目的 探讨个体化肠内营养联合电动起立床训练对老年脑卒中卧床患者器官功能的影响。方法 严格执行纳排标准后前瞻性选取2021年7月—2022年9月期间我院收治的97例老年脑卒中卧床患者作为研究对象,按照随机数字表法分为单一组48例给予脑卒中基础干预,联合组49例给予个体化肠内营养联合电动起立床训练干预,观察2组患者营养状况、肺功能指标以及心功能指标。结果 干预4周后,2组血清前蛋白、血清白蛋白、血红蛋白水平均上升且联合组高于单一组（P<0.05）;2组用力肺活量（FVC）、第1秒用力呼吸容积（FEV₁）、FEV₁/FVC均上升且联合组高于单一组（P<0.05）;联合组左心室收缩期内径、左室舒张末期内径低于单一组,联合组左心室射血分数高于单一组（P<0.05）。结论 个体化肠内营养联合电动起立床训练干预可有效改善老年脑卒中卧床患者营养状况及心肺功能,促进其机体功能的恢复。

目的 观察脑性瘫痪（CP）伴营养不良患儿进行系统性饮食调整的效果。方法 2015年1月—2022年1月我院收治以CP伴营养不良患儿80例,以随机数字表法分为对照组和研究组各40例,常规护理指导用于对照组,系统性饮食调整护理用于研究组。比较2组患儿在干预前、后的生化指标（白蛋白、血红蛋白、肌酐、低密度脂蛋白水平）、身体指标（体质量、身高、体质指数、腹部皮下脂肪厚度）、肠内营养混悬液使用剂量及饮食行为能力评分和患儿监护人对干预的满意率。结果 干预后2组的生化指标可见明显变化,其中研究组与对照组相比,白蛋白、血红蛋白、肌酐指标提升更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后两组间的身体指标可见明显变化,其中研究组与对照组相比,体质量、体质指数、腹部皮下脂肪厚度较干预前增加更多更平稳,而低密度脂蛋白研究组较对照组相比,降低更多更平稳,（P<0.01）。在干预后2组的肠内营养混悬液使用剂量及饮食行为能力评分较干预前可见明显变化,其中研究组与对照组相比,肠内营养混悬液使用剂量及饮食行为能力降低更多更平稳（均P<0.05）。研究组监护人对干预的满意率高于对照组（P<0.05）。结论 在CP伴营养不良患儿中,开展有效的系统性饮食调整干预,可有效改善患儿的生化指标,提升各项身体指标,减少肠内营养混悬液的使用剂量,改善饮食行为能力,获得患儿监护人的认可,效果理想。

Objective To observe the effect of systematic diet adjustment in children with cerebral palsy（CP）and malnutrition．Methods A total of 80 CP children with malnutrition treated in our hospital（from January 2015 to January 2022）were divided into two groups by random number table method．Control group received routine nursing guidance and study group received systematic diet adjustment nursing．The biochemical indexes（albumin,hemoglobin,creatinine,low-density lipoprotein levels）,physical indexes（weight,height,body mass index,abdominal subcutaneous fat thickness）,the dosage of enteral nutritional suspension and the score of dietary behavior ability were compared between the two groups before and after the intervention．The satisfaction rate of the children's families with the intervention was evaluated．Results After the intervention,the biochemical indexes of the two groups showed significant changes．Compared with the control group,the indexes of albumin,hemoglobin and creatinine in the study group increased more and more stably,while the index of low-density lipoprotein in the study group decreased more and more stably（P<0.01）．After the intervention,the physical indexes of the two groups showed significant changes．Compared with the control group,the weight,body mass index and abdominal subcutaneous fat thickness of the study group increased more and more stably than before the intervention,while the low-density lipoprotein study group decreased more and more stably（P<0.01）．After the intervention,the dosage of enteral nutritional suspension and the score of dietary behavior ability in the two groups showed significant changes compared with those before the intervention．Compared with the control group,the immune indexes in the study group increased more and more stably,while the dosage of enteral nutritional suspension and the score of dietary behavior ability in the study group decreased more and more stably（P<0.05）．The satisfaction rate of family members in the study group was higher than that in the control group（P<0.05）．Conclusions In children with CP and malnutrition,carrying out effective systematic diet adjustment intervention can significantly improve the biochemical indexes of children,improve various physical indexes,improve immune ability,reduce the dosage of enteral nutritional suspension,improve dietary behavior,and obtain the recognition of children's family members,which has ideal effects．

