胃肠外营养支持对老年慢性阻塞性肺疾病急性加重期合并营养不良患者肺功能的改善

慢性阻塞性肺疾病(chronic obstructive pul-monary diseases,COPD)是临床常见病变,我国人口老龄化加快导致临床老年COPD患者增多。老年COPD患者通常存在营养不良,严重影响病情和患者机体免疫功能,使其呼吸系统防御机制减弱,甚至损伤重要器官;营养不良、感染、机体免疫和COPD患者肺功能相互影响,一旦发生营养不良则容易形成恶性循环[1]。据不完全统计,临床20%~60%的COPD患者存在营养不良,而老年患者更高[2]。胃肠外营养支持是目前干预营养不良患者的重要方法之一,本研究分析其对老年COPD急性加重期合并营养不良患者肺功能的影响,报告如下。

有氧锻炼可有效提高面肱肌营养不良患者的运动能力

Exercise programs have been shown to increase strength and endurance in patien ts with myopathic disorders. The authors investigated the effect of aerobic trai ning in patients with facioscapulohumeral dystrophy (FSHD). Twelve weeks of lowi ntense aerobic exercise improved maximal oxygen uptake and workload with no sign s of muscle damage. The authors conclude that aerobic training is a safe method to increase exercise performance in patients with FSHD.

在特殊类型锥细胞营养不良患者的锥细胞cGMP磷酸二脂酶γ亚基因中发现一种G替代C的替代物

To identify genes responsible for cone dystrophies and determine the functiona l consequences of their underlying mutations. Case-control study. Two hundred f orty unrelated patients diagnosed with cone dystrophy, cone-rod dystrophy, macu lar dystrophy, macular degeneration, or Stargardt disease, 95 control individual s, and 2 unrelated families with a distinctive type of cone dystrophy. The DNAs of the 240 probands were screened for sequence variants in the PDE6H gene (that encodes the inhibitory γ-subunit of cone cyclic guanosine monophosphate [cGMP ] -phosphodiesterase [PDE]) by single-strand conformation polymorphism electro ph oresis. The effect of a nucleotide substitution in the DNA of a patient on gene expression efficiency was analyzed by in vitro transcrip-tion/translation. Cone -specific gene variants, fundus, visual field and electroretinogram (ERG) findi ngs, and protein synthesis efficiency. We found a heterozygous G to C substituti on in the 5′untranslated region (UTR) of the PDE6H gene in the DNA of a patient with a distinctive form of cone dystrophy, her sibling, and their father. This rare form of disease is very different in manifestation from other cone dystroph ies and has been described as “cone dystrophy with nyctalopia and supernormal r od responses,”“cone dystrophy with supernormal scotopic ERGs”and “supernorma l and delayed rod ERG syndrome.”Among the 240 patients that we studied, only 1 proband had the G to C variant. Furthermore, none of the 95 controls used in thi s study had this nucleotide change. We also determined that the PDE6H variant wa s not present in another family affected with this particular type of cone dystr ophy. Because the 5’UTR of mRNAs plays a critical role in the regulation of pro tein synthesis, we determined the effect of the G to C change in this process. B y use of in vitro transcription/translation experiments, we demonstrated that th is substitution could lead to an increase in PDE6H gene expression. Our results indicate that mutations in the PDE6H gene are not common, because only 1 of 240 patients with cone dystrophy showed a single nucleotide substitution in the 5′U TR of PDE6H mRNA that could be associated with the disease. If the effect of the G to C substitution we observed in vitro also occurs in vivo, it will lead to P DE6H overexpression in the photoreceptors. Excess of PDEγmay affect normal cone cGMP-PDE function by inhibiting the catalytic PDEα,βactivity and lead to pat hogenic elevation of cGMP and eventual degeneration of cone photoreceptors.

