不同营养支持方式对重症急性胰腺炎患者肠道菌群失调的影响分析

目的 探讨不同营养支持方式对重症急性胰腺炎(SAP)患者肠道菌群失调的影响.方法 将2003年1月至2010年6月收治的66例SAP患者按随机数字表法分为研究组和对照组,每组33例,分别接受肠内营养和全胃肠外营养支持治疗,观察并比较两组患者肠道菌群失调的发生情况.结果 经营养支持治疗后,研究组大肠埃希菌和肠球菌的数量明显低于对照组,差异有统计学意义(P＜0.05);双歧杆菌和乳酸杆菌的数量则显著高于对照组,差异有统计学意义(P＜0.05).研究组肠道菌群失调的发生率为24.2%(8/33),显著低于对照组的51.5%(17/33),差异有统计学意义(P＜0.05).结论 肠内营养支持较单独全胃肠外营养支持能减少SAP患者肠道菌群失调的发生.

Abstract：

Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.     

肠内营养对获得性免疫缺陷综合征患者T淋巴细胞免疫功能的影响

目的 研究肠内营养对获得性免疫缺陷综合征(AIDS)患者T淋巴细胞免疫功能的影响.方法 采用随机数字法将79例AIDS患者随机分为两组:(1)对照组(n=33):仅给予常规治疗;(2)肠内营养(EN)组(n=46):在常规治疗的基础上,每日给予EN.于试验前和试验第30天,分别测定两组患者的CD3、CD4、CD8细胞计数.结果 试验前,两组患者的血糖及血丙氨酸转氨酶、天冬氨酸转氨酶、总蛋白(TP)、白蛋白(ALB)和尿素氮、肌酐、前白蛋白(PA)水平间差异均无统计学意义(P均＞0.05);试验第30天,EN组患者的血TP(P=0.015)、ALB(P=0.007)和PA(P=0.022)水平明显高于对照组.对照组试验前与试验第30天的CD3、CD4、CD8细胞计数间差异均无统计学意义(P均＞0.05),EN组患者试验第30天的CD4细胞计数明显高于试验前(P=0.012).结论 EN支持可改善AIDS患者的营养状况和T淋巴细胞免疫功能.

Abstract：

Objective To investigate the effect of enteral nutrition (EN) on the T lymphocytes-mediated immune function in patients with acquired immune deficiency syndrome (AIDS). Methods Totally 79 AIDS patients were randomly divided into enteral nutrition ( EN ) group ( supported with EN daily in addition to conventional treatment; n = 46) and control group (underwent conventional treatment only; n = 33 ). T lymphocytes including CD3, CD4, and CD8 cells as well as blood biochemical parameters including alanine aminotransferase ( ALT), aspartate aminotransferase (AST), glucose ( Glu ), total protein (TP), albumin ( ALB ), blood urea nitrogen (BUN) , Cr, and prealbumin (PA) were determined immediately before management (T0) and on the 30th day(T1). Results ALT, AST, Glu, TP, ALB, BUN, Cr, and PA showed no significant differences between these two groups before management ( all P ＞ 0. 05 ). The levels of TP ( P = 0. 015), ALB ( P = 0. 007 ), and PA ( P =0. 022 ) were significantly higher in EN group than those in control group at T1. The cell counts of CD3, CD4, and CD8 were not significantly different at T0, while the cell count of CD4 was significantly higher in EN group than that in control group at T1 ( P ＜ 0. 05 ). Conclusion EN can improve the nutritional status and T lymphocytesmediated immune function in AIDS patients.     

胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床随机对照研究

目的 比较胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床疗效.方法 采用随机数字表法,将126例拟行开腹胃肠道手术的患者随机分为早期肠内肠外营养支持疗法组(EEN+PN组,n=62)和肠外营养支持组(PN组,n=64),分别于手术前,手术后第3、7天监测患者的体重、体重指数、血清白蛋白、前白蛋白、血脂、血生化、血淋巴细胞计数、血C反应蛋白变化情况,比较两组患者术后胃肠道功能恢复时间、手术并发症、营养支持相关费用及住院天数.结果 术前两组患者的营养相关指标、血生化指标和炎症及免疫指标差异均无统计学意义(P>0.05);术后第3天,EEN+PN组患者前白蛋白水平显著高于PN组[(160.3±23.0)g/L比(137.0±28.7)g/L,P=0.000];术后第7天,EEN+PN组患者前白蛋白[(210.6±34.6)g/L比(154.8±36.9)g/L,P=0.000]、白蛋白[(33.6±3.8)g/L比(31.8±4.7)g/L,P=0.042]、淋巴细胞计数[(2.33±0.53)×109/L比(1.04±0.36)×109/L,P=0.046]水平均显著高于PN组,血γ-谷氨酰转肽酶[(48.12±33.84)U/L比(71.54±34.00)U/L,P=0.048]、C反应蛋白[(31.15±19.00)mmol/L比(45.90±23.21)mmol/L,P=0.042]、总胆固醇[(3.09±0.83)mmol/L比(3.29±0.91)mmoL/L,P=0.045]、低密度脂蛋白[(2.01±0.39)mmoi/L比(2.31±0.72)mmol/L,P=0.049]水平显著低于PN组.EEN+PN组患者术后胃肠道功能恢复时间显著短于PN组[(65.7±15.6)h比(75.1±27.0)h,P=0.036],围手术营养支持疗法总费用显著低于PN组[(2634.5±1306.8)元比(3058.6±1216.0)元,P=0.046].结论 胃肠道手术后早期规范化序贯肠内肠外营养支持疗法可以改善机体术后前白蛋白水平,有益于术后患者免疫功能和组织损伤水平的恢复,促进早期胃肠道功能恢复,降低营养支持疗法相关费用.

Abstract：

Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.     

不同营养治疗方法在妊娠期糖代谢异常中的应用

目的 探讨不同营养治疗方法对改善妊娠期糖代谢异常的代谢紊乱及妊娠结局的影响.方法 选择83例妊娠期糖代谢异常孕妇作为研究对象,孕30周前来营养门诊并按数字表法随机分为传统的食物交换份组(EFS组,42例)和基于血糖负荷概念的食物交换份组(FES+GL组,41例).分别采用相应的营养治疗方法进行干预直至分娩,观察不同的营养治疗方法对血糖及妊娠结局的影响.结果 FES+GL组营养治疗后每日食物血糖负荷值(145.9±26.3)明显低于FES组(179.9±28.9),差异有统计学意义(t=5.602,P＜0.01).FES+GL组营养治疗后的空腹血糖和餐后2 h 血糖[分别为(4.63±0.97)、(6.15±1.07)mmol/L]均较营养治疗前[分别为(4.96±0.81)、(9.13±1.61)mmol/L]明显下降(t值分别为2.237、11.202,P值均＜0.05).FES+GL组营养治疗后的餐后2 h血糖[(6.15±1.07)mmol/L]低于FES组[(6.86±1.26)mmol/L],差异有统计学意义(t=2.760,P＜0.05).FES+GL组孕妇总的并发症发生率为19.51%(8/41),低于FES组的26.19%(11/42),但差异无统计学意义(χ2=0.524,P＞0.05).结论 基于血糖负荷概念的食物交换份比传统食物交换份更容易控制血糖.这两种营养治疗方法对改善糖代谢异常孕妇的妊娠结局均有帮助.