目的 研究益生菌结合肠内营养(enteral nutrition,EN)干预纠正缺血急性脑梗死(acute cerebral infarction,ACI)患者肠道菌落紊乱的作用及对患者预后的影响。方法 将97例无法自主进食的ACI患者根据治疗方法不同分为观察组(采用益生菌结合EN进行营养支持)和对照组(单纯EN为营养支持)进行治疗,疗程30 d,比较2组肠道菌落生长情况、患者营养水平、临床疗效及预后。结果 治疗后,2组双歧杆菌、肠球菌、大肠杆菌数量先降低后升高,2相邻时间点之间差异显著(P<0.05),2组乳酸杆菌数量持续升高,观察组各时间点之间差异显著(P<0.05),对照组治疗第7 d开始有明显差异(P<0.05),且治疗第7 d后观察组双歧杆菌、肠球菌、大肠杆菌数量高于对照组,差异有统计学意义(P<0.05),治疗第14 d后,观察组乳酸杆菌数量高于对照组,差异有统计学意义(P<0.05);治疗后,观察组体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thinkness,TSF)、上臂肌围(arm muscle circumference,AMC)及血红蛋白(hemoglobin,HB)明显降低(P<0.05),对照组BMI、TSF、AMC、HB、白蛋白(albumin,ALB)及三酰甘油(triglyceride,TG)均明显降低(P<0.05),且观察组BMI、TSF、AMC、HB、ALB及TG高于对照组,差异有统计学意义(P<0.05);观察组治疗过程中腹胀、腹泻发生率低于对照组,差异有统计学意义(P<0.05);治疗后2组APACHEⅡ评明显降低(P<0.05),且观察组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后观察组日常生活活动能力(activities of daily life,ADL)评分高于对照组,ADL分级优于对照组,差异有统计学意义(P<0.05)。结论 益生菌结合EN治疗可有效纠正患者肠道菌落平衡,保护胃肠道功能,从而改善机体营养水平,提高ACI治疗效果,改善患者预后。

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 探讨超低频经颅磁刺激(ILF-TMS)联合艾司唑仑对失眠症患者睡眠脑电图参数及血清神经营养因子表达的影响。方法 选取2018年8月—2020年4月我院失眠症患者114例,随机数字表法分为研究组(n=57)、对照组(n=57)。对照组予以艾司唑仑联合ILF-TMS假性刺激,研究组予以艾司唑仑联合ILF-TMS真性刺激,均治疗1个月。对比2组疗效与治疗前、治疗1个月后睡眠进程参数(总睡眠时间、入睡时间、睡眠效率、觉醒时间)、睡眠结构(非快速眼动睡眠期、快速动眼睡眠期)、匹兹堡睡眠质量量表(PSQI)评分、失眠严重程度指数量表(ISI)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、血清神经营养因子[胶质细胞源性神经营养因子(GDNF)、脑源性神经营养因子(BDNF)]水平。结果 (1)疗效:研究组治疗1个月后总有效率高于对照组(P＜0.05);(2)睡眠进程参数:治疗1个月后研究组总睡眠时间、睡眠效率高于对照组,入睡时间、觉醒时间短于对照组(P＜0.05);(3)睡眠结构:治疗1个月后研究组Ⅲ期、Ⅱ期、非快速眼动睡眠期高于对照组,Ⅰ期睡眠期低于对照组(P＜0.05);(4)PSQI、ISI评分:治疗1个月后研究组PSQI、ISI评分低于对照组(P＜0.05);(5)SAS、SDS评分:治疗1个月后研究组SAS、SDS评分低于对照组(P＜0.05);(6)血清神经营养因子:治疗1个月后研究组血清GDNF、BDNF水平高于对照组(P＜0.05)。结论 ILF-TMS联合艾司唑仑治疗失眠症效果确切,可上调血清神经营养因子表达,改善睡眠脑电图参数,提高睡眠质量,控制焦虑、抑郁症状。