1型肌强直性营养不良患者的有氧训练

The effect of 12 weeks of aerobic training on a cycle ergometer was studied in 12 patients with myotonic dystrophy. Efficacy was evaluated by cycle testing an d muscle morphology before and after training. Patients increased their maximal oxygen uptake by 14%, the maximal workload by 11%, muscle fiber diameter incre ased significantly, and creatine kinase did not increase with training. The stud y indicates that aerobic training is safe and can improve fitness effectively in patients with myotonic dystrophy.

老年慢性阻塞性肺疾病并发自发性气胸的营养不良患者的饮食护理

老年慢性阻塞性肺疾病(COPD)营养不良发生率高,自发性气胸是其常见并发症。2011年5月至2012年12月,我科收治了21例老年COPD并发自发性气胸的营养不良患者,经积极治疗和护理,效果满意。现将饮食护理体会总结如下:1临床资料所有病例均符合我国2007年修订的慢性COPD诊治指南中的诊断标准,并经影像学检查确诊。21例中男15例,

眩光敏感度与专业司机的安全:1例视网膜电图阴性的视锥视杆营养不良患者

Background: To obtain a driver’s licence certain requirements for visual acui ty and visual field have to be fulfilled. Mesopic contrast and glare sensitivity are not regularly tested and are not crucial to passing the driving test. Case report: We report a case of a 39-year-old professional bus driver whose only c omplaint was increased glare sensitivity. After he had been involved in four tra ffic accidents, ophthalmological investigations revealed binocular annular scoto mata and night blindness, leading to the diagnosis of rod-cone dystrophy. Discu ssion: Enhanced glare sensitivity is a common complaint in elderly people or peo ple with the beginnings of cataract but may also represent an initial symptom of a retinal disorder. It is therefore advisable for traf-fic safety if drivers w ith such complaints undergo a complete ophthalmological investigation including visual field testing.

成人黄斑中心凹卵黄样营养不良患者中心凹下组织切除术后黄斑转位的光镜和电镜观察

Purpose:To correlate the functional results of maculartranslocation(MT )in a patient suffering from an adult-onset foveomacular vitellif orm dystrophy(AFVD)with the microscopic findings of the surgically removed subfoveal retinal pigment epithelium(RPE).Methods:A78-year-old woman with AFVD underwe nt MT with 360°retinotomy 3-4months after loss of r eading ability.Most of the vitelliform material was lost during surgery;the subfoveal tissue was excised,fixed in aldehydes,postfixed in reduced OSO4and embedded in epoxy resin.Semithin sections were stained with toluidin e blue for light mi-croscopy(LM)and thin sections with uranyl acetate and lead citrate for transmission electron microscopy(TEM).Results:Postoperatively,the pati ent developed a retinal detachment complicated by proliferative vitreoretinopathy(PVR)requiring two additional vitreoretinal procedures before finally the silicone oil coul d be removed.Twen-ty-two months after MT the distance v isual acuity was un-changed at 0.2;the near visual acuit y had improved from less than 0.1before MT to 0.4.The retina was completely attached.LM and TEM revealed seriou s alterations in-dicative of a breakdown of the outer l ayer of the retina.Conclusion:Through the present sin gle case it is not possible to determine whether MT cou ld be a therapeutic approach in patients with AFVD.The m ost important cause for the limited postoperative visual improvement seems to be a primary injury of the foveal function due to the AFVD.This is supported by the extensive subfoveal degeneration and necrosis affectin g not only the RPE cells but also their basement membrane and the interposed basal laminar deposits.

