经外周静脉输注全营养混合液安全性观察

目的：观察经外周静脉输注全营养混合液的安全性。方法：随机选择５０例普外科危重病人苛大手术后病人，经外周静脉输注全营养混合液３￣１５天，平均１０天。结果：４例（８％）因外周静脉输注ＴＮＡ而产生症状，其中６％（３例）为患肢疼痛或穿刺部位血管周围红肿，更换穿刺部位后继续营养支持，２％（１例）因严重血栓性静脉炎终止输注营养液。结论：通过外周静脉输注全营养混合液进行营养支持是安全，可行的，适用于短期肠外营养     

经外周静脉输注全营养混合液的安全性和适应证

研究经外周静脉输注全营养混合液安全性和适应证。随机选择 5 0例普外科大手术后病人 ,经外周静脉输注全营养混合液约 2周。结果 3例轻度静脉炎 ,更换穿刺部位后继续营养支持 ,1例严重血栓性静脉炎终止输注营养液外 ,均顺利完成营养支持治疗 ,无严重并发症。结论 :通过外周静脉输注全营养混合液进行营养支持是安全、可行的 ,适用于需短期进行营养支持的病人 ,但需防治血栓性静脉炎。经外周静脉输注全营养混合液的安全性和适应证@姜海平$暨南大学医学院第一附属医院普外科 @容松$暨南大学医学院第一附属医院普外科 @杨雪华$暨南大学医…     

全营养素混合液在胃肠手术后早期胃肠外营养中疗效的观察

比较全营养素混合液(TNA)三升袋输入外周静脉和传统非三升袋外周静脉营养两种方式对胃肠手术后早期胃肠外营养(TPN)疗效的影响。为此将117例胃肠手术后早期TPN的患者随机分为A、B两组。A组(61例)采用以三升静脉营养输液袋将TNA均匀输入外周静脉的方式，B组(56例)则采用将氨基酸、葡萄糖、脂肪酸等营养制剂分瓶相继连续由外周静脉输注的方式进行TPN。TPN的疗效采用肠外营养疗效的积分评定法进行评定。结果表明，TNA的三升袋(EVA)输入方式可显著提高TPN的疗效，并可有效减少TPN的并发症。     

1208例全营养混合液临床应用的前瞻性调查

目的了解与分析住院患者全营养混合液（TNA）临床应用情况。方法前瞻性分析1208例患者的营养风险、科室分布、TNA使用时间、输液途径等。结果使用TNA的患者遍及临床各科室。欧洲营养风险筛查（NRS2002）≥3分的患者1090例,占90．2％,〈3分的患者118例,占9．8％。接受TNA治疗时间〈5d者495例,占41％。接受TNA治疗时间≤14d者908例,其中使用中心静脉插管占12％,使用外周静脉插管占88％;接受TNA治疗时间〉14d者300例,其中使用中心静脉插管占95％,使用外周静脉插管占5％。结论TNA应用广泛,但还需进一步规范与完善。应加强全面的临床营养培训,并进一步推广NRS2002的应用,推荐采用经外周置入中心静脉导管输液途径。     

1208例全营养混合液临床应用的前瞻性调查

目的 了解与分析住院患者全营养混合液(TNA)临床应用情况.方法 前瞻性分析1208例患者的营养风险、科室分布、TNA使用时间、输液途径等.结果使用TNA的患者遍及临床各科室.欧洲营养风险筛查(NRS 2002)≥3分的患者1090例,占90.2%,<3分的患者118例,占9.8%.接受TNA治疗时间<5 d者495例,占41%.接受TNA治疗时间≤14d者908例,其中使用中心静脉插管占12%,使用外周静脉插管占88%;接受TNA治疗时间>14d者300例,其中使用中心静脉插管占95%,使用外周静脉插管占5%.结论 TNA应用广泛,但还需进一步规范与完善.应加强全面的临床营养培训,并进一步推广NRS 2002的应用,推荐采用经外周置人中心静脉导管输液途径.     

重症胰腺炎经外周静脉行营养支持治疗的体会

目的：探讨经外周静脉行营养支持在重症胰腺炎治疗中的作用。方法：回顾分析近8年我院收治的重症胰腺炎病例,观察经外周静脉行营养支持病例的治疗结果和并发症情况。结果：33例应用营养支持的病例中治愈31例,无与外周静脉输注相关的并发症。结论：营养支持是治疗重症胰腺炎的一项重要措施。经外周静脉输入营养是一条安全、有效的重要途径。     

经门静脉肠外营养的临床对照研究

本研究旨在比较经门静脉途径肠外营养与常规外周静脉途径营养支持的代谢效果。１２例大肠癌行根治术的病人，随机分成两组。６例于术中放置门静脉导管，术后经门静脉行营养支持连续５个月；对照组经外周静脉途径行肠外营养。肠外营养以富含支链氨基酸的肝安注射液提供氮源...     