Objective To investigate the effects of infra-low frequency transcranial magnetic stimulation (ILF-TMS) combined with estazolam on sleep EEG parameters and serum neurotrophic factors expression in patients with insomnia. Methods One hundred and fourteen patients with insomnia in our hospital from August 2018 to April 2020 were divided into study group (n=57) and control group (n=57) by random number table method. The control group was treated with estazolam combined with pseudo ILF-TMS stimulation, and the study group was treated with estazolam combined with real ILF-TMS stimulation, all of which were treated for 1 month. Comparing curative effect of two groups before and 1 month after treatment, and sleep process parameters (total sleep time, falling asleep time, sleep efficiency, waking time), the structure of the sleep stages (stage Ⅲ, Ⅱ, Ⅰ, rapid eye movement sleep), Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, serum neurotrophic factors (GDNF, BDNF) levels. Results (1) Efficacy: the total effective rate of the study group was higher than that of the control group after 1 month of treatment (P＜0.05). (2) Sleep process parameters: after 1 month of treatment, the total sleep time and sleep efficiency in the study group were higher than those in the control group, and the falling asleep time and waking time were shorter than those in the control group (P＜0.05). (3) Sleep structure: after 1 month of treatment, compared to the control group, the study group had more in stageⅢ, Ⅱ, rapid eye movement sleep, and less in stage Ⅰsleep(P＜0.05). (4) PSQI and ISI scores: after 1 month of treatment, PSQI and ISI scores of the study group were lower than those of the control group (P＜0.05). (5) SAS and SDS scores: after 1 month of treatment, SAS and SDS scores in the study group were lower than those in the control group (P＜0.05). (6) Serum neurotrophic factors: after 1 month of treatment, serum GDNF and BDNF levels in the study group were higher than those in the control group (P＜0.05). Conclusions ILF-TMS combined with estazolam is an effective treatment of insomnia. It can up-regulate the expression of serum neurotrophic factors, improve the parameters of sleep EEG, improve sleep quality, and control the symptoms of anxiety and depression.

目的 运用品管圈管理方法,提高临床全肠外营养合理应用率,规范TPN的合理应用,保证临床营养支持的安全性与合理性。方法 按照品管圈问题解决型的方法,对影响临床全肠外营养合理应用率的原因进行分析、寻找对策、实践检验,提高临床全肠外营养合理应用率。结果 通过品管圈活动,找出造成TPN不合理应用的关键环节,制定相关制度并优化流程。结论 运用品管圈模式提高临床全肠外营养合理应用率(由65.22%上升为85.32%),改善全肠外营养液成品质量,为患者提供了安全有效经济合理的营养支持治疗。

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.

目的 分析某院中期早产儿体格发育及肠外营养状况,为中期早产儿制定合理的肠外营养方案提供参考。方法 收集某院2017年10月—2018年12月50例(32～33⁺⁶)周早产儿的病例进行回顾分析。结果 50例患儿出生平均体质量、身长、头围各为(1.84±0.24) kg、(42.92±2.16) cm、(29.77±1.20) cm,生后 1周和生后2周的平均体质量、身长、头围分别为(1.83±0.24) kg、(43.28±1.95) cm、(29.97±1.32) cm和(2.07±0.23) kg、(43.91±1.79) cm、(30.62±1.13) cm。营养素的起始剂量各为:氨基酸(1.11±0.37)g·kg^-1·d ^-1,脂肪乳(0.78±0.22)g·kg^-1·d ^-1,葡萄糖(5.86±1.51)mg·kg^-1·min^-1,肠外营养平均天数(22.8±6.46)天,体质量平均下降幅度(7.22±3.82)%,恢复至出生体质量平均天数(8.3±2.72)天。结论 该院中期早产儿肠外营养设计需完善,以控制生理性体质量下降程度及持续时间,更适于体格发育。

