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双语推荐：营养支持策略

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随着近年来早产儿成活率的提高,营养支持成为新生儿重症监护的一个重要内容.积极的营养支持策略可减少宫外生长发育迟缓,加快体格生长,促进智能发育.但体质量过度增长,也可能会增加远期肥胖和心血管疾病的风险.现主要介绍并解读“2010欧洲儿科胃肠肝病学与营养学会(ESPGHAN)对于早产儿肠内营养需求的建议”,为早产儿医护人员提供一个循证医学的营养摄入指南.
As survival of premature infants has increased,nutritional support has become a more prominent component of patient care.Aggressive nutritional strategies can reduce the incidence of extrauterine growth retardation (EUGR),speed up the physical growth and promote the development of intelligence.But excessive weight gain may also increase the risk of obesity and cardiovascular diseases in the future.This review mainly introduces and interprets the "enteral nutrient supply for preterm infants:commentary from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN),2010",to provide an evidence-based medicine nutritional guideline for preterm infants.

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营养不良由于严重影响外科危重症患者康复，所以营养治疗被作为一项重要的治疗手段得到广泛的重视和关注。随着科技的发展，肠内营养逐渐代替肠外营养成为外科营养支持的首要途径。近年来，对于肠内营养优越性的认识、适应证、时机把握等观点都有了突破性的进展。尤其在危重患者的救治中日益发挥了重要的治疗作用。然而，国内对肠内营养应用认识尚不够充分，在外科危重患者的救治中，肠外营养而非肠内营养是营养治疗的主要策略。
Enteral nutrition can decrease postoperative complications, stress reaction, shorten length of hospital stay and improve patients′outcome. enteral nutrition′s superiority,indication,timing and route selec-tion were reviewed in order to provide scientific basis for effective nutrition treatment among surgical critically patients. As malnutrition Seriously affected rehabilitation of surgicalcritically ill patients So the nutrition ther-apy as an important means of treatment received wide attention and concern. With the development of tech-nology,enteral nutrition has become the primary method of the nutrition support for the surgical critical pa-tients. For the superiority of enteral nutrition awareness , indications, timing and other views have to grasp a breakthrough. However, the domestic application of knowledge of enteral nutrition is still insufficient,In the surgical treatment of critically ill patients, parenteral nutrition rather than enteral nutrition is the main st

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目的采用纠正胎龄别体重Z评分法评估极低出生体重儿入院时、恢复出生体重时与出院时营养状况,探讨其与出生时营养状况、生后营养支持方式、恢复出生体重时间及住院时间之间的关系。方法选择出生胎龄28~33+6周,出生体重1500g,生后24h内入院,住院时间≥2周新生儿,分别按出生胎龄和营养支持方式、出院时营养状况分组,比较每组出生时、恢复出生体重时和出院时的Z评分,以及恢复出生体重所需时间和住院时间的关系。结果每组患儿出院时Z评分均低于入院时;小出生胎龄组恢复出生体重时和出院时Z评分均高于大胎龄组;营养支持滞后组,恢复出生体重时及出院时Z评分均较积极组更低,滞后组恢复出生体重所需时间和住院时间也均更长;出生时Z评分越低,恢复出生体重时Z评分和出院时Z评分越低,恢复出生体重所需时间和住院时间也越长;差异均有统计学意义(P0.001)。结论极低出生体重儿生后早期营养状况较出生时差,并与宫内营养状况正相关;积极的营养支持策略可改善其住院期间营养状况。
Objective To evaluate the nutrition status in very low birth weight at reture birth weight and discharge with Z score of weight for correct age( CA) . Methods 141 appropriate for gestational age( GA) premature infants with hospital stay ex-ceeding 2 weeks but no major congenital diseases were included. Z scores of weight for age were calculated at birth and reture birth weight and discharge. Their clinical data were retrospectively analyzed. Results At all the subgroups( categorized by GA at birth or by nutrition support method or by nutrition status at discharge) ,The Z scores at reture birth weight and discharge were positively related with Z scores at birth(P<0. 001);Different nutrition support method were significantly related with Z score at reture birth weight and discharge(P<0. 001). The lower Z scores at birth, the time of reture birth weight and discharge were longer. Conclu-sion Very low birth weight infants occurred growth retardation during admission. Nutritional support st

