. Design . Prospective, controlled, nonrandomized. Setting . Tertiary care medical center and outpatient clinics. Patients . Thirty patients with AFF and 16 matched controls. Interventions . Serial blood samples were collected from patients with AFF at baseline and for 28 days after cardioversion. The control group received no treatment and a single blood sample was obtained. Measurements and Main Results . Concentrations of AAG were measured by Laurell-Rocket immunoelectrophoresis. Quinidine concentrations were determined by fluorescence polarization immunoassay using the Abbott TDx system. Baseline AAG concentrations in patients with AFF (122 ± 55 mg/dl) were significantly increased compared with the control group (62 ± 28 mg/dl, p<0.0005). Concentrations of AAG remained elevated after conversion to sinus rhythm and did not significantly change over the study period, regardless of method of cardioversion (p>0.2). In patients with AFF, the free fraction of quinidine at the highest AAG concentration was 8.5 ± 2.3%. This was significantly reduced compared with the value in the control group (12.5 ± 3.0%, p<0.05) as well as that in patients with AFF at the lowest AAG concentration (11.0 ± 2.5%, p<0.05). Overall at the highest AAG concentration, patients with AFF had a relative reduction in the quinidine free fraction by 32% compared with controls. Regression analysis showed an indirect relationship between serum AAG concentration and the unbound fraction of quinidine (r=0.56) Conclusions . Concentrations of AAG are increased in patients with AFF and remain elevated for at least 28 days after cardioversion. Elevated AAG concentrations significantly reduce the free fraction of quinidine.     

肿瘤患者肠内、外营养及围术期营养支持用药现状分析

目的:了解肿瘤患者肠内、外营养药物的应用情况及围术期的营养支持现状。方法:调查某"三甲"肿瘤专科医院2002、2005、2010年肠内、外营养药物的消耗情况及2010年5月采用营养支持治疗的外科手术出院患者260份病历,对照《临床诊疗指南——肠外肠内营养学分册》,分析肠内、外营养药物的应用变化趋势。结果:该院肠内、外营养药物的用量不断上升,2005年较2002年增加18.23%,2010年较2005年增加54.44%,尤其在外科围术期消化系肿瘤患者中用量最多;临床尚存在肠内肠外营养药应象用,术倒前置9问4.7题%,和26术0例后中35肠.9内%与的肠患外者营营养养支支持持的不时足间5比d,为术后1∶3前,日3天均有费用23比.3%为的1∶患4.2者;还每存天在热营量养>支25持k不cal·足k和g-营1。养结支论持:营过养度支并持存治等疗现在该院逐渐被临床医师所重视,但其应用的合理性尚需规范。     

An open-label evaluation of rifaximin in the treatment of active Crohn's disease

ABSTRACT

Objective: This open-label study was conducted as a preliminary assessment of rifaximin (200?mg TID for 16 weeks) for the treatment of active Crohn's disease in patients (n = 29) with symptoms for at least 3 months before screening and a Crohn's Disease Activity Index (CDAI) score > 220 and < 400.

Results: At the end of month 4, mean ± SD CDAI score was reduced by 43% compared with baseline in the intent-to-treat population (n = 29; baseline = 278 ± 51; month 4 = 159 ± 102; p < 0.0001 month 4 versus baseline). A similar pattern of results was observed in the per-protocol population (i.e., patients at least 70% compliant with the treatment regimen and having no protocol violations thought to affect efficacy results; n = 16), in which mean CDAI scores at month 4 were reduced by 41% from a baseline of 262.9 ± 38.2 to 155.6 ± 104.5 (?p = 0.0009 month 4 versus baseline). Fifty-nine percent of patients (59%) had a ≥ 70‐point improvement in CDAI score beginning with the first assessment at the end of month 1. By the end of the treatment period, 78% of patients had a ≥ 70‐point improvement in CDAI score. Clinical remission, defined as CDAI score < 150, was observed at the end of treatment months 1, 2, 3, and 4 in 41%, 56%, 56%, and 59% of patients, respectively. Twenty-three (23) patients completed the 4-month course of rifaximin therapy, and 6 prematurely withdrew. The most common adverse events were abdominal pain, fatigue, and headache.

Conclusion: These data, which are consistent with the possibility that rifaximin may be useful for active Crohn's disease, warrant confirmation in a randomized, double-blind, placebo-controlled trial.     

