肠内营养不同递增输注速度对重症急性胰腺炎患者喂养耐受性、生存质量和胃肠功能恢复的影响

摘要 目的：观察肠内营养不同递增输注速度对重症急性胰腺炎（SAP）患者喂养耐受性、生存质量和胃肠功能恢复的影响。方法：选取2019年3月~2021年2月期间我院收治的SAP患者120例，按照随机数字表法分为低速组、中速组和高速组，各为40例，输注速度递增幅度由低到高给予肠内营养。对比三组患者的腹内压、喂养耐受性、生存质量和胃肠功能恢复情况。结果：干预8 h后、干预16 h后、干预20 h后低速组腹内压低于高速组、中速组，而中速组低于高速组（P<0.05）。低速组排气排便恢复时间、肠鸣音恢复时间、经口进食时间、腹胀缓解时间短于中速组、高速组，中速组则短于高速组（P<0.05）。低速组干预7 d后世界卫生组织生存质量简明量表（WHO-QOL-BREF）各维度评分高于中速组、高速组，中速组则高于高速组（P<0.05）。低速组喂养不耐受发生率低于中速组、高速组，中速组则低于高速组（P<0.05）。结论：肠内营养低速递增输注有利于防止腹内压升高，提高SAP患者喂养耐受性，促进胃肠功能恢复，进而提高患者生存质量。     

Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection.

OBJECTIVES: To assess whether immediate post-operative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective. DESIGN: Randomised trial of immediate post-operative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the reintroduction of normal diet. SETTING: Teaching hospitals in London. SUBJECTS: 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent, chronic gastrointestinal disease. Two patients did not proceed to resection. MAIN OUTCOME MEASURES: Nutritional state, nutritional intake and nitrogen balance, gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test, complications, and outcome. RESULTS: Successful immediate enteral feeding was established in all 14 patients with a mean (SD) daily intake of 6.78 (1.57)MJ (1622 (375) kcal before reintroduction of oral diet compared with 1.58 (0.14) MJ (377 (34) kcal) for those on intravenous fluids (P < 0.0001). Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients (mean (SD) - 13.2 (11.6) g v 5.3 (2.7) g; P < 0.005). There was no difference by day 5. There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids (0.11(0.06) v 0.15 (0.12); P < 0.005). There were also fewer postoperative complications in the enterally fed group (P < 0.005). CONCLUSIONS: Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe, prevents an increase in gut mucosal permeability, and produces a positive nitrogen balance.     

预消化的肠内营养对ICU危重症患者的营养状况及肠内营养耐受性的影响

目的:研究预消化的肠内营养制剂对ICU危重症患者营养状况及肠内营养耐受性的影响。方法:本试验为前瞻、随机、对照、单盲研究,将符合入组条件的ICU患者随机分为试验组和对照组。试验组给予预消化型肠内营养制剂,而对照组给予整蛋白型肠内营养制剂进行营养支持。比较两组患者入组及营养支持2周后的营养指标、肠内营养耐受性及ICU住院天数等。结果:治疗2周后,试验组前白蛋白、转铁蛋白较对照组明显升高(P0.05),肠内营养不耐受、腹内压升高、腹泻、肠鸣音减弱及胃肠道出血发生率较对照组明显降低(P0.05),ICU住院时间也较对照组明显缩短(P0.05)。结论:预消化的肠内营养制剂对ICU患者有良好的治疗效果,可降低胃肠道不良反应发生率,提高耐受性,明显改善患者营养状况。     

Timing of enteral feeding in cerebral malaria in resource-poor settings: a randomized trial

Background

Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.

Method and Findings

A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.

Conclusions

In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.

