目的 回顾分析慢性阻塞性肺疾病急性加重期并或不并肺部结核感染在感染及营养方面指标的差异性,明确结核感染对AECOPD的影响。方法 选取2013年7月—2015年6月因急性发作入住我院的COPD患者105例,根据GOLD 2011对COPD的诊断标准及卫生部2008年制定的肺结核诊断标准将其分为无结核组、稳定期组、好转期组及进展期四组。分别在入院时测定患者白细胞计数、中性粒细胞比率、总淋巴细胞计数、淋巴细胞比值、红细胞沉降率、血红蛋白浓度、血清白蛋白及C反应蛋白及体重指数。结果 各组感染指标比较,WBC、CRP两指标差异不显著(P>0.05),而无结核组相较于其他三组,NEUT%更高(F=4.004,P=0.010)、LY%及ESR更低(F/P分别为3.668/0.015和20.197/0.000);各组营养指标比较,合并有肺结核的三组,其Hb、ALB及BMI均比无结核组低,达到统计学差异(P<0.05),而TLC在各组间无差异(F=0.858,P=0.466)。结论 合并有结核感染的AECOPD患者更容易出血贫血(Hb降低)、低蛋白血症(ALB降低)、低体重(BMI降低)、中性粒细胞含量偏低(NEUT%降低)而血沉(ESR)、淋巴细胞比率(LY%)升高的情况,对出现此类情况的AECOPD患者应进行结核感染相关检查。

目的 调查住院患儿的营养风险及营养状况,探讨儿科营养风险筛查新方法的应用。方法 使用新的儿科营养风险筛查工具,对住院患儿进行营养风险筛查,根据体格测量评价儿童营养状况;与国外三种儿科营养风险筛查工具比较一致性。结果 402例住院患儿中高营养风险患儿占24.1%,营养不良的检出率为18.4%。有36.8%的患者接受营养支持,其中肠外营养支持率为23.1%,肠内营养支持率为16.7%,PN:EN为1.39:1。结论 对住院患儿采用新方法做营养风险筛查,能客观地反映住院患儿的营养风险,为临床营养支持提供依据。

Objective To investigate nutritional risk and the nutritional status in hospitalized children,and to validate the new screening tool of nutritional risk in hospitalized pediatric patients. Methods The nutritional risk of hospitalized pediatric patients was investigated using the new screening tool,and compared with other three pediatric nutritional risk screening tools;the nutritional status was assessed according to children physical measurement. Results Among 402 hospitalized children,children with high nutritional risk accounted for 24.1%.The overall prevalence of malnutrition was 18.4%.The proportion of patients receiving nutritional support was 36.8%.The rate of parenteral and enteral nutrition support was 23.1% and 16.7%,respectively.The ratio of parenteral nutrition to enteral nutrition was 1.39:1. Conclusion The new screening tool can reflect the possible nutritional risk in hospitalized pediatric patients objectively and provide the basis for clinical nutritional support.

目的 探讨生长抑素对腹部手术后早期肠内营养支持顺应性的影响。方法 选择在本院接受中等以上腹部手术的住院病人60例,随机分成实验组和对照组各30例,手术后12 h开始给予早期肠内营养支持,连续5 d,实验组按常规使用生长抑素5 d,而对照组未使用生长抑素;比较两组在术后5 d内胃肠道不适的发生与否,胃肠减压的引流量,肠蠕动功能恢复情况,以及术后7 d的血液常规、肝、肾功能及血糖等血液生化指标。结果 与对照组比较,实验组在手术后胃肠道不适的发生,鼻胃管(胃肠减压)引流量,肠蠕动功能恢复时间等差异有统计学意义;术后7 d的血液常规、肝、肾功能及血糖等指标比较差异无统计学意义。结论 生长抑素有助于机体对腹部手术后肠内营养支持的顺应性,并安全可行。