肠内免疫营养对胃癌切除术后患者免疫功能的影响

目的:研究比较肠内免疫营养和普通肠内营养对胃癌切除术后患者免疫功能的影响。方法:36例胃癌行胃大部或全胃切除术后需做营养支持的患者随机分为肠内免疫营养组(n=18)普通肠内营养组(n=18),均在手术后第2~8天给予等热卡(125 kJ.kg-1.d-1)营养支持;在术前1 d、术后1 d和术后9 d检测淋巴细胞总数、B淋巴细胞、T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)、免疫球蛋白(IgG、IgM、IgA)、细胞因子(IL-1α、IL-2、IL-6、IL-10、TNF-α)及NK细胞活性。结果:经过7 d的营养支持,与普通肠内营养组相比肠内免疫营养组的CD3、IgM、IL-2显著增加(P<0.05),淋巴细胞总数、IgA、CD4、CD4/CD8、IgG、IgA、IL-6和NK细胞活性非常显著增加(P<0.01)。结论:早期肠内免疫营养较普通肠内营养能更加有效的改善胃癌术后患者的免疫功能,从而减少术后感染及并发症的发生,更好地促进患者康复。     

An Assessment of Recent Pharmacy Graduates' Knowledge and Competency,Professional Practice Functions,and Involvement in Pharmacy Teaching Programs

Study Objectives . To determine self-evaluated professional knowledge and competency, functions, demographic information, lifelong learning, degree and training status, practice sites, involvement in pharmacy teaching programs, and salary for recent pharmacy graduates. Design . A survey of recent Bachelor of Science (B.S.) pharmacy graduates of the University of Wisconsin School of Pharmacy. Measurements and Main Results . A total of 371 B.S. pharmacy graduates (55% response rate) provided information. Graduates who had an advanced degree or training (from many programs) after completing their B.S. pharmacy degree, and those who were teaching in pharmacy programs generally had higher self-rated levels of knowledge and competencies. Hospital pharmacists spent less of their work time in dispensing activities (33.82% ± 30.39%) than community pharmacists (61.04% ± 19.97%; t =8.78, df = 288, p<0.001); community pharmacists spent twice as much of their work time counseling and educating patients (16.65% ± 10.47% vs 7.13% ± 7.39%; t = 9.06, df = 288, p<0.001). The amount of time pharmacists spent in dispensing functions had a negative association with knowledge and competencies in the sections on pharmacokinetic and disease process (r=−0.277, p<0.01), patient communications (r=−0.272, p<0.01), and administrative and economic aspects of practice (r=−0.210, p<0.01) for all respondents. Pharmacists reported that they spent 13.78 ± 14.06 hours per month outside work in professional lifelong learning. There was a negative association between the time pharmacists spent dispensing and the time they spent in professional lifelong learning (r=−0.239, p<0.001), and a positive relationship between the time spent in such learning and the time providing information to prescribers and other health care professionals (r=0.214, p<0.001), monitoring patients (r=0.216, p<0.001), and performing primary care activities (r=0.176, p<0.001). Graduates reported a mean yearly salary of $46,879 ± $8183. More hospital pharmacists were involved in teaching (48, 37%) than those practicing in a community setting (19, 12%). Conclusions . Practice site, advanced degree or training, lifelong learning, involvement in teaching programs, and time spent in various professional functions were associated with pharmacists' self-rated knowledge and competencies. (Pharmacotherapy 1994;14(6):712–723)     

慢性阻塞性肺疾病急性加重期患者早期肠内营养护理干预

目的探讨早期肠内营养在慢性阻塞性肺疾病（chronicobstructive pulmonarydisease）急性加重期患者治疗中的护理干预。方法将慢性阻塞性肺疾病（COPD）急性加重期患者60例随机分为试验组和对照组,于入院后24h内分别给予鼻饲肠内营养支持和普通鼻饲饮食,两组患者分别于入院第1天及21天测定血清总蛋白质、血清白蛋白、血红蛋白含量。并观察营养指标的变化和呼吸功能变化。结果21天后,肺功能和血气检查,试验组的FVC、FEV／FVC及PaO2有明显改善（P〈0．05）,试验组的营养指标亦显著优于对照组。结论早期肠内营养是COPD患者的一项重要治疗措施,良好细致的护理是保证其成功实施的关键。     