Abstract：

Objective To explore the effect of different nutrition therapies on abnormal glucose metabolism during pregnancy and pregnancy outcomes. Methods The 83 cases of pregnant women withabnormal glucose metabolism who came to nutrition clinic were randomly divided into two groups before 30 weeks pregnancy: 42 cases in traditional food exchange serving group ( FES ) and 41 cases in foodexchange serving based on glycemic load group (FES + GL). Traditional food exchange serving and food exchange serving based on glycemic load were used as the different nutrition therapies for two groupsrespectively until the time of delivery. The influence of two nutrition therapies on the blood glucose andpregnancy outcomes were observed. Results The daily food glucose load (GL) after nutrition therapy in the FES + GL group ( 145.9 ± 26. 3 ) were significantly decreased than that of the FES group( 179.9 ± 28. 9,t =5. 602, P ＜ 0.01 ). Fasting plasma glucose (FPG) and 2 h postprandial glucose ( 2 h PG ) ( ( 4.63 ± 0.97 )and (6. 15 ± 1.07) mmol/L,respectively) after nutrition therapy in the FES ± GL group were significantlylower than that in pre-nutrition therapy ( (4. 96 ± 0. 81 ) and ( 9. 13 ± 1.61 ) mmol/L, t = 2. 237,11. 202,respectively,all P values ＜ 0. 05 ). The 2 h PG in the FES + GL group ( (6. 15 ± 1.07 ) rmmol/L) afternutrition therapy was significantly lower than that of the FES group ( (6. 86 ± 1. 26)mmol/L,t = 2. 760, P ＜0.05). 19.51%(8/41 )of the total incidence of complications in the FES + GL group was lower than that ( 11/42,26. 19% ) in the FES group, but the difference was not significant ( χ2 = 0. 524, P ＞ 0. 05 ).Conclusion FES based on GL was much easier to reduce blood glucose compared with FES. Two nutrition therapies can improve maternal and neonatal outcomes in pregnant women with abnormal glucose metabolism.     

泵输注法和传统推注法对脑卒中患者肠内营养支持相关并发症影响的比较

目的 比较泵输注法和传统推注法对脑卒中患者肠内营养支持相关并发症的影响.方法 采用随机数字表法,将53例急性脑卒中患者随机分为泵输注组(n=28)和传统推注组(n=25),比较两组患者腹胀、腹泻、高血糖和反流相关下呼吸道感染的发生情况.结果 泵输注组腹胀、腹泻和高血糖的发生率分别为14.3%、25.0%和17.9%,均明显低于传统推注组的64.0%(P=0.0002)、52.0%(P=0.0429)和44.0%(P=0.0385).两组反流相关下呼吸道感染发生率间差异无统计学意义(32.1%比40.0%,P=0.5516).结论 与传统推注法相比,泵输注法可以降低脑卒中患者肠内营养支持相关并发症发生率.

Abstract：

Objective To investigate the influence of enteral nutrition (EN) via feeding pump-based continuous infusion (FPBCI) on nutrition support-associated complications in stroke patients. Methods Totally 53 patients were randomized into BPBCI group (n = 28) and control group (bolus feeding) (n = 25 ). The nutrition support-associated complications including bloating, diarrhea, hyperglycemia, and regurgitation-associated low respiratory tract infection were compared between these two groups. Results The incidences of nutrition support-associated complications were significantly lower in BPBCI group than in control group (bloating: 14.3%vs. 64.0%, P=0.0002; diarrhea: 25.0% vs. 52.0%, P=0.0429; hyperglycemia: 17.9% vs. 44.0%, P=0. 0385 ). There was no significant difference in regurgitation-associated lower respiratory tract infection between these two groups (32. 1% vs. 40.0% , P = 0. 5516). Conclusion Compared with conventional bolus feeding,BPBCI may greatly decrease tube-feeding related complications.     

不同干预方式对超重、肥胖青少年体重指数和体脂含量的影响

目的 观察不同干预方式对超重、肥胖青少年体重指数(BMI)和体脂含量的影响,以期得到合理有效的青少年减重方案.方法 选择北京市某初中67名超重、肥胖学生为研究对象,采用随机配伍法随机分为对照组(n=16)、膳食干预组(n=22)和综合干预组(膳食+运动,n=29)3组,观察干预前后BMI和体脂率的变化情况.结果 膳食干预组(P=0.000)和综合干预组(P=0.018)试验后的BMI明显低于试验前,膳食干预组BMI的降低幅度明显大于对照组(P=0.035).膳食干预组(P=0.000,P=0.013)和综合干预组(P=0.000,P=0.000)试验后的躯干和全身体脂率均明显低于试验前,综合于预组躯干和全身体脂率的降低幅度明显大于对照组(P=0.005,P=0.003).结论 膳食和综合干预都可使青少年达到减重效果,综合干预效果更佳.