Objective To analyze the physical development and parenteral nutrition status of preterm infant in a hospital in order to provide reference for the formulation of reasonable parenteral nutrition treatment plan for medium preterm infants. Methods The clinical data of 50 preterm infants aged 32～33⁺⁶ weeks from October 2017 to December 2018 were collected and analyzed retrospectively. Results The average birth weight, body length and head circumference of the child patients were (1.84±0.24) kg, (42.92 ±2.16) cm, (29.77±1.20) cm respectively. After one week and After two weeks,the average birth weight, body length and head circumference were(1.83±0.24) kg, (43.28±1.95) cm, (29.97±1.32) cm respectively and (2.07±0.23) kg, (43.91±1.79) cm, (30.62±1.13) cm respectively. The initial dose of amino acid(1.11±0.37)g·kg^-1·d^-1, fat emulsion(0.78±0.22)g·kg^-1·d^-1, glucose(5.86±1.51)mg·kg^-1·min^-1. The average days of parenteral nutrition treatment were(22.8±6.46)d, the average weight loss was(7.22±3.82)% and the average days of recovery to birth weight were (8.3±2.72)d. Conclusion The design of parenteral nutrition for preterm infants still needs to be improved in order to control the degree and duration of physiological weight loss of preterm infants in the mid-term, which is conducive to the physical development of preterm infants in the mid-term.

目的 观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法 回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果 经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.

目的 探讨广州地区老年住院患者营养状态与日常生活能力(ADL)的相关性。方法 选取2018年7月—2019年6月在广州市第一人民医院住院年龄≥60岁的老年人共275例,收集其一般资料信息,各项临床营养指标(BMI、血清白蛋白、血红蛋白、总胆固醇、甘油三酯)、并运用营养风险筛查2002(NRS2002)评估营养风险、采用Barthel指数评定量表评估日常生活能力;分析老年住院患者营养状态与ADL之间的相关性。结果 在本组研究中,根据NRS2002评分(营养风险:NRS2002≥3;无营养风险NRS2002＜3),营养风险发生率58.9%(162/275);无营养风险发生率41.1%(113/275)。老年住院患者的NRS2002评分与ADL评分呈负相关关系(r=-0.393,P＜0.05);ADL评分与BMI、血清白蛋白、总胆固醇、血红蛋白水平呈正相关关系(P＜0.05)。结论 广州地区老年住院患者NRS2002为日常生活能力的影响因素,通过降低NRS2002评分来减少营养风险可改善老年人的日常生活能力;老年人的营养风险发生率高,应当尽早进行营养干预。

Objective To investigate relationship between nutritional status and activities of daily living(ADL) in elderly inpatients in Guangzhou. Methods Total of 275 people older than 60 were included in this study from Guangzhou First People's Hospital from July 2018 to June 2019. Their nutritional markers(including BMI, plasma albumin, hemoglobin, total cholesterol, triglyceride),the activities of daily living(ADL) were evaluated with Barthel index and the nutrition risk screening 2002(NRS2002)used to assess the nutritional risk status were collected to analyze the relationship between nutrition and ADL. Results In these subjects, based on the NRS2002 scores(nutritional risk that the NRS2002 scores were equal or greater than 3, and the non-nutritional risk that the NRS2002 scores were less than 3),58.9%(162/275) patients were having nutritional risk and 41.1%(113/275) were having non-nutritional risk. In elderly inpatients,NSR2002 were negatively associated with ADL(r=-0.393,P＜0.05). ADL was positively associated with BMI, plasma albumin and hemoglobin level(P<0.05). Conclusion In the old, the NRS2002 is an influencing marker of activities of daily living in Guangzhou. Reducing the nutritional risk by lowering the NRS2002 scores can improve ADL in the elderly. The incidence of nutritional risk is highly prevalent in elderly and early nutritional treatment will be needed.