序贯性与非序贯性早期肠内营养对食管癌术后患者临床疗效的比较研究

目的 观察食管癌术后序贯性早期肠内营养与非序贯性早期肠内营养的临床疗效,明确食管癌患者是否从序贯性营养支持疗法中获益。方法 将92例拟行食管癌根治术的患者分为序贯性早期肠内营养组（46例）和非序贯性早期肠内营养组（46例）,比较两组临床结局指标（胃肠道功能恢复情况、肠内营养耐受情况、术后并发症、术后住院时间）和营养指标（白蛋白、前白蛋白等）。结果 与非序贯性早期肠内营养组相比,序贯性早期肠内营养组首次肛门排气时间缩短,首次自然排便和肠内营养耐受性良好例数增加,差异均有统计学意义（P<0.05）。两组患者的术后营养指标、人体成分、术后并发症、术后住院时间比较,差异均无统计学意义（P>0.05）。结论 对于食管癌术后患者,序贯性早期肠内营养支持方案有利于胃肠道功能的恢复和肠内营养耐受性的提高,值得临床进一步推广。     

The efficacy of nutrition support in infected patients with chronic renal failure

Patients with chronic renal failure are at considerable nutritional risk due to restricted diets, poor intake, and dialysis-related protein losses; therefore, they often require specialized nutrition support. It is difficult, however, to gauge the success of the intervention, since the gold standard nitrogen balance cannot be easily employed. We examined the usefulness of three visceral proteins, insulinlike growth factor 1 (IGF-1), fibronectin (FBN), and prealbumin (PA), as markers of nutrition support efficacy in patients with chronic renal failure. Fourteen patients receiving enteral (1) or parenteral (13) nutrition were studied for 7-28 days. The six males and eight females attained intakes of protein and nonprotein energy of 1.3 +/- 0.3 (mean +/- SD) g/kg/day and 34 +/- 6 kcal/kg/day, respectively. Blood samples taken on days 1, 4, 7, 14, 21, and 28 were assayed for IGF-1, FBN, and PA concentrations. Protein levels were correlated with cumulative nonprotein energy and protein intake. Concentrations of IGF-1 at baseline (0.90 +/- 0.48 U/ml) rose significantly by day 4 (1.35 +/- 0.78 U/ml) and remained significantly above baseline at days 7 (1.44 +/- 0.68 U/ml), 14 (1.63 +/- 1.05 U/ml), and 28 (1.59 +/- 0.98 U/ml). Baseline FBN (113 +/- 53 micrograms/ml) and PA (15.3 +/- 7.8 mg/dl) concentrations rose significantly by day 28 (FBN, 163 +/- 51 micrograms/ml; PA, 24.6 +/- 19.0 mg/dl). The PA concentrations correlated significantly with cumulative nonprotein calories and cumulative protein intake (r = 0.37, p less than 0.01; r = 0.43, p less than 0.01, respectively). Both IGF-1 and PA show promise as markers of nutrition support efficacy in this complex patient population.     

危重型胰腺炎全身炎症采用谷氨酰胺联合早期肠内营养治疗的临床效果

目的 探讨采用谷氨酰胺联合早期肠内营养治疗危重型胰腺炎对患者炎症反应的影响.方法 在2014年6月至2016年4月期间本院收治的危重型胰腺炎患者中选取82例,按照治疗方案的不同将其分为观察组和对照组,其中对照组患者仅接受肠外营养,观察组患者则采用早期肠内营养联合谷氨酰胺进行治疗,对两组患者炎症反应、氨基酸代谢情况进行观察分析.结果 观察组患者在治疗后MCP-1[(25.3±3.4) ng/ml]、HMGB-1[(6.7±0.9) ng/ml]水平均明显低于对照组[(41.2±6.3) ng/ml、(10.5±1.7)ng/ml],差异有统计学意义(P＜0.05);观察组患者在治疗结束后,其血清苏氨酸[(11.2±1.5) μmol/L]、苯丙氨酸[(4.3±0.6)μmol/L]、缬氨酸[(4.9±0.7) μmol/L]及赖氨酸[(6.6±0.8)μmol/L]水平均明显高于对照组[(7.6±0.9)μmol/L、(2.3±0.4)μmol/L、(3.5±0.4)μmol/L、(2.7±0.3)μmol/L],差异有统计学意义(P＜0.05).结论 采用早期肠内营养联合谷氨酰胺治疗危重型胰腺炎,可有效促进患者蛋白质合成的改善,有助于缓解机体负氮平衡,并有利于促进患者全身炎症反应的缓解,建议在临床推广应用.