目的:分析妊娠糖尿病(GDM)孕妇孕期各阶段体重增重情况,为GDM的预防及控制提供科学数据.方法:选取2018年10月-2019年10月在我院定期产检并分娩的孕妇700例.通过病历查询获取孕妇一般情况、妊娠期各时期体重以及妊娠结局和新生儿体重,与非GDM孕妇及IOM标准比较,分析不同孕前BMI的GDM孕妇妊娠期各阶段增重情况.结果:与非GDM孕妇相比,GDM孕妇其生产年龄、孕前BMI、有无糖尿病家族史、孕期各阶段增重及总增重差异均有统计学意义(P＜0.05).孕妇早孕期增重过快会增加GDM的发病风险(OR = 1.187,95％CI 1.090-1.293).不同孕前BMI的GDM孕妇其孕24周后增重及总增重均较非GDM组更少(P＜0.05),与IOM标准比较,两组增重不足、增重适宜及增重过度人数差异有统计学意义(P＜0.05).仅孕前体重正常组的GDM孕妇早孕期及孕12～24周增重与非GDM组差异有统计学意义(P＜0.05),与IOM标准比较后的各组人数差异有统计学意义(P＜0.05).按新生儿体重分组,排除早产的47例孕妇,发现各组间母亲孕期各阶段体重增长差异均无统计学意义(P＞0.05).结论:加强早孕期体重管理有助于降低GDM的发病风险.对于已确诊GDM的孕妇其24周后体重增长普遍低于非GDM组及IOM标准,其适宜增重范围有待进一步研究.

目的 应用修订的膳食平衡指数(DBI-07)方法评价北京市某社区中老年人群的膳食质量状况,为改善中老年人的膳食质量,开展有针对性的膳食营养干预提供理论依据.方法 2016年2-7月,采用问卷调查的方法,对北京市某社区的1 158名50岁以上中老年人进行一般状况及膳食调查(FFQ法).应用修订的DBI-07对中老年人群的膳食质量状况进行评价.结果 中老年人群奶类和大豆类、蔬菜水果类及动物性食物存在明显的摄入不足情况.食物种类达到或接近推荐摄入种类的仅占34.7％.在不同性别和年龄中DBI总分(DBI_TS)、正端分(DBI_HBS)和负端分(DBI_LBS)的差异有统计学意义(P＜0.05).受教育程度较高的人群负端分(DBI_LBS)和膳食质量距(DBI_DQD)的得分较低(P＜0.05).结论 中老年人群存在膳食摄入总体不均衡的问题,膳食摄入状况低度失衡,并且膳食结构中以蔬菜水果类、奶类和豆类以及动物性食物的摄入不足为主要问题.应指导中老年人群合理膳食,适量增加蔬菜水果类、奶类及大豆类和动物性食物的摄入,以提高中老年人群的膳食质量状况.

Objective To investigate the weight gain in the second and third trimesters of pregnancy and its related factors among urban women so as to provide a scientific basis for rational control of body weight in pregnant women. Methods Historical cohort study was used to survey 1, 176 pregnant women who had antenatal examination records and underwent prenatal check-up and delivery in a third-grade class-A hospital in Beijing in 2015. Medical record inquiry method was employed to investigate the data about the pregnant women's general information and their body weight at the 6 th-8 th, 16 th, 20 th, 24 th, 28 th, 32 nd and 36 th weeks of gestation and on parturition day. We explored the trend of weight gain during pregnancy and its related influencing factors through analyzing the pregnant women's gestational weight gain and weekly weight gain. Results The total gestational weight gain of the surveyed pregnant women was (13.8±4.3) kg averagely. The weekly weight gain decreased from the 24 th week of pregnancy, and it was found to be higher in the second trimester than in the third one. The gestational weight gain was closely correlated with body mass index (BMI) at the 6 th-8 th weeks of pregnancy. The total gestational weight gain ((11.8± 4.6) kg) and weekly weight gain in the overweight/obesity group were significantly lower than those in the low body weight group ((14.1±3.3) kg) and the normal body weight group ((13.9±3.9) kg), showing statistically significant differences (both P＜0.05), but the changes in the weekly weight gain in the overweight/obesity group were generally stable. According to the 2009 Institute of Medicine Guidelines, 41.2％ of the pregnant women had proper weight gain, 23.3％ insufficient weight gain and 34.5％ excessive weight gain. The proportion of insufficient gestational weight gain was higher in the low body weight group (31.7％), but the proportion of excessive gestational weight gain was higher in the overweight/obesity group (58.6％). The gestational weight gain was lower in pregnant women aged ≥35 years than in ones aged ＜ 35 years, but no statistically significant difference was found in the changing trend (P＞0.05).The weekly weight gain of different age groups showed a decreasing tendency and statistically significant differences (P＜0.001), of which the changes in the weekly weight gain of the age group of ≥35 years were stable (P＞0.05). The gestational weight gain was lower in multiparas than in primiparas (P ＜ 0. 05), without a statistically significant difference (P＞ 0. 05). Multivariate analysis showed that weight gain during pregnancy was correlated with maternal age, BMI at the 6 th-8 th weeks of pregnancy and pregnancy week at delivery, and the equation was Y = 9.027-0.114 X1-0.258 X2+0.352 X4. Conclusion The weight gain during pregnancy of the pregnant women is found to be higher in the second trimester in comparison with the third one, and the total gestational weight gain is closely associated with BMI at the 6 th-8 th weeks of pregnancy.