Objective To study the clinical effects of somatostatin on compliance of early enteral nutrition after abdominal surgery. Methods 60 cases who accepted above medium abdominal operations were randomized into two groups including 30 cases of treatment group with somatostatin on the bases of early enteral nutrition and 30 cases of control group with early enteral nutrition, continued for 5 days after abdominal surgery. The promotion of clinical manifestations and signs, gastrointestinal decompression, blood routine examination, liver and renal function, blood glucose and so on were compared between the two groups. Results As for clinical manifestations and signs promotion, there were statistically significance in the alleviation of pain and distension of the abdominal and the average volume gastrointestinal decompression and the time of recovering peristalsis and passing flatus (P<0.05).As for blood routine examination, liver and renal function, blood glucose there were no statistically significance between the two groups. Conclusion Somatostatin can effected on compliance of early enteral nutrition after abdominal surgery.

目的 探讨黄芪枳术汤结合肠内营养的对颅脑术后患者ALB/PA/TP的影响。方法 将60例颅脑术后患者随机分为观察组(n=30)和对照组(n=30)。观察组给予中药黄芪枳术汤和整蛋白肠内营养液,对照组仅给予整蛋白肠内营养液。通过观察两组病人营养支持前后各项营养指标的变化和胃肠道的并发症,对两种治疗方式的疗效进行比较。结果 观察组病人营养支持后第7,14 天各项营养指标总蛋白(TP),白蛋白(ALB),前白蛋白(PA),血红蛋白(HGb)水平均高于对照组,差异有意义(P均＜0.05),观察组的胃肠道症状的发生率较对照组少。结论 黄芪枳术汤能加强肠内营养疗效,促进胃肠功能恢复及减少术后并发症,黄芪枳术汤结合肠内营养能增加颅脑术后患者的摄入量,提高血清蛋白水平,改善机体的营养状况,促进患者的早日康复。

      目的 探讨老年营养风险指数（GNRI）与慢性阻塞性肺疾病者急性加重期患者预后的相关性。方法 选择贵州省六盘水水旷医院2019年1月—2022年1月收治的COPD急性加重期患者，根据GNRI值，分为正常营养组（GNRI＞98）和营养不良组（GNRI≤98），应用生存曲线和Cox比例风险回归评估营养状况与死亡率之间的关联。结果 共纳入198例COPD急性加重期患者，正常营养组90例，营养不良组108例，营养不良发生率为54.5%；Kaplan-Meier曲线表明，营养不良组的全因累积死亡率更高（58.3% vs 35.0%，P＜0.001）。Cox比例风险回归分析显示在未校正模型中，HR为2.31（1.25~4.28），P＜0.001。在完全校正模型中，HR为2.48（1.37~4.51），P=0.005，提示与正常营养状况相比，营养不良与全因死亡风险升高相关。结论  GNRI低是COPD患者急性加重期全因死亡的独立危险因素。

      Objective  To investigate the correlation between elderly nutritional risk index（GNRI）and prognosis of patients with AECOPD．Methods  Patients with AECOPD admitted to our hospital from January 2019 to January 2022 were selected and divided into normal nutrition group（GNRI＞98）and malnutrition group（GNRI≤98）according to GNRI value．Survival curve and Cox regression were used to evaluate the association between nutritional status and mortality．Results  A total of 198 patients with AECOPD were included in this study．According to GNRI scores，90 patients were in the normal nutrition group and 108 were in the malnutrition group，with malnutrition incidence of 54.5%．The Kaplan-Meier curve showed that the cumulative all-cause mortality was higher in the malnutrition group（58.3% vs 35%，P＜0.001）．Cox proportional hazard  regression analysis showed that HR in the uncorrected model was 2.31（1.25-4.28），P＜0.001．In the fully corrected model，HR was 2.4（1.37-4.51）and P=0.005，suggesting that malnutrition was associated with a significantly higher risk of all-cause mortalitycompared with normal nutritional status．Conclusions  Low GNRI is an independent risk factor for all-cause death in AECOPD patients．