彩超引导联合改良塞丁格行PICC置管在疑难输液患者的应用

<正>静脉输液发展至今已经有100多年的历史,输液的途径已由单一外周静脉向深静脉输液发展,经外周静脉置入中心静脉导管(PICC)20世纪90年代后期被美国BD公司引入中国,广泛用于肿瘤化疗、成人术后肠外营养和早产儿营养通路的建立等方面[1]。随着中国人口的老龄化,慢性病患者增多,长期反复     

经外周静脉穿刺中心静脉置管应用于胃肠外营养

目的探讨经外周静脉穿刺中心静脉置管(PICC)应用于胃肠外营养。方法通过对我科33例应用PICC进行长期静脉营养患者的观察,分析常见并发症发生原因及处理方法。结果PICC能满足长期胃肠外营养,并发症少。结论PICC为静脉营养支持的良好途径,而专业的护理可延长PICC使用时间,减少患者费用。     

双头联体女婴静脉护理

2011年5月9日第三军医大学附属新桥医院收治了1例双头联体女婴,因患儿病情重,用药种类多,补液时间长,与外周多处建立静脉通道补液,随着患儿病情加重,外周静脉反复穿刺,静脉营养、人血白蛋白、血浆等各种血液制品等高渗透、刺激大的药物输入,使得静脉留置针保留时间短,穿刺难度大,患儿补液不足。于6月17日行左侧大隐静脉置管,与外周静脉同时建立通道以便及时有效的补液用药。     

Norepinephrine and the control of food intake

The focus of the present review is to reconsider the role of endogenous norepinephrine (NE) in brain, specifically within the hypothalamic paraventricular nucleus (PVN), with regard to its potential role in eliciting eating or satiety. The PVN is innervated by NE fibers and is a site at which infusion of exogenous NE elicits eating at low doses. Two subtypes of alpha-adrenergic receptors within the PVN exert antagonistic actions on eating in the rat: activation of PVN alpha(2)-adrenoceptors increases eating, whereas activation of PVN alpha(1)-adrenoceptors suppresses eating. Pharmacologic manipulations that elevate NE can increase or decrease food intake, depending on the site and type of NE manipulation. Certain antiobesity drugs may act to reduce eating via release of NE and subsequent activation of alpha(1)-adrenoceptors. The PVN exhibits a reliable rhythm in the secretion of endogenous NE over the dark-and-light cycle, and this rhythm may interact with changes in numbers of PVN alpha(1)- and alpha(2)-adrenoceptors to modulate eating during the dark-and-light cycle. Push-and-pull and microdialysis studies indicate that NE secretion is strongly associated with eating, particularly at the start of the dark phase. The present review considers potential interactions of NE with substances such as leptin and neuropeptide Y that alter eating.     

Suppression of feeding induced by phenylephrine microinjections within the paraventricular hypothalamus in rats.

Rats were treated with the alpha-2 agonist clonidine (4, 20 and 50 nMol) and with the alpha-1 agonist 1-phenylephrine (50, 100, 200 and 400 nMol). Phenylpropanolamine (PPA) is a phenythylamine anorectic drug that exerts direct agonist effects predominantly on alpha-1 adrenergic receptors, with some alpha-2 adrenergic activity. We recently reported that injection of PPA significantly suppressed feeding in rats. Prior studies have noted that into the paraventricular hypothalamus (PVN) microinjections of the alpha-2 adrenergic receptor agonist clonidine into the PVN induced feeding behavior in satiated rats. However, the effect on feeding of administration of alpha-1 adrenergic agonists within the PVN remains unknown. In the present study, unilateral guide cannulae aimed at the PVN were surgically implanted in adult male rats. In an initial 60 min feeding test conducted under free-feeding ("non-deprived") conditions, each rat was found to eat significantly more food after injection of 25 nMol norepinephrine (NE) into the PVN. In subsequent tests, the feeding increased significantly to 4 nMol clonidine; however, feeding was suppressed by 50 nMol clonidine. Food intake after 20 nMol clonidine was not significantly different from that recorded after vehicle. In contrast, phenylephrine (100-400 nMol) reliably suppressed feeding behavior. In the final phase of the study, the rats ate significantly less food after injection of 160 nMol PPA into the PVN but consumed significantly more food after a final injection of 25 nMol NE into the PVN. These results suggest that the anorexic action of PPA may be linked to activation of alpha-1 adrenergic receptors within the PVN.     