Trial Registration

Controlled-Trials.com ISRCTN57488577     

Enteral feeding induces diet-dependent mucosal dysfunction, bacterial proliferation, and necrotizing enterocolitis in preterm pigs on parenteral nutrition

Preterm neonates have an immature gut and metabolism and may benefit from total parenteral nutrition (TPN) before enteral food is introduced. Conversely, delayed enteral feeding may inhibit gut maturation and sensitize to necrotizing enterocolitis (NEC). Intestinal mass and NEC lesions were first recorded in preterm pigs fed enterally (porcine colostrum, bovine colostrum, or formula for 20-40 h), with or without a preceding 2- to 3-day TPN period (n = 435). Mucosal mass increased during TPN and further after enteral feeding to reach an intestinal mass similar to that in enterally fed pigs without TPN (+60-80% relative to birth). NEC developed only after enteral feeding but more often after a preceding TPN period for both sow's colostrum (26 vs. 5%) and formula (62 vs. 39%, both P < 0.001, n = 43-170). Further studies in 3-day-old TPN pigs fed enterally showed that formula feeding decreased villus height and nutrient digestive capacity and increased luminal lactic acid and NEC lesions, compared with colostrum (bovine or porcine, P < 0.05). Mucosal microbial diversity increased with enteral feeding, and Clostridium perfringens density was related to NEC severity. Formula feeding decreased plasma arginine, citrulline, ornithine, and tissue antioxidants, whereas tissue nitric oxide synthetase and gut permeability increased, relative to colostrum (all P < 0.05). In conclusion, enteral feeding is associated with gut dysfunction, microbial imbalance, and NEC in preterm pigs, especially in pigs fed formula after TPN. Conversely, colostrum milk diets improve gut maturation and NEC resistance in preterm pigs subjected to a few days of TPN after birth.     

Is Early Oral Feeding after Gastric Cancer Surgery Feasible? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Aim

To assess the feasibility and safety of early oral feeding (EOF) after gastrectomy for gastric cancer through a systematic review and meta-analysis based on randomized controlled trials.

Methods

A literature search in PubMed, Embase, Web of Science and Cochrane library databases was performed for eligible studies published between January 1995 and March 2014. Systematic review was carried out to identify randomized controlled trials comparing EOF and traditional postoperative oral feeding after gastric cancer surgery. Meta-analyses were performed by either a fixed effects model or a random effects model according to the heterogeneity using RevMan 5.2 software.

Results

Six studies remained for final analysis. Included studies were published between 2005 and 2013 reporting on a total of 454 patients. No significant differences were observed for postoperative complication (RR = 0.95; 95%CI, 0.70 to 1.29; P = 0.75), the tolerability of oral feeding (RR = 0.98; 95%CI, 0.91 to 1.06; P = 0.61), readmission rate (RR = 1; 95%CI, 0.30 to 3.31; P = 1.00) and incidence of anastomotic leakage (RR = 0.31; 95%CI, 0.01 to 7.30; P = 0.47) between two groups. EOF after gastrectomy for gastric cancer was associated with significant shorter duration of the hospital stay (WMD = −2.36; 95%CI, −3.37 to −1.34; P<0.0001) and time to first flatus (WMD = −19.94; 95%CI, −32.03 to −7.84; P = 0.001). There were no significant differences in postoperative complication, tolerability of oral feeding, readmission rates, duration of hospital stay and time to first flatus among subgroups stratified by the time to start EOF or by partial and total gastrectomy or by laparoscopic and open surgery.

Conclusions

The result of this meta-analysis showed that EOF after gastric cancer surgery seems feasible and safe, even started at the day of surgery irrespective of the extent of the gastric resection and the type of surgery. However, more prospective, well-designed multicenter RCTs with more clinical outcomes are needed for further validation.     

Preoperative bi-fractionated accelerated radiation therapy for combined treatment of locally advanced rectal cancer in a consectutive series of unselected patients

Background

although preoperative RT (Radiation Therapy) is becoming the preferred approach for combined treatment of locally advanced rectal adenocarcinoma, no regimen can be now considered as a standard. Since the toxicity of preoperative RT isn't yet completely known, and the advantages of preoperative RT could be counterbalanced by increased postoperative morbidity and mortality, a monocentre series of preoperative bifractionated accelerated RT was retrospectively reviewed to clarify toxicity and outcomes after a prolonged follow up.