Abstract：

Objective To observe the effects of different interventions on the body mass index (BMI) and body fat content in overweight and obese adolescents, with an attempt to design reasonable weight relief program.Methods Totally 67 overweight or obese adolescents from a middle school of Beijing were randomly divided into three groups: control group ( n = 16 ), diet intervention group ( n= 22), and combined interventions group ( n =29). The changes of BMI and body fat rate (BFR) were observed. Results BMI significantly decreased after interventions ( diet intervention group: P = 0. 000; combined interventions group: P = 0. 018 ); the change of BMI in diet intervention group was significantly larger than that in control group ( P = 0. 035 ). The trunk and body BFRs also significantly decreased after interventions (diet intervention group: P=0. 000, P = 0. 013; combined interventions group: P = 0. 000, P = 0. 000 ); the changes of trunk and body BFRs were significantly larger in combined interventions group than those in control group ( P = 0.005, P = 0. 003 ). Conclusion Diet intervention and combined interventions are both effective in achieving weight loss in adolescents, and combined interventions have superior effectiveness.     

早期肠内营养对高血压性脑出血患者医院获得性肺炎的影响

目的 探讨早期肠内营养(EN)对重症高血压性脑出血患者医院获得性肺炎(HAP)的临床价值.方法 将140例重症高血压性脑出血患者按随机数字表法分成治疗组和对照组,治疗组(70例)术后48 h开始EN支持.对照组(70例)术后第2天开始全胃肠外营养(TPN)支持.观察两组HAP发生率、HAP持续时间、肺部二重感染发生率、呼吸机使用率、呼吸机使用时间以及HAP病死率.结果 治疗组HAP发生率、肺部二重感染发生率、呼吸机使用率分别为30.0%(21/70)、12.9%(9/70)、35.7%(25/70),显著低于对照组的47.1%(33/70)、27.1%(19/70)、47.1%(33/70)(P＜0.05);治疗组HAP持续时间、呼吸机使用时间分别为(6.4±2.3)、(6.4±0.5)d,显著短于对照组的(15.6±2.1)、(11.4±0.3)d(P＜0.01或＜0.05).治疗组HAP病死率(8.6%,6/70)显著低于对照组(18.6%,13/70)(P＜0.05).结论 早期EN不仅能有效降低重症高血压性脑出血患者HAP和肺部二重感染的发生率,还可以降低呼吸机使用率,缩短呼吸机使用时间,最终缩短了HAP的治疗时间,降低了HAP的病死率.

Abstract：

Objective To investigate the clinical value of early enteral nutrition (EN) on hospital acquired pneumonia (HAP) in postoperative patients with severe hypertensive cerebral hemorrhage.Methods One hundred and forty postoperative patients with severe hypertensive cerebral hemorrhage were divided into treatment group (70 cases) and controll group (70 cases) by random digits table. The treatment group was given EN from the second day after operation, while the control group was given total parenteral nutrition (TPN). The incidence and duration of HAP,the incidence of superinfection,the percent and duration of mechanical ventilation and the mortality rate of HAP was observed. Results The incidence of HAP, superinfection and using mechanical ventilation in treatment group [30.0% (21/70), 12.9% (9/70),35.7%(25/70)] were significantly lower than those in control group [47.1%(33/70) ,27.1%(19/70) ,47.1%( 33/70 )] (P ＜ 0.05 ). The duration of HAP and using mechanical ventilation in treatment group[(6.4 ± 2.3 ),(6.4 ± 0.5 ) d] were significantly lower than those in control group [( 15.6 ± 2.1 ), ( 11.4 ± 0.3 ) d] (P ＜ 0.01or ＜ 0.05 ). The mortality rate of HAP in treatment group was significantly lower than that in control group [8.6% (6/70) vs. 18.6% (13/70),P ＜0.05]. Conclusion Early EN not only effectively decreases the incidence of HAP and superinfection,but also decreases the incidence of mechanical ventilation, shortens the duration of mechanical ventilation and decreases the mortality rate of HAP.     