Noradrenergic activity in the paraventricular nucleus and macronutrient choice during early dark onset by zinc deficient rats

Carbohydrate is a preferred macronutrient of rats during the early dark phase and associated with an increase in norepinephrine (NE) and neuropeptide Y (NPY) in the paraventricular nucleus (PVN). Macronutrient choice is altered during zinc deficiency (ZD). The relationship between NE activity in the PVN and macronutrient choice during early dark was evaluated in rats fed zinc adequate (ZA) or ZD diet for 14 days. Total caloric intake was similar for ZA and ZD groups (-20 kJ) but ZA rats selected 63 +/- 5% of calories as carbohydrate while ZD rats selected 53 +/- 5% of their calories from protein (p < 0.01). Pair-fed (PF) rats selected 62 +/- 5% of calories as carbohydrate. Noradrenergic activity was lower (p < 0.01) in ZD and PF compared to ZA. The association between increased NE in the PVN at dark onset and selection of carbohydrate is not supported by the present results.     

Noradrenergic activity in the paraventricular nucleus and macronutrient choice during early dark onset by zinc deficient rats

Abstract

Carbohydrate is a preferred macronutrient of rats during the early dark phase and associated with an increase in norepinephrine (NE) and neuropeptide Y (NPY) in the paraventricular nucleus (PVN). Macronutrient choice is altered during zinc deficiency (ZD). The relationship between NE activity in the PVN and macronutrient choice during early dark was evaluated in rats fed zinc adequate (ZA) or ZD diet for 14 days. Total caloric intake was similar for ZA and ZD groups (～20 kJ) but ZA rats selected 63 ± 5% of calories as carbohydrate while ZD rats selected 53 ± 5% of their calories from protein (p < 0.01). Pair-fed (PF) rats selected 62 ± 5% of calories as carbohydrate. Noradrenergic activity was lower (p < 0.01) in ZD and PF compared to ZA. The association between increased NE in the PVN at dark onset and selection of carbohydrate is not supported by the present results.     

Superimposed cold stress-induced hypothalamic-pituitary-adrenal response during long-duration restraint stress

It has been reported that animals exposed to prior stress exhibit enhanced, reduced or equivalent hypothalamic-pituitary-adrenal (HPA) response to a subsequent acute stressor. We demonstrated previously that a long-duration restraint stress (RTS) evoked adaptive change, characterized by transient increase and gradual recovery to basal level in c-fos mRNA/c-fos protein (Fos) expression in the hypothalamic paraventricular nucleus (PVN) and in plasma adrenocorticotropin (ACTH) levels, although circulating corticosterone (CORT) remained at a high level. In order to investigate the HPA response to another stressor during the adaptive phase of long-duration RTS, we superimposed acute cold stressor (CS) to 16 hours RTS rats. Superimposed CS-induced re-expression of c-fos mRNA/Fos in the parvocellular region of the PVN (PVNpv) was observed in 16 hours RTS rats. The degree of expression of c-fos gene in superimposed CS rats was the same as those observed in single CS rats. The plasma ACTH levels induced by superimposed CS in 16 hours RTS rats were significantly higher compared with those in single CS rats. On the other hand, there were no significant differences between plasma CORT levels induced by superimposed CS in 16 hours RTS rats and those in single CS rats, and between plasma CORT levels before and after additional CS exposure in 16 hours RTS rats. The present study indicated that c-fos gene expression in PVN induced by superimposed CS was normo-responsive, ACTH secretion was hyper-responsive (facilitation), CORT secretion was slightly increased, but not hyper-responsive in long-duration RTS rats. These findings suggest that stress response induced by superimposed CS during long-duration RTS may occur in a different way at each level of the HPA.     

Hypothalamic nuclei are malformed in weanling offspring of low protein malnourished rat dams

Maternal low protein malnutrition during gestation and lactation (LP) is an animal model frequently used for the investigation of long-term deleterious consequences of perinatal growth retardation. Both perinatal malnutrition and growth retardation at birth are risk factors for diabetic and cardiovascular disturbances in later life. The pathophysiologic mechanisms responsible are unknown. Hypothalamic nuclei are decisively involved in the central nervous regulation of food intake, body weight and metabolism. We investigated effects of a low protein diet (8% protein; control diet, 17% protein) during gestation and lactation in rat dams on the organization of hypothalamic regulators of body weight and metabolism in the offspring at weaning (d 20 of life). LP offspring had significantly lower body weight than control offspring (CO; P: < 0.001), associated with hypoglycemia and hypoinsulinemia (P: < 0. 005) on d 20 of life. This was accompanied by a greater relative volume of the ventromedial hypothalamic nucleus (P: < 0.01) and a greater numerical density of Nissl-stained neurons in this nucleus (P: < 0.01) as well as in the paraventricular hypothalamic nucleus (PVN; P: < 0.001). In contrast, no significant differences in neuronal densities were observed generally in the lateral hypothalamic area, arcuate hypothalamic nucleus (ARC), and dorsomedial hypothalamic nucleus between LP offspring and CO offspring. On the other hand, LP offspring displayed fewer neurons immunopositive for neuropeptide Y in the ARC (P: < 0.05), whereas in the PVN, lower neuronal densities of neurons immunopositive for galanin were found in LP offspring compared with CO offspring (P: < 0.001). On the contrary, in the PVN, no significant group difference in the numerical density of cholecystokinin-8S-positive neurons was present. A long-term effect of these specific hypothalamic alterations on body weight and metabolism in LP offspring during later life is suggested.     