Methods

patients were screened following these eligibility criteria: histology-proven adenocarcinoma of the rectum; distal tumour extent at 12 cm or less from the anal verge; clinical stage T3–4/anyN, or anyT/N1–2; ECOG Performance Status 0–2. A total dose of 41.6 Gy (26 twice daily fractions of 1.6 Gy) was delivered. Surgery was carried out 17 ± 2 days after RT completion, adopting the total mesorectal excision technique.

Results

24 men and 23 women were enrolled; median age was 55 years (r.: 39–77). Twenty-eight patients were stage II and 19 stage III. 9 patients suffered from a recurrent tumour. 2 patients experienced a severe grade 4 gastrointestinal toxicity (a colo-vaginal fistula and an intestinal obstruction, both successfully treated). Operative mortality was nil; postoperative early complications occurred in 13 cases; mean length of hospital stay was 15 days. After a mean follow up of 44 months (r.: 18–84) 8 patients had deceased for recurrent disease, 15 were alive with a disease progression (2 pelvic recurrences and 13 pure distant deposits) and 24 were alive, without disease. The 5-year actuarial overall survival was 74.2%, the disease-free survival 62.9% and the regional control rate 84.7%. Long-term complications included 1 case of radiation enteritis requiring surgery, 2 cases of anastomotic stricture and 3 cases of bladder incontinence.

Conclusion

bifractionated accelerated RT administered in the preoperative setting to patients bearing locally advanced rectal cancer is reliable and safe, as its immediate and late toxicity (mainly infectious) is acceptably low and long-term survivals are achievable. These findings support the increasing use of preoperative RT for treatment of this malignancy in experienced centres. Ongoing multicentric trials are expected to address still unsolved issues, including the benefit of CT adjunct to preoperative RT.

     

Improvement of Expressed Breast Milk in Mothers of Preterm Infants by Recording Breast Milk Pumping Diaries in a Neonatal Center in China

Objectives

Because inadequate expression of human milk (EBM) in mothers of hospitalized infants were noticed in a neonatal center of our hospital, family education program was carried out to increase the EBM.

Methods

A breast milk pumping diary was introduced to the mothers with preterm infant(s) admitted in the NICU. The ratios of EBM (days of EBM to NICU/hospitalized days), breast milk feeding (BMF) (days of infants fed with exclusive human milk/hospitalized days), mixed feeding (MF) (days of infants fed with partial breast milk and partial formula/hospitalized days), and formula feeding (FF) (days of infants fed with preterm formula/hospitalized days) were evaluated.

Results

During January to April, 2014, the ratios of EBM to the NICU, BMF, MF and FF were 28.11%, 6.6%, 32.8% and 60.6%, respectively. After the introduction of breast milk pumping diary to the mothers from May 2014, the ratio of EBM to the NICU increased significantly to 53.3% (p<0.01) within the following eight months. Both the ratios of BMF and MF also rose to 23.8% and MF 55.3%, respectively. Consequently, the ratio of FF was reduced to 20.9%. Exclusive breast milk feeding also significantly reduce the duration of nil per oral (NPO) of the very low birth weight infants during hospital stay as compared to those fed with mixed feeding and formula feeding.

Conclusion

The introduction of a breast milk pumping diary was associated with a significant increase in the intake of EBM of the hospitalized preterm newborns.     

磁压榨技术建立大鼠胃肠吻合模型的实验研究

目的:探讨采用磁压榨技术建立大鼠胃肠吻合模型的可行性。方法:设计加工适用于大鼠胃肠吻合的子、母磁体。将10只SD大鼠采用磁压榨技术进行胃肠吻合,子、母磁体分别经口置入大鼠胃和空肠内,子母磁体相吸压榨胃壁和肠壁,磁体间受压组织缺血坏死后连同磁体从吻合口脱落入肠道,胃肠吻合即建立,磁体最终经消化道自行排出体外,术后2周处死动物,获取吻合口标本,检测吻合口爆破压、肉眼和光镜下观察吻合口愈合情况。结果:10只SD大鼠中,1只因麻醉意外死亡,其余9只大鼠均顺利完成手术操作并存活至术后2周;手术平均操作时间(15.89±3.25)min,磁体排出体外时间(8.56±1.26)天(范围7-11)天;吻合口爆破压均大于200 mm Hg,吻合口组织HE染色和Masson染色可见粘膜层连续性建立,愈合良好。结论:磁压榨技术可用于大鼠胃肠吻合模型制备,具有操作简单、成功率高的优点。     

