ObjectiveTo introduce the progresses and applications of nutritional status assessment in hospitalized patients. MethodsThe related literatures of nutritional status assessment were reviewed. ResultsThe rates of malnutrition and nutritional risk were high in hospitalized patients worldwide. Traditional nutrition assessment tools were not in common use in all hospitalized patients. All clinical health care workers should use the most suitable tool when faced with different patients. ConclusionAll hospitalized patients should be screened for nutritional risk on admission in order to improve clinical outcomes and reduce overall treatment costs.
Objective To promote the clinical application of parenteral and enteral nutrition preparations in hospitalized patients. Methods Domestic and foreign articles about parenteral and enteral nutrition support were enrolled to make a review. Results Nowadays, parenteral and enteral nutrition played an important role in the medical treatment of perioperative and critically ill patients. Rational nutrition support could improve the condition of patients with nutritional risk and result in better clinical outcomes. Different enteral nutrition formulations should be used according to the diseases. Supplementally parenteral nutrition may also be useful in combination with enteral nutrition to reach the required intake targets. We should pay attention to the application of glucose, lipid emulsion, amino acids, vitamins, and so on, when performed parenteral nutrition support. Conclusion It is necessary to standardize parenteral and enteral nutrition support in the work of clinical practice, including the application of nutrition support and selection of nutrition preparations.
Objective To study the effects and mechanisms of major immune nutrients and to introduce the progresses of clinical applications about enteral immunonutrition. Methods The related literatures about the effects and clinical applications of enteral immunonutrition were reviewed. Results Infection rate can be reduced and the hospitalization can be shortened as a result of the improved nutritional status and immune competence of patients which can be enhanced by reasonable enteral immune nutrition. Most of the patients suffering from serious diseases can benefit from enteral immunonutrition, such as gastrointestinal cancers, post-transplantation complications, chronic liver disorders, acute pancreatitis and so on. However, as a new nutrition therapy, the clinical use of enteral immunonutrition in critically ill patients is still controversial. Conclusions Enteral immunonutrition plays an important role in the nutritional support of patients with serious diseases, such as gastrointestinal cancers, organ failures. However, much work remains to be done.
Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.
【摘要】 目的 探讨住院患者肝功异常病因及影像学诊断意义。方法 对2008年1月—12月住院的223例18～83岁肝功异常患者进行相关实验室检查,以及B超、CT和MRI检查。结果 肝脏本身疾病引起135例,占6054%,肝外疾病引起83例,占37.22%,原因不明5例,占2.24%。B超作为无创性检查,价格低亷,准确率高,可作为常规检查。结论 住院患者肝功损害病因复杂,以药物性肝炎、胆道系统疾病及脂肪肝较多见。
目的:探讨青年人群中脂肪肝的相关危险因素。方法:收集2008年在我院体检中心同期体检,年龄≤45岁脂肪肝患者127人,非脂肪肝患者116人,询问病史,进行身高、体重、血生化及B超检查并分脂肪肝组和非脂肪肝组进行比较。结果:脂肪肝组肥胖、饮酒、高血脂、高血糖、肝功异常发病率明显高于对照组。结论:肥胖、饮酒是脂肪肝的重要危险因素,脂肪肝患者多伴有糖脂代谢紊乱及肝功受损。
ObjectiveTo investigate the nutritional risk, incidence of malnutrition, and clinical application of nutrition support in hospitalized patients with gastric cancer by the nutritional risk screening (NRS) 2002 score summary table. MethodsFrom June 2009 to February 2010, nutritional risk screen and application of clinical nutritional support were carried out in the hospitalized patients with gastric cancer in this hospital. Nutritional risk was assessed case-by-case according to the severity of illness, nutritional status 〔including body mass index (BMI), recent changes in body weight and eating〕 and patients age. NRS ≥3 was accepted as nutritionally at-risk, while NRS lt;3 no nutritional risk; BMI lt;18.5 kg/m2 (or albumin lt;30 g/L) combined with clinical conditions was judged to be malnourished. Results Three hundreds and eighty-six patients were included, 329 of which completed the NRS2002 screening. One hundred and sixty-five patients (50.15%) were at nutritional risk, while another 164 (49.85%) were no nutritional risk. Malnutrition was found in 57 patients (17.33%). By gender, male malnourished patients and nutritionally at-risk patients were accounting for 16.45% (38/231) and 48.05% (111/231) respectively, while female nutritionally at-risk patients and malnourished patients were accounting for 55.1% (54/98) and 19.39% (19/98) respectively, 72.04% (237/329) of the screened patients accepted clinical nutrition support, among which, 115 patients were at nutritional risk, accounting for 69.70% in that group, and 122 patients were no nutritional risk, accounting for 74.39% in that group. ConclusionsThe incidences of malnutrition and nutritionally at-risk in hospitalized gastric cancer patients are high. And irrationality of clinical nutrition support exists. Evidence-based guidelines are required to improve the nutritional status of support.