广西中小医院住院患者营养风险原因调查

Objective To investigate the causes of nutritional risks among inpatients in middle and small hospitals in Guangxi Zhuang Autonomous Region of China. Methods All the screened subjects were surveyed through classified collection of medical records and telephone follow-up. Factors including education background of patients and their family members, career, income, residence, medical payment methods, grade of hospital, and awareness of nutrition were analyzed. Results Lower education background of patients and their family members,less income, and self-funded health care payment were significantly associated with higher nutritional risks ( P ＜0. 01 ). The scores of malnutrition risks were significantly lower in patients whose careers were involved with culture, education and health and in patients whose family members had higher education levels (P ＜ 0.01 ). The nutrition risk was also significantly higher in patients from the rural areas than those from urban areas ( P＜0.01 ). It was also significantly higher in middle and small hospitals than in tertiary hospitals ( P＜0.01). Patients who had good awareness of nutritional knowledge had significantly lower incidence of nutritional risk (P ＜ 0. 01 ). Conclusion Low education level and poor economy in Guangxi are the main reasons for high nutritional risks.     

饮食、C反应蛋白与2型糖尿病颈动脉内膜厚度的关系

Objective To compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.     

支链氨基酸强化的肠内肠外营养对肝硬化大鼠术后肝功能及血浆氨基酸谱的影响

目的探讨支链氨基酸（BCAA）强化的早期肠内肠外营养支持对肝硬化大鼠肝部分切除术后肝功能及血浆氨基酸谱的影响,为临床合理应用提供实验依据。方法将24只雄性SD肝硬化大鼠按编号法随机分为肠内营养组、肠内营养＋BCAA组和肠外营养＋BCAA组3组,3组大鼠行肝部分切除术后1d分别进行等热量等氮量营养支持,共5d。术后6d测定大鼠体重、肝功能、前白蛋白、转铁蛋白、肝组织白蛋白mRNA的表达、Ki67蛋白表达指数及进行血浆氨基酸谱分析。结果与术前比较,术后肠内营养、肠内营养＋BCAA、肠外营养＋BCAA组大鼠体重均减轻（P〈0．05）。术后肠外营养＋BCAA组较肠内营养组碱性磷酸酶水平升高（P〈0．05）;肠外营养＋BCAA组较肠内营养＋BCAA组血清天冬氨酸氨基转移酶、丙氨酸氨基转移酶、碱性磷酸酶水平升高（P〈0．05）。术后肠外营养＋BCAA组较肠内营养、肠内营养＋BCAA组血清前白蛋白水平降低（P〈0．05）,转铁蛋白差异无统计学意义（P〉0．05）。肠外营养＋BCAA、肠内营养＋BCAA组较肠内营养组血浆中亮氨酸、异亮氨酸明显升高,酪氨酸、苯丙氨酸、精氨酸、色氨酸明显降低（P〈0．05）;肠外营养＋BCAA组与肠内营养＋BCAA组比较,各氨基酸浓度差异均无统计学意义（P〉0．05）。肠外营养＋BCAA、肠内营养＋BCAA组较肠内营养组总氨基酸及芳香族氨基酸均降低,BCAA及BCAA／芳香族氨基酸比值升高（P〈0．05）。肠外营养＋BCAA组较肠内营养、肠内营养＋BCAA组肝组织白蛋白mRNA表达水平及Ki67蛋白表达指数均降低（P〈0．05）。结论BCAA强化的肠内肠外营养支持能改善肝硬化大鼠血浆氨基酸失衡,恢复血浆中BCAA／芳香族氨基酸比值;肠内营养在改善肝功能、促进肝脏蛋白质合成和肝硬化大鼠肝切除术后残肝肝再生方面优于肠外营养,但仍不能提高血浆白蛋白水平。     