Early intervention to promote oral feeding in patients with intracerebral hemorrhage: a retrospective cohort study

Background  

Stroke is a major cause of dysphagia, but little is known about when and how dysphagic patients should be fed and treated after an acute stroke. The purpose of this study is to establish the feasibility, risks and clinical outcomes of early intensive oral care and a new speech and language therapist/nurse led structured policy for oral feeding in patients with an acute intracerebral hemorrhage (ICH).     

Gastrointestinal peptides and the adaptation to extrauterine nutrition

The adaptation to extrauterine nutrition involves complex physiological changes at birth which may be regulated by genetic endowment; enteral nutrients, secretions, and bacteria; and endogenous hormones and exogenous hormones in breast milk. The hypothesis is explored that enteral feeding after birth may trigger key adaptations in the gut and in metabolism partly through the mediation of gastrointestinal hormone secretion. Gut peptides are found in the early human fetal gut and by the second trimester some are found in high concentrations in the fetal circulation and amniotic fluid. Major plasma hormonal surges occur during the neonatal period in term and preterm infants: notably in enteroglucagon, gastrin, motilin, neurotensin, gastrointestinal peptide, and pancreatic polypeptide. These events do not occur in neonates deprived of enteral feeding. A progressive development of dynamic gut hormonal responses to feeding is observed. The pattern of gut endocrine changes after birth is influenced by the type and route of feeding. Potential pathophysiological effects of depriving high risk neonates of enteral feeding are considered. It is speculated that infants committed to prolonged total parenteral nutrition from birth may benefit from the biological effects of intraluminal nutrients used in subnutritional quantities.     

Nutritional Support for Patients Sustaining Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies

Background

In traumatic brain injury (TBI), the appropriate timing and route of feeding, and the efficacy of immune-enhancing formulae have not been well established. We performed this meta-analysis aiming to compare the effects of different nutritional support modalities on clinical outcomes of TBI patients.

Methods

We systematically searched Pubmed, Embase, and the Cochrane Library until October, 2012. All randomized controlled trials (RCTs) and non-randomized prospective studies (NPSs) that compared the effects of different routes, timings, or formulae of feeding on outcomes in TBI patients were selected. The primary outcomes included mortality and poor outcome. The secondary outcomes included the length of hospital stay, the length of ventilation days, and the rate of infectious or feeding-related complications.

Findings

13 RCTs and 3 NPSs were included. The pooled data demonstrated that, compared with delayed feeding, early feeding was associated with a significant reduction in the rate of mortality (relative risk [RR] = 0.35; 95% CI, 0.24–0.50), poor outcome (RR = 0.70; 95% CI, 0.54–0.91), and infectious complications (RR = 0.77; 95% CI, 0.59–0.99). Compared with enteral nutrition, parenteral nutrition showed a slight trend of reduction in the rate of mortality (RR = 0.61; 95% CI, 0.34–1.09), poor outcome (RR = 0.73; 95% CI, 0.51–1.04), and infectious complications (RR = 0.89; 95% CI, 0.66–1.22), whereas without statistical significances. The immune-enhancing formula was associated with a significant reduction in infection rate compared with the standard formula (RR = 0.54; 95% CI, 0.35–0.82). Small-bowel feeding was found to be with a decreasing rate of pneumonia compared with nasogastric feeding (RR = 0.41; 95% CI, 0.22–0.76).

Conclusion

After TBI, early initiation of nutrition is recommended. It appears that parenteral nutrition is superior to enteral nutrition in improving outcomes. Our results lend support to the use of small-bowel feeding and immune-enhancing formulae in reducing infectious complications.     

Early Complications Following Oesophagectomy for Cancer in Relation to Long-Term Healthcare Utilisation: A Prospective Population-Based Cohort Study

Background

Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period.

Methods

This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI).

Results

There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively.

Conclusion

This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.     