Malnutrition is associated with many adverse clinical outcomes, including increased deaths and complications in perioperative period. The immunonutrition support plays an important role in the recovery process of patients with nutritional risk. Reasonable support can efficiently improve the condition of these cases and strongly suppress the inflammatory response. The immuno-nutrients include glutamine, ω-3 polyunsaturated fatty acids, arginine, nucleotides and so on. More and more evidences show that different kinds of immuno-nutrients play a regulatory role in metabolism and inflammatory response in patients with different disease stages and courses, and affect clinical outcomes and prognosis. Nowadays, there is an urgent need to standardize immunonutrition support in clinical work. In this paper, the related literatures about immunonutrition in recent years were reviewed. Our goal is to reduce the number of irregularities in the nutrition support practice, and to help nutritional risk patients achieve better clinical outcomes.
Objective To investigate the influence of different mechanical ventilation modes on inflammatory reaction among COPD patients with severe respiratory failure. Methods A total of 102 COPD patients with severe respiratory failure, admitted in Zhongshan Hospital between January 20007 and June 2012, were enrolled in this study. The subjects were divided into an ASV group receiving adaptive support ventilation, and a SIMV + PSV group received synchronized intermittent mandatory ventilation and pressure support ventilation, with 51 cases in each group. Breathing pattern, respiratory mechanics, hemodynamic parameters and seruminflammatory factors were examined among all patients. Results Tidal volume ( VT ) was significantly higher, and the control respiratory rate and ventilation time were significantly lower in the ASV group than those in the SIMV + PSV group ( P lt; 0.05) . Comparing with the SIMV + PSV group, obviously lower peak airway pressure ( Ppeak) ,mean airway pressure ( Pmean) and airway plateau pressure ( Pplat) were observed in the ASV group ( P lt; 0.05) . The patients in the ASV group had obviously lower levels of C-reactive protein, procalcitonin and α1 acid glycoprotein. Conclusion ASV ventilation mode may reduce the inflammatory reaction, facilitate spontaneously breathing and decrease mechanical ventilation time.
Objectives To detect expressions of heat shock protein 70 (HSP70) and glial fibrillary acidic protein (GFAP) , and to estimate the post-injury interval after concussion of brain via the ratios of percentage of HSP70/GFAP-positive cells. Methods We established a brain concussion model of rat. Tissue levels of HSP70 and GFAP were determined by immunohistochemical staining at different time points after injury. Finally, the relationship between the ratio of percentage of HSP70/GFAP-positive cells and the post-injury interval was measured. Results The ratio of percentage of positive cells (increased from 7.15 to 11.73) and the percentage of HSP70-positive cells (P<0.05, compared with control group) increased, and the percentage of GFAP-positive cells did not change remarkably (P<0.05, compared with control group); the post-injury interval was between 0.5 hour and 3 hours. High ratio (>6.66) and high percentage of HSP70 and GFAP-positive cells (P<0.05, compared with control group) indicated the post-injury interval was between 3 and 12 hours. A low ratio (<6.66) and high percentage of HSP70 and GFAP-positive cells (P<0.05, compared with control group) suggested that the post-injury interval was later than 12 hours. Conclusion By analyzing the variation rule of the ratio of percentage positive cells after brain concussion, the post-injury interval after concussion of brain could be estimated.