慢性阻塞性肺病急性加重合并呼吸衰竭病人早期肠内营养联合胸腺肽a1的疗效观察

目的 :探讨早期肠内营养(EN)联合胸腺肽a1对AECOPD合并呼吸衰竭的疗效。方法 :135例AECOPD病人随机分为试验A组(EN)45例,试验B组(EN+胸腺肽a1)45例,和对照组45例,对照组予常规临床治疗,试验A组在此基础上予瑞能早期肠内营养鼻饲,试验B组在此基础上予瑞能早期肠内营养鼻饲联合皮下胸腺肽a1针,观察三组机械通气时间,检测炎症指标、营养指标以及T细胞亚群。结果 :治疗一周后,试验A组的炎症指标明显低于对照组(P0.05)、营养指标以及T细胞亚群明显高于对照组(P0.05)、机械通气时间较对照组明显缩短(P0.05);而与试验A组相比,试验B组的炎症指标明显降低(P0.05)、营养指标以及T细胞亚群明显升高(P0.05)、机械通气时间明显缩短(P0.05)。结论 :早期肠内营养治疗不仅能缩短AECOPD合并呼吸衰竭病人机械通气时间,而且能改善病人营养状况,降低其炎症指标,增强其免疫功能,进而提高临床疗效,而早期肠内营养联合胸腺肽a1治疗能进一步改善AECOPD合并呼吸衰竭病人的临床疗效。     

肠内营养和肠外营养对全身炎性反应综合征患者炎性因子及免疫功能影响的比较

目的 比较肠内营养（EN）和肠外营养（PN）对全身炎性反应综合征（SIRS）患者炎性因子和免疫功能的影响.方法 以2006年4月至2010年4月在山西医科大学第一医院、山西省人民医院和太原市中心医院收治的85例SIRS患者为研究对象,根据营养支持方式分为EN组（n=49）和PN组（n=36）,比较两组患者营养支持前后炎性和免疫指标的变化情况.结果 全热量营养支持后第7、14天,两组患者的体重、上臂周径、三头肌皮褶厚度及血清总蛋白和白蛋白水平均明显高于支持前（P均＜0.05）;全热量营养支持后第14天,EN组患者的血清总蛋白和白蛋白水平明显高于PN组患者（P均＜0.05）.全热量营养支持后第7、14天,EN组患者的血清肿瘤坏死因子α、白细胞介素（IL）-8、IL-l β水平均明显低于支持前和PN组患者（P均＜0.05）;血CD4/CD8及IgG水平均明显高于支持前和PN组患者（P均＜0.05）.结论 PN和EN均可有效改善SIRS患者的营养状态.EN在改善患者营养状况、提高免疫功能和降低炎性介质释放方面的效果优于PN.     

肠内和肠外联合阶段性营养对重症急性胰腺炎患者治疗效果的影响

目的观察肠内和肠外联合阶段性营养对重症急性胰腺炎患者治疗效果的影响。方法重症急性胰腺炎患者45例分为完全胃肠外营养组（TPN组，n=25）和肠内营养加肠外阶段性营养组（PN＋EN组，n=20）。观察两组治疗结果以及临床指标的变化。结果营养支持后PN＋EN组的APACHEⅡ评分和CT评分均显著低于TPN组（P〈0．01）。营养支持两周后两组患者的血糖、血清淀粉酶和血肌酐水平均较营养支持前显著下降（P〈0．01），血清白蛋白、总蛋白、血钙水平均较营养支持前显著升高（P〈0．01），但是两组的各项指标比较无显著性差异（P〉0．05）。PN＋EN组患者的感染并发症发生率显著低于TPN组（P〈0．01），平均住院天数也显著短于TPN组（P〈0．01）。结论肠内和肠外联合阶段性营养支持方式的疗效优于完全胃肠外营养，对重症急性胰腺炎的治疗起了积极作用。     