深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察

目的:评估深度水解配方奶(eHPF)在不同体重早产儿早期喂养中临床应用效果。方法:选取2017年9月至2018年12月出生的早产儿,分为极低出生体重儿组(体重1000-1500g之间)62例和低出生体重儿(体重1500-2000g之间)100例,每组再随机分为两组,分别予以深度水解蛋白奶(eHPF)和早产儿配方奶(SPF)喂养。极低出生体重儿组于12小时后开始微量喂养,低出生体重儿12小时内适量喂养;极低出生体重儿组深度水解蛋白奶喂养2周后改早产儿奶喂养,低出生体重儿组深度水解蛋白奶1周后改早产儿奶喂养。比较深度水解蛋白奶在不同体重早产儿早期喂养中的临床应用效果,不同体重早产儿恢复出生体重时间、每日体重增长速度、胃管留置时间、完全肠内喂养天数、住院天数、喂养不耐受发生率、宫外发育迟缓发生率及尿素氮、碱性磷酸酶指标。结果:深度水解蛋白喂养组极低出生体重儿/低出生体重儿恢复出生体重天数、完全肠道喂养天数、胃管留置时间、住院天数较早产儿奶喂养组明显缩短(P0.05),每天体重增长优于早产儿组,喂养不耐受、宫外发育迟缓发生率明显低于早产儿组(P0.05),尿素氮、碱性磷酸酶无统计学差异(P0.05)。结论:深度水解蛋白奶用于不同体重早产儿早期喂养效果明显优于早产儿配方奶,其更有助于早产儿的生长发育。     

Efficacy,tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials

ObjectiveTo determine the efficacy, gastrointestinal safety, and tolerability of celecoxib (a cyclo-oxygenase 2 (COX 2) inhibitor) used in the treatment of osteoarthritis and rheumatoid arthritis.DesignSystematic review of randomised trials that compared at least 12 weeks'' celecoxib treatment with another non-steroidal anti-inflammatory drug (NSAID) or placebo and reported efficacy, tolerability, or safety. Trials identified from manufacturer and by searching electronic databases and evaluated according to predefined inclusion and quality criteria. Data combined through meta-analysis.Participants15 187 patients with osteoarthritis or rheumatoid arthritis.ResultsNine randomised controlled trials were included. Celecoxib and NSAIDS were equally effective for all efficacy outcomes. Compared with those taking other NSAIDs, in patients taking celecoxib the rate of withdrawals due to adverse gastrointestinal events was 46% lower (95% confidence interval 29% to 58%; NNT 35 at three months), the incidence of ulcers detectable by endoscopy was 71% lower (59% to 79%; NNT 6 at three months), and the incidence of symptoms of ulcers, perforations, bleeds, and obstructions was 39% lower (4% to 61%; NNT 208 at six months). Subgroup analysis of patients taking aspirin showed that the incidence of ulcers detected by endoscopy was reduced by 51% (14% to 72%) in those given celecoxib compared with other NSAIDs. The reduction was greater (73%, 52% to 84%) in those not taking aspirin.ConclusionCelecoxib is as effective as other NSAIDs for relief of symptoms of osteoarthritis and rheumatoid arthritis and has significantly improved gastrointestinal safety and tolerability.

What is already known on this topic

Long term NSAID use is associated with the development of peptic and duodenal ulcersCOX 2 specific inhibitors are claimed to cause fewer gastrointestinal complicationsThe National Institute for Clinical Excellence has recently recommended that COX 2 specific inhibitors are used in patients with arthritis who are at risk of gastrointestinal complications but not in those taking prophylactic aspirin

What this study adds

Systematic review of randomised trials shows that celecoxib is as effective as other NSAIDs for osteoarthritis and rheumatoid arthritisCelecoxib has significantly improved gastrointestinal safety and tolerability compared with standard NSAIDsAn improvement in gastrointestinal safety was still evident in patients who were also taking aspirin     