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背景 围手术麻醉期的应激反应不利于患者的术后恢复,这与正在快速发展的快速康复外科(fast track surgery,FTS)理念相背离.营养支持是FTS的一个重要策略,输注氨基酸作为围手术麻醉期营养支持的有效方式已有较多临床和基础研究. 目的 探讨围手术麻醉期输注氨基酸对机体体温和营养物质代谢的影响. 内容 氨基酸通过其营养物热效应(nutrient induced thermogenesis,NIT)为围手术麻醉期患者提供了保温作用,并通过多种途径抑制脂肪动员和蛋白分解,促进蛋白合成,但可能加速血糖的升高. 趋向 把握围手术麻醉期输注氨基酸的时机和剂量,使这一FTS的策略得到优化.
Background The perioperative period stress response is not conducive to the patient''s postoperative recovery.It goes against the fast track surgery (FTS),which is rapidly developing recently.Nutritional support is an important strategy of FTS,and there are already many clinical and basic studies which confirm that perioperative amino acid infusion is an effective mean of nutritional support.Objective This review will discuss the influence of perioperative amino acids infusion to the body temperature and metabolism.Content Amino acid infusion alleviates hypothermia via nutrient induced thermogenesis (NIT),and can inhibit fat mobilization and muscle protein breakdown,promote protein synthesis,while accelerate the increase of blood glucose concentration.Trend It is an optimical strategy for FTS to explore appropriate time and dose of perioperative amino acids infusion.

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胃癌是常见的消化道恶性肿瘤，以手术切除为主的综合治疗是治疗胃癌的主要手段。手术应激、术后禁食以及漫长的饮食恢复过程都可能对患者的机体代谢和营养状况造成影响。生物电阻抗法测量人体成分较常用人体测量指标更能够客观且及时地反映机体的各种成分变化，为理解胃癌术后患者的机体代谢特点和营养状况提供更好的依据。本研究旨在分析胃癌手术患者的人体成分指标变化，了解患者术后营养状况恢复情况，为术后饮食指导和营养支持策略的制定提供依据。
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介绍了卡氏肺孢子虫肺炎(PCP)感染的临床特点,从提高病原体的检出率、低氧血症的观察与护理、高热护理、药物护理、保护性隔离、营养支持、心理护理、肺孢子虫病的预防策略方面综述了卡氏肺孢子虫肺炎的护理进展。
It introduced the clinical characteristics of pneumocystis carinii pneumonia(PCP).It reviewed the nursing progress on pneu-mocystis carinii pneumoni from aspects of improving the detection rate of pathogens,observation and care of hypoxemia,fever nursing, medical care,protective isolation,nutritional support and psychologi-cal nursing and prevention strategies of lung cysticercosis.

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通过介绍日本孕期管理模式：孕期小班化教育、营养指导与严格的体重管理、分娩期管理以及政策支持自然分娩等，为国内降低剖宫产率并制定相关政策和策略提供借鉴，以最大限度地减少剖宫产对母婴带来的危害，促进并保障母婴健康和社会家庭的稳定。
By introducing Japan''s pregnancy management mode includes small class education, nutrition guidance during pregnancy and strict weight management, stage management of labor and policy supporting natural childbirth, the reference to reduce cesarean section rate in China was discussed to maximum reduce the harm of cesarean section and to promote mother and infant’s health and social stability of the family.

