目的 探讨个体化肠内营养支持在胃肠术后早期应用的可行性及安全性。方法 选取2022年1月—12月安徽省亳州市中医院普通外科收治的胃肠手术患者100例。使用随机数字表法将患者随机为观察组和对照组,每组各50例。观察组在常规治疗基础上实施个体化肠内营养,持续7 d。对照组则接受术后常规处理。术后第7天测定实验室指标,并比较两组胃肠功能的恢复情况。结果 观察组术后肛门首次排气时间短于对照组[（55.41±19.63）h vs （81.46±19.39） h],前白蛋白水平高于对照组[（241.14±65.73）g/L vs（217.35±51.63）g/L],组间比较差异有统计学意义（P<0.05）。血清总蛋白水平[（70.55±18.89）g/L vs （68.16±20.05）g/L]、血清白蛋白水平[（53.22±17.76）g/L vs（50.76±18.54）g/L]、淋巴细胞计数[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L]以及肛门排便时间[（89.67±22.31）h vs （97.77±21.27）h ]在组间比较差异无统计学意义（P>0.05）。结论 根据个体情况在胃肠术后早期实施个体化的肠内营养支持是安全可行的,能够促进胃肠功能的快速恢复,从而改善患者的营养状况。

Objective To investigate the feasibility and safety of personalized enteral nutrition support during the early postoperative period of gastrointestinal surgery．Methods A total of 100 patients who underwent gastrointestinal surgery at the Department of General Surgery,Bozhou Hospital of Traditional Chinese Medicine,who were enrolled in this study during January 2022 to December 2022．Patients were randomly allocated into either the observational or control group,with 50 patients in each group．The randomization was performed using a random number table．The observational group received personalized enteral nutrition support in addition to routine treatment for 7 days．The control group received standard postoperative care．Laboratory indicators were measured on the 7th postoperative day to compare recovery of gastrointestinal function between the two groups．Results The observational group exhibited a significantly shorter time to the first passage of flatus from the anus compared to the control group（55.41±19.63 h vs 81.46±19.39 h,P<0.05）,as well as higher prealbumin levels（241.14±65.73 g/L vs 217.35±51.63 g/L,P<0.05）．However,there were no significant differences between the two groups in terms of serum total protein levels（70.55±18.89 g/L vs 68.16±20.05 g/L）,serum albumin levels（53.22±17.76 g/L vs 50.76±18.54 g/L）,lymphocyte counts[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L],and time to the first defecation from the anus（89.67±22.31 h vs 97.77±21.27 h）（all P>0.05）．Conclusions Personalized enteral nutrition support based on individual conditions is safe and feasible in the early postoperative period of gastrointestinal surgery．It can promote the rapid recovery of gastrointestinal function and improve patients' nutritional status．

目的 构建并验证机械通气患儿肠内营养支持发生误吸的风险预测模型。方法 回顾性分析中山市博爱医院2021年3月—2023年3月儿童重症监护病房330例行机械通气并进行肠内营养的患儿临床资料,通过二元Logistic回归,获取机械通气患儿肠内营养支持发生误吸的预测因素,绘制列线图模型,并进行模型评价及验证。结果 330例机械通气患儿中,104例患儿发生误吸、226例未发生误吸。两组患儿在意识状态、机械通气方式、管饲量、胃残留量、胃管置入深度、促胃动力药、镇静剂等方面对比差异具有统计学意义（P<0.05）。二元Logistic结果显示,胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂是机械通气患儿肠内营养支持发生误吸的影响因素（P<0.05）。建模组AUC为0.810（95%CI：0.760~0.860）,Hosmer-Lemesh结果显示,χ²=3.245,P=0.846;外部验证组AUC为0.873（95%CI：0.831~0.914）,Hosmer-Lemesh结果显示,χ²=3.567,P=0.875。建模组和训练组DCA曲线大部分落于Y=0上方。建模组与外部验证组校准曲线均与参考曲线高度贴合,预测概率与实际概率接近,校准度良好。结论 基于胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂等7项指标构建的风险预测模型具有一定的临床价值,可作为医护人员识别肠内营养机械通气误吸高危患儿的工具。

Objective To establish and verify the risk prediction model of enteral nutritional aspiration in children with mechanical ventilation．Methods The clinical data of 330 children who underwent mechanical ventilation and enteral nutrition in the PICU of Zhongshan Boai Hospital from March 2021 to March 2023 were retrospectively analyzed．The independent predictive factors of enteral nutrition support aspiration in children with mechanical ventilation were obtained by binary Logistic regression,and the nomographic model was drawn,and the model was evaluated and verified. Results Among 330 children with mechanical ventilation,104 had aspiration and 226 did not．There were statistically significant differences between the two groups in consciousness state,mechanical ventilation mode,tube feeding amount,gastric residual amount,gastric tube insertion depth,gastric motivity drugs,sedatives,etc.（P<0.05）．Binary Logistic results showed that gastric residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motonics and sedatives were the influential factors of enteral nutritional aspiration in children with mechanical ventilation（P<0.05）．The AUC of the modeling group was 0.810（95%CI：0.760-0.860）,and the Hosmer-Lemesh result showed that χ²=3.245,P=0.846．The AUC of the external verification group was 0.873（95%CI：0.831-0.914）,and the Hosmer-Lemesh result showed that χ²=3.567,P=0.875．The DCA curves of modeling group and training group mostly were above Y=0．The calibration curves of the modeling group and the external verification group are highly fit to the reference curves,and the prediction probability was close to the actual probability,and the calibration degree was good．Conclusion sThe risk prediction model based on 7 indexes,including stomach residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motivity drug and sedative,with certain clinical value,and can be used as a tool for medical staff to identify children at high risk of enteral nutritional mechanical aspiration．

目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P＜0.05);干预后观察组SA、PA、TF高于对照组(P＜0.05);干预后观察组癌因性疲乏低于对照组(P＜0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P＜0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。

Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.

目的 探讨抗肿瘤联合营养支持治疗对老年晚期恶性肿瘤癌因性疲倦及厌食行为的影响。方法 选取2015年4月—2017年4月晚期恶性肿瘤老年患者160例,随机分为抗肿瘤治疗组(对照组)和抗肿瘤联合营养支持治疗组(观察组),各80例,对比分析两组治疗前、后癌因性疲倦及厌食行为评分情况。结果 治疗前,两组厌食行为、癌因性疲倦评分比较无差异(P>0.05);治疗后,观察组厌食行为及癌因性疲倦评分均低于对照组(P<0.05)。结论 营养支持治疗在老年晚期恶性肿瘤患者厌食行为及癌因性疲倦方面的改善效果显著,一定程度上提高患者生活质量,减轻痛苦,具有较高临床应用价值。

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording 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.