Leptin expression in hypothalamic PVN reverses dietary obesity and hyperinsulinemia but stimulates ghrelin

OBJECTIVE: In order to circumvent the multiple peripheral effects of hyperleptinemia and leptin resistance, the efficacy of leptin transgene expression in the hypothalamic paraventricular nucleus (PVN) to reinstate the central energy homeostasis in obesity was examined. RESEARCH METHODS AND PROCEDURES: A recombinant adeno-associated viral vector encoding either leptin (rAAV-lep) or green fluorescent protein (rAAV-GFP) was microinjected into the PVN of obesity-prone rats consuming a high-fat diet (HFD). RESULTS: rAAV-lep, and not rAAV-GFP, microinjection significantly reduced energy intake and enhanced energy expenditure, thereby resulting in normalization of weight and blood levels of leptin, insulin, free fatty acids, and glucose concomitant with enhanced ghrelin secretion during the extended period of observation. DISCUSSION: Thus, we show, for the first time, that amelioration of leptin insufficiency with enhanced localized leptin availability in the PVN alone can reverse dietary obesity and the attendant hyperinsulinemia and concurrently block the central stimulatory effects of elevated endogenous ghrelin on food intake and adiposity.     

Early and post-weaning malnutrition impairs alpha-MSH expression in the hypothalamus: a possible link to long-term overweight

The present study explored the effects of early and post-weaning malnutrition and nutritional rehabilitation on orexigenic (orexin (ORX) and neuropeptide Y (NPY)) and anorexigenic peptides (alpha-melanocyte stimulating hormone (alpha-MSH)) expressed in hypothalamic nuclei. Male Wistar rats were malnourished during gestation-lactation (MGL) or from weaning to post-natal day 55 (MPW; P55). Two groups of rats were rehabilitated with a balanced diet until P90 (MGL-R and MPW-R, respectively). After a glucose tolerance test (GTT) brains were processed for immunohistochemistry. Malnourished groups were hyperglycemic after GTT. ORX expression did not display any difference. Only MGL rats showed increased NPY immunoreactivity in ARC and PVN nuclei, and both malnourished groups showed low alpha-MSH expression in the PVN and DMH, as compared with their controls. After nutritional rehabilitation rats showed normal GTT, increased rate of body and adipose tissue weights and high proportion of food ingestion. Both rehabilitated groups maintained low alpha-MSH expression in the PVN, indicating a deleterious long-lasting effect.     

论医疗设备管理模式

临床学科的发展在很大程度上取决于仪器的发展。因此,医院医疗设备的管理已成为现代医院管理的一个重要领域。本文提出了医院对医疗仪器的管理面临的技术转变与挑战,指出了在医疗仪器的采购方面,医院应重视和加强理论创新,并遵循＂定额管理、合理使用、保证供应、加速周转＂的原则,加强大型医疗设备的采购、安装验收、使用与维护等管理工作,促进高科技技术人才与高精尖设备的有机结合,形成先进技术与现代管理相互配合的产、学、研优势。     

Ingestion of non-caloric liquid diet is sufficient to restore plasma corticosterone level, but not to induce the hypothalamic c-Fos expression in food-deprived rats

Male Sprague-Dawley rats were subjected to four different conditions; free fed control (FC), 48 h of food deprivation (FD), 1 h of refeeding with chow (RF/CW) or with a non-caloric liquid diet following FD (RF/NC) and then sacrificed for c-Fos immunohistochemistry in the hypothalamic paraventricular nucleus (PVN) and the nucleus tractus of solitarius (NTS). Plasma corticosterone level and the postmortem weight of gastric contents were measured. Plasma level of corticosterone significantly increased during FD, and then decreased within 1 h after ad libitum access to chow or non-caloric liquid diet. c-Fos-ir in the brain regions was not changed by FD; however, significantly increased by chow refeeding, but not by non-caloric diet. Chow, but not the non-caloric, refeeding significantly increased gastric contents. Results suggest that caloric load and/or gastric distension may require for the postprandial activation of neurons in the PVN and NTS, but ingestion of non-caloric palatable mixture may be sufficient to normalize the fasting-induced increase of plasma corticosterone. In conclusion, feeding-related changes in the HPA axis activity may not be related with meal-induced c-Fos expression in the PVN and NTS.