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急性肾损伤(AKI)是临床常见危重病症,发病率不断升高,死亡率居高不下,防治形势极为严峻。由于危重AKI死亡率很高,因此预防发病和阻止病情进展是AKI防治的重要环节。不同病因和不同类型AKI,预防和治疗方法不同,总的原则是尽早识别并纠正可逆性病因,在AKI起始期及时干预能最大限度减轻肾脏损伤,促进肾功能恢复;加强支持对症治疗,酌情限制水、钠和钾的摄入,维持水、电解质和酸碱平衡,适当营养支持,可优先通过胃肠道提供营养;积极防治并发症;重症AKI患者应适时开始肾脏替代疗法(RRT),应针对临床具体情况,明确患者的治疗需求和RRT治疗目标,权衡利弊,综合决定RRT开始时机、剂量及模式,并在治疗期间及时调整治疗方案,实行目标导向的个体化肾脏替代策略。
Acute kidney injury (AKI)is clinically a common critical disease,whose incidence increases continually with the mortality being high.The situation for prevention and treatment of AKI is very rigorous.Due to the high mortality of patients with AKI,prevention of morbidity and disease progression is a very important part of the prevention and treatment of AKI.Different causes and types of AKI result in different methods of AKI management.The main principle of AKI management is identifying and correcting the reversible causes as early as possible.Timely intervention at the initiation of AKI may be able to alleviate the kidney injury as much as possible,promoting the recovery of renal functions.Symptomatic treatment should be strengthened,and the intake of fluid and sodium and potassium be restricted so as to maintain the volume,electrolyte and acid-base balance.Nutrition support should also be given through the gastrointestinal tract first,and different kinds of complications should be pre

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目的：：分析维持性血液透析(MHD)患者住院原因及相关因素，探讨减少MHD患者住院的策略。方法：对2010~2013年某院39例MHD住院患者进行回顾性分析，并和同期非住院的MHD患者比较，观察透析次数、营养状况、血红蛋白、铁蛋白、超敏C反应蛋白、脑钠肽等指标。结果：MHD患者住院的首要原因为呼吸道感染和心功能不全；营养不良、透析充分性、透析间期体重增加过多、炎症状态、BNP增高等是MHD住院的相关因素。加强营养支持治疗和卫生宣教，及早控制潜在心功能不全及炎症状态可能会减少MHD患者住院率，改善预后。
Objective:To analyze the reasons why the MHD patients Hospitalize and relevant factors,and investigate the countermeasures to reduce the hospitalization of MHD patients.Methods:A retrospective anal-ysis was made on the data of 39 cases of hospitalized MHD patients during 2010~2013in our hospital.Com-pare them with concurrent non-hospitalized MHD patients,detect dialysis times,nutritional status,hemoglo-bin,feeritin,high sensitivity C-reactive protein(hs-CRP),BNP and other indexes.Results:The primary cau-ses for the hospitalization of the MHD patients were respiratory infection and cardiac insufficiency;dystro-phy,dialysis adequacy,excessive weight gain during dialysis,inflammation and rising in BNP were the correl-ative factors.Conclusion:To strength nutrition-supported therapy and propaganda and education about health and try to control possible cardiac insufficiency and the inflammation earlier would lower MHD patients''hos-pitalization rate and improve prognosis.

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总结烧伤合并创面脓毒症的临床特点和防治措施。方法:回顾性分析我科2007年1月至2012年12月收治的烧伤合并创面脓毒症40例的临床资料。结果:治愈32例,死亡8例。结论:烧伤早期休克渡过不平稳及创面早期处理不当易致创面脓毒症,预防强调积极有效的液体复苏、早期肠道营养、加强代谢与免疫调理、尽早封闭创面及加强多器官功能保护与支持,治疗强调以创面处理为核心的综合治疗策略,尽早手术覆盖封闭深度创面是救治成功的关键。
Objective:To summarize the clinical characteristics , preventive and treatment measures of burn combined wound sepsis. Methods: The clinical data of 40 patients with massive burn combined wound sepsis were analyzed from Jan 2007 to Dec 2012. Results: 32 cases were cured and 8 cases died. Conclusion: Early unstable burn shock and improper wound treatment may cause wound sepsis. It was very important for prevention of burn wound sepsis to strengthen proper fluid resuscitation , positive and effective early enteral nutrition , and eary wound closure as soon as possible,immune regulation, and the protection and support of multiple organ function;Comprehensive therapy strategy to wound burn sepsis was the core management , and the operation of covering depth wound as soon as possible was the key to treat burn wound sepsis successly.

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