营养支持治疗在老年危重患者救治中的应用

目的探讨不同营养支持方式在老年危重患者救治中的作用。方法选择老年危重患者98例,根据不同营养支持方式分为肠外营养(PN)组30例,肠内营养(EN)组32例,PN+EN组36例。摄入同等总热量和同等氮量,营养支持治疗时间14 d。治疗0 d和连续营养支持治疗14 d后,检测血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞总数(TLC)、免疫球蛋白(IgA、IgG、IgM)值并进行回顾性对比分析。结果 3组患者Hb均较治疗前增高。EN+PN组患者Alb、PA较PN组及EN组治疗后增高。营养支持治疗后,3组患者TLC明显增高。EN组IgA、IgM,EN+PN组IgA、IgG、IgM均较PN组增高。PN+EN组并发症低于PN组及EN组。结论老年危重患者救治中应根据老年人特点及疾病不同情况合理选择营养支持方式,PN+EN联合应用更有利于改善老年危重患者营养状况及免疫功能,减少并发症发生,促进疾病的康复。     

肠内营养或肠外营养对结直肠癌患者术后脏器功能和排气时间的影响

目的 探讨早期肠内营养或肠外营养在结直肠癌术后应用对患者脏器功能和排气时间的影响.方法 将30例患者随机分为肠内营养支持组和肠外营养支持组,两组均给予等热量等氨基酸的营养支持至术后第7天.检测术前、术后脏器功能指标,观察胃肠功能恢复时间及并发症发生率.结果 肠内营养组术后平均住院时间、总胆红素较肠外营养组显著减少(P＜0.01,P＜0.05).并发症两组比较差异无显著性.结论 结直肠癌术后期实施肠内营养是安全可行的,有助于促进患者胃肠功能康复,减少手术后住院时间,减少费用.     

早期肠内营养对胃癌术后近期免疫和营养状况的影响

目的:比较早期肠内(EN)与肠外营养(PN)对胃癌术后免疫和营养状况的影响.方法:将72例胃癌病人随机分为EN组26例、PN组26例及常规输液(对照)组20例.术后24 h开始给予EN或PN,分别检测术前和术后第9天营养和免疫指标,并观察术后严重并发症及肠功能的恢复.结果:EN组和PN组术后体质量、前清蛋白、清蛋白、IgG、IgM及IgA均显著高于对照组(P＜0.05).而EN组与PN组间差异无显著性意义;EN组、PN组术后CD3 、CD4 、CD4 /CD8 均显著高于对照组(P＜0.01),并且EN组术后CD4 、CD4 /CD8 亦显著高于PN组(P＜0.05);EN组胃肠功能恢复时间明显短于PN组和对照组(P＜0.001).结论:早期肠内营养可明显改善胃癌术后近期的营养和免疫状况,在术后细胞免疫和肠功能恢复方面明显优于肠外营养.     

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.     

纽纯素在结肠癌病人术后肠内营养支持中的应用

目的 :用纽纯素 (Nutren)作为肠内营养制剂 ,对结肠癌病人术后进行肠内营养治疗。　方法 :6 0例结肠癌病人 ,平均年龄 (5 2 .5 3± 13 .0 4)岁 ,随机分为肠内营养纽纯素组 (EN)和静脉营养对照组 (PN) ,每组 30人。按体重每天供给热能 12 5kJ(30kcal) /kg和蛋白质 1.2 5 g/kg(0 .2 g氮 /kg) ,热氮比值为非蛋白热能 6 2 7.6kJ(15 0kcal)∶1g氮。　 结果 :EN组未见有恶心、呕吐、腹胀、腹泻等胃肠反应。全部病人的切口均Ⅰ期愈合。体重、握力、上臂围(MAC)、上臂肌围 (MAMC)、肱三头肌皮褶厚度 (TSF)、外周血淋巴细胞总数、血红蛋白 (Hb)、总蛋白 (TP)、白蛋白(A)、尿素氮 (BUN)、肌酐 (Cr)、钠 (Na)、钾 (K)、氯 (Cl)、血糖、胆固醇 (Tch)、甘油三酯 (TG)等指标均在正常范围内。EN组血清谷氨酰胺和谷氨酸水平高于PN组 ,有显著差异 (P <0 .0 5 ) ,其余氨基酸无差异。PN组尿乳果糖 /甘露醇比率 (L/M)升高 ,与EN组相比 ,有显著差异 (P <0 .0 5 )。　结论 :纽纯素对术后结肠癌病人有明显的营养治疗效果和维护肠粘膜通透性的作用。