2型糖尿病胃肠转流术后早期肠内营养对血糖的影响

目的：探讨2型糖尿病Roux-en-Y胃肠转流术（RYGBP）后早期肠内营养对患者血糖的影响。方法：回顾2011年7月至2012年7月我科63例不同发病年龄、不同病程的2型糖尿病患者行Roux-en-Y胃肠转流术（RYGBP）后的恢复情况。共分两组：A组为术后完全肠外营养直至胃肠道功能恢复正常的患者;B组为术后早期开始肠内营养患者。监测两组患者术后3天至2周的血清白蛋白含量、血脂、肠蠕动恢复时间、血糖水平、C肽水平。结果：A、B两组术后血清白蛋白含量及血脂水平无显著性差异。B组患者肠功能恢复时间少于A组,血糖水平下降时间较A组快,其血糖下降时间与肠功能恢复时间一致,B组血清C肽水平变化时间较A组提前。结论：2型糖尿病胃肠转流术（RYGBP）后早期肠内营养支持可以促进肠道功能恢复,加快血糖水平下降,改善胰岛调节功能。     

序贯肠内外营养支持对AECOPD合并呼吸衰竭患者营养指标、胃肠黏膜功能和免疫功能的影响

摘要 目的：观察序贯肠内外营养支持在慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者中的应用价值。方法：选用随机数字表法将我院2019年1月-2020年12月期间收治的90例AECOPD合并呼吸衰竭患者分为肠内组（n=30）、肠外组（n=30）和序贯组（n=30）。对比三组患者营养指标、胃肠黏膜功能和免疫功能,观察并记录三组抗菌药物使用天数、住院天数和并发症发生率。结果：序贯组的抗菌药物使用天数、住院天数短于肠内组、肠外组（P<0.05）。序贯组营养支持2周后白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TF）均高于肠内组、肠外组（P<0.05）。序贯组营养支持2周后免疫球蛋白（Ig）A、IgM、IgG均高于肠内组、肠外组（P<0.05）。序贯组营养支持2周后D-乳酸、二胺氧化酶（DAO）均低于肠内组、肠外组（P<0.05）。三组并发症发生率组间对比无明显差异（P>0.05）。结论：序贯肠内外营养支持应用于AECOPD合并呼吸衰竭患者,可促进患者免疫功能提高,营养状况改善,同时还可促进胃肠黏膜功能恢复,缩短抗菌药物使用天数和住院天数。     

2 型糖尿病胃肠转流术后早期肠内营养对血糖的影响

目的：探讨2 型糖尿病Roux-en-Y 胃肠转流术（RYGBP）后早期肠内营养对患者血糖的影响。方法：回顾2011 年7 月至 2012 年7 月我科63 例不同发病年龄、不同病程的2 型糖尿病患者行Roux-en-Y 胃肠转流术（RYGBP）后的恢复情况。共分两组： A 组为术后完全肠外营养直至胃肠道功能恢复正常的患者;B 组为术后早期开始肠内营养患者。监测两组患者术后3 天至2 周的 血清白蛋白含量、血脂、肠蠕动恢复时间、血糖水平、C 肽水平。结果：A、B 两组术后血清白蛋白含量及血脂水平无显著性差异。B 组患者肠功能恢复时间少于A组,血糖水平下降时间较A 组快,其血糖下降时间与肠功能恢复时间一致,B组血清C肽水平变 化时间较A 组提前。结论：2 型糖尿病胃肠转流术（RYGBP）后早期肠内营养支持可以促进肠道功能恢复,加快血糖水平下降,改 善胰岛调节功能。     

Endpiece: Two of the same

ObjectiveTo determine the effectiveness of anticholinergic drugs for the treatment of overactive bladder syndrome.DesignSystematic review of randomised controlled trials.ConclusionsAlthough statistically significant, the differences between anticholinergic drugs and placebo were small, apart from the increased rate of dry mouth in patients receiving active treatment. For many of the outcomes studied, the observed difference between anticholinergics and placebo may be of questionable clinical significance. None of these studies provided data on long term outcome.

What is already known on this topic

Anticholinergics are the first line medical treatment for overactive bladderThe effectiveness of these drugs is unclear

What this study adds

Anticholinergics produce significant improvements in overactive bladder symptoms compared with placeboThe benefits are, however, of limited clinical significance