RPE65基因突变相关的早发性、重症视网膜营养不良患者自儿童期始眼底缺乏488nm自体荧光

Purpose Fundus autofluorescence is due to accumulation of lipofuscin in the retinal pigment ep ithelium(RPE)resulting from incomplete digestion of N-retinylidene-phosphatidyl-ethanolamine from shed photorecep tor outer segment discs.Alteration in autofluorescence reflects changes in lipofuscin content of the RPE.Mutations on both alleles of RPE65result in absent or largely decrease d formation of rhodopsin,due to a defect in alltrans retinol is omerization in the RPE.Autofluorescence could therefore b e altered.This study was conducted to evaluate fundus autofl uorescence in patients with early-onset severe retinal dystrophy(EOSRD,or ear-ly-onset rod-cone dystrophy)associated with mutations on both alleles of RPE65.Design Case se ries.Participants and controls Ten 10-to 55-year-old p atients with EOSRD and compound heterozygous or homozy gous mutations in RPE65.For comparison,6heterozygous parents and 2patients with other forms of EOSRD we re examined.Methods Participants underwent,in addition to standard clinical and electrophysiological examination,autofluores-cence imaging using a confocal scanning laser ophthalmo-scope.Three of the patients were als o examined by optical coherence tomography(OCT)to evaluate the status of retinal degeneration.Mutations in7patients have been reported previously;the other pati ents were investigated by polymerase chain reaction-single-strand conformation poly-morphism and direct sequencing for mutations in RPE65and lecithin retinol acyltransfera se(LRAT).Main outcome measures Fundus autofluorescence a nd OCT.Results Ab-sent or minimal autofluorescence wa s found in all patients with compound heterozygous or homozygous RPE65muta-tions.Autofluorescence was normal in the heterozygous parents.Autofluorescence was present in 2children with EOSRD not associated with mutations in RPE65or LRAT,another gene involved in retinol recycling.Optical coher-ence tomography in younger patients revealed an intraretinal appearance similar to that of their h ealthy,heterozygous parents.Conclusions Lack of autofl uorescence in patients with EOSRD associated with mutation s in RPE65is in ac-cordance with the biochemical defect and can be used as a clinical marker of this genotype.Optical coherence tomog-raphy results in younger patients wo uld indicate still viable photoreceptors despite the absence of autofluorescence.

左卡尼汀联合血液透析治疗尿毒症性营养不良患者的临床价值评估

讨论使用左卡尼汀加血液透析对尿毒症性营养不良患者进行诊治的效果。方法 这次讨论一共应用在2022年1月到2023年1月之间在我院进行诊治的80例尿毒症性营养不良的患者,把这80例患者应用随机分组的模式,分为有40例患者的讨论组和有40例患者的数据组。应用血液透析进行诊治的患者作为数据组,应用左卡尼汀加血液透析进行诊治的患者作为讨论组。本次讨论主要对比两个组别的诊治效果和血清营养学指标。结果 诊治之前,当做参考资料的组别为数据组,而讨论组患者的PA、TRF、AIB、HGB以及TP等指标和数据组接近,两组比较不具有差异性(P>0.05);诊治之后,当做参考资料的组别为数据组,而讨论组患者的PA、TRF、AIB、HGB以及TP等指标都比较高,两组比较具有差异性(P<0.05);数据组应用血液透析诊治的总有效率占该组患者的70.00%,而讨论组应用左卡尼汀加血液透析诊治的总有效率占该组患者的97.50%。当做参考资料的组别为数据组,而讨论组患者的诊治效果都比较好,两组比较具有差异性(P<0.05)。结论 使用左卡尼汀加血液透析对尿毒症性营养不良患者进行诊治的效果比较明显,同时还可以提升患者的各项血清指标,居然还能缓解患者营养不良的情况,减少患者产生并发症的几率,同时也便于患者接受,该诊治模式值得社会推广与应用。

维持性血液透析患者营养不良的饮食护理干预

目的 观察维持性血液透析患者营养不良的饮食护理干预分析.方法 将2019年7~11月在广州市第一人民医院血液净化中心行规律血液透析患者总计100例,采取针对性饮食护理干预.比较干预前后患者饮食的依从性优良率、营养指标MIS评分、血清白蛋白(ALB)、血红蛋白(Hb)水平.结果 干预前患者对饮食护理的优良率为98.00%,干预后为96.00%,差异无统计学意义(P>0.05).干预后患者MIS评分明显低于干预前,ALB、Hb水平明显高于干预前,差异有统计学意义(P<0.01).结论 在维持性血液透析患者中,采取针对性的饮食护理干预,可明显提高患者饮食护理干预后营养指标,提高血液中血清白蛋白与血红蛋白水平,效果理想.

自拟健脾益肾汤对维持性血液透析患者营养不良的改善效果观察

营养不良是维持性血液透析(MHD)患者较为常见的合并症,是对透析患者血透效果及预后状况评估的一项十分重要的指标,其临床发生率达40%~70%[1-2]。营养不良会引起MHD患者免疫水平低下,透析耐受性差,且极易诱发感染以及合并心脑血管疾病等,对患者预后状况造成极大的影响[3]。对此,应该强化对MHD营养不良的合理干预。西医采取营养管理干预效果有限[4]。中西医结合疗法预防或治疗MHD患者慢性并发症的作用越来越受到重视[5-6]。笔者在西医常规治疗基础上加用自拟健脾益肾汤治疗MHD营养不良患者64例,取得较满意效果,现报道如下。

营养不良患者急性侵袭性肺曲霉病一例的诊治体会

临床资料患者男,53岁,因"咳嗽、咯血、发热1个月余"于2017年10月18日收入复旦大学附属中山医院呼吸科。患者于2017年9月初受凉后出现阵发性咳嗽、咳痰,初为黄黏痰,1 d后为棕红色血痰,伴发热,体温最高达39℃。就诊于当地医院,查血红蛋白(Hb)114 g/L,白细胞计数(WBC)10.05×10^(9)/L,中性粒细胞百分比88.6%;C反应蛋白(CRP)218.3 mg/L,降钙素原(PCT)0.12 ng/mL;白蛋白(ALB)33 g/L,钠(Na^(+))138 mmol/L,钾(K^(+))3.41 mmol/L,尿素氮(BUN)6.7mmol/L,肌酐(Cr)51.7μmol/L,多次痰涂片找抗酸杆菌(-),结核杆菌(TB)DNA(-),半乳甘露聚糖抗原试验(GM试验)、β-D-葡聚糖试验(G试验)结果均为阴性。

家庭营养管理团队在出院老年营养不良患者中的构建及应用

探讨出院老年营养不良患者接受家庭营养管理团队干预后对营养状态及体重的影响。方法 选择2020年1月-2021年12月在我院科室治疗后出院的老年营养不良患者60例作为研究对象,随机分作对照组(30例)与观察组(30例),对照组予以常规干预,观察组实施家庭营养管理团队干预,比较两组患者出院时及出院3个月后营养状态变化,调查各组患者对此次营养管理工作的满意度情况。结果 两组患者出院时体重、白蛋白测定结果、NRS 2002评分比较无统计学差异(p>0.05),出院后3个月,观察组患者体质量、白蛋白测定结果均高于对照组,NRS 2002评分低于对照组(p<0.05)。另外,观察组患者对此次营养管理工作的总满意度高于对照组(p<0.05)。结论 针对出院老年营养不良患者开展家庭营养管理团队干预能够有效改善营养状态,为患者提供高质量的管理服务,提高满意度,提倡运用推广。

糖尿病肾病3~5期住院患者营养风险影响因素分析

糖尿病肾脏病(DKD)是糖尿病患者最常见和最严重的微血管病,全球范围内进入肾脏替代治疗的主要病因,发病率呈上升趋势。DKD中近50%患者易出现营养不良[1],且出现营养不良患者临床结局往往不良。本研究回顾性分析了我院肾内科住院DKD118例患者资料,探讨影响DKD3~4期以及尚未进入透析阶段DKD5期患者营养风险的主要因素。

肌萎缩侧索硬化患者的营养饮食管理

肌萎缩侧索硬化(ALS)是一种进展性神经肌肉疾病,因肌肉无力及萎缩而逐渐丧失运动和生活自理能力。一经诊断,为了延缓病情进展、提高患者生活质量、延长生存期限,除了药物治疗,营养管理、呼吸支持、心理治疗、康复锻炼也至关重要。研究发现,营养状态的管理可能对延长ALS患者生存期及提高生存质量有相当重要的作用。就诊前半年内体重下降>10%,其生存期较其他ALS患者下降18.3个月。营养不良患者的死亡风险较营养充足患者增加7.7倍。

口服营养补充的基本问题

口服营养补充(oral nutritional supplements,ONS)在营养不良患者中的使用已经日益广泛,然而口服营养补充的相关术语在文献写作中并不统一。本文通过检索国内外文献,对口服营养补充的英文名称、使用起源以及针对疾病的临床使用情况进行了综述,旨在进一步明确口服营养补充的相关定义和用途。1口服营养补充的起源口服营养补充目前已经得到广泛的认可和应用。然而,追溯其起源。

营养性疾病

921513 小儿营养不良问题探讨/傅举亮//中国农村医学.-1992,（2）.36～37营养不良患者按临床表现分为轻、中、重三度,体重分别低于正常值的15～25％、25～40％,】40％。病因有喂养不当、消化系统疾病、慢性消耗性疾病、早产、双胎、多胎、活动量过大等。病理上表现为代谢失常、组织器官功能障碍、免疫功能低下等。治疗原则:

不同儿科评定营养不良筛查工具评分的住院患儿血清前白蛋白检测及意义

目的：观察住院患儿血清前白蛋白变化，探讨其在住院患儿儿科评定营养不良筛查工具评分中的价值。方法选取2013年3月至2014年4月福建医科大学附属第一医院儿科住院治疗的867例患儿为研究对象，所有患儿均于入院24 h内完成儿科评定营养不良筛查工具评分，根据评分结果分成低评分营养不良组及高评分营养不良组，同期抽取静脉血进行血清前白蛋白检测和问卷调查患儿性别、年龄、患病前后主要饮食类型等，并从临床病历中摘取患儿临床资料及实验室检查结果。结果高评分营养不良组463例（53.4％）、低评分营养不良组404例（46.6％）；高评分营养不良组、低评分营养不良组患儿血清前白蛋白浓度分别为（144.7±50.6） mg／L和（173.6±71.3） mg／L，两组比较差异有统计学意义（ t＝6.795， P＝0.000）；协方差分析在控制患儿年龄、入院前病程、白细胞数、血白蛋白、谷草转氨酶、 C反应蛋白协变量后，两组住院患儿血清前白蛋白边缘估计均值及其95％CI分别为139.8（134.9～144.8） mg／L和157.9（151.9～163.8） mg／L，高评分营养不良组患儿血清前白蛋白含量仍然显著低于低评分营养不良组（ F＝20.433， P＝0.000）。高评分营养不良并低血清前白蛋白、单纯高评分营养不良、单纯低血清前白蛋白及低评分营养不良且血清前白蛋白正常患儿临床治愈率分别为62.9％（95／151）、80.5％（251／312）、77.1％（27／35）及98.1％（362／369）（χ2＝112.80， P＝0.000），医院内获得性感染发生率分别为21.9％（33／151）、8.7％（27／312）、22.9％（8／35）及1.9％（7／369）（χ2＝63.55， P＝0.000）。结论对住院患儿进行营养不良评定筛查的同时进行血清前白蛋白检测，能更客观反映住院患儿是否存在高营养不良。

白蛋白临床使用的几个问题

白蛋白不是“强身剂”,也不是营养制剂。在普通老百姓的印象中,白蛋白是一种营养品,用于营养不良患者、手术后患者或危重患者,可以纠正低白蛋白血症,并对体弱多病者有强身健体作用。事实并非如此,医用白蛋白的来源为献血者的血浆经血浆分离和灭菌处理后配置而成。白蛋白中的某些成分(如制剂中的微量α-1酸性糖蛋白)不但不能提高机体免疫力,反而可使机体免疫力下降。此外,若给白蛋白含量正常的患者输注外源性白蛋白,还可抑制机体自身白蛋白的合成,加速白蛋白的分解,并可使循环负荷过重、血钠增高等。