目的 探讨骨科2型糖尿病患者围手术期存在营养不良的类型、原因及其对临床结局的影响.方法 回顾性分析163名骨科围手术期2型糖尿病患者的临床特征、营养状况、血糖水平以及膳食摄入情况,根据患者存在的营养不良情况进行分组,分析其可能的影响因素及对临床结局的影响.结果 (1)根据主成分分析结果将患者营养不良状况分为4个类型,分别是内脏蛋白消耗型营养不良、蛋白质—能量营养不良、免疫功能低下型营养不良以及急性蛋白质营养不良.最后营养不良患者共72例(44.2%).(2)不同年龄组、不同血糖控制水平以及不同糖尿病病程的患者其营养不良的发生率差异有统计学意义(P<0.05).而根据患者的性别、是否超重、是否摄入热量不足和是否进行择期手术进行分组后,其营养不良的发生率差异无统计学意义(P>0.05).(3)与营养状况正常的患者相比,存在营养不良的患者其总住院时间更长,术后并发症发生率更高(P<0.05),而住院费用二者之间差异无统计学意义(P>0.05).结论 骨科围手术期2型糖尿病患者的营养不良发生率较高,尤其针对老年患者、血糖控制不佳者以及糖尿病病程较长的患者更应加强营养监测,及早给予个体化的营养支持,以便缩短住院时间,减少术后并发症的发生.

目的 了解现阶段城市女性在孕中晚期膳食营养素摄入情况,为孕妇合理膳食提供科学依据.方法 采用现况调查的方法,调查于2012-2014年在北京市某三甲医院建档产检并生产的孕妇172例,采用称重法分别于孕16、20、24、28、32、36周由调查对象填写连续3d膳食摄入记录.结果 本次调查提示北京城镇孕妇每日膳食营养素总体摄入状况有所好转.但总能量摄入略为不足,孕中期维生素B1摄入量偏低;维生素A及维生素E超标;矿物质中以硒的摄入量最低,铁、钙的摄入明显增加,但存在阶段性摄入不足;三大供能营养素的构成比中脂肪供能比较高.结论 与近年来全国调查结果相比较,本次调查者的膳食营养素摄入有较大程度的改善,但仍然存在能量及部分微量营养素摄入不足的问题.

<正>患者男,59岁,骨盆软骨肉瘤术后肠瘘行结肠造瘘术后2 d。既往高血压病史20余年,糖尿病10余年。患者精神、饮食及睡眠差。术后第2天实验室检查结果见表1。术后给予抗炎、补液等对症治疗。患者血糖偏高,予胰岛素控制血糖。结肠造瘘术后第2天营养科会诊,患者身高173 cm,卧床体重无法测量。总蛋白55.0 g/L,白蛋白30.0 g/L,营养风险筛查评分6分,应给予营养支持。营养支持过程:(1)第一阶段:肠外+肠内(鼻饲)营养支持:术后第2天,北京积水潭医院营养科会诊考虑患者胃

目的 观察因吸入性损伤进行气管切开患者的营养支持的效果.方法 对因吸入性损伤接受气管切开治疗的14例患者进行个体化营养支持,分别监测患者入院时、入院后3天、7天、14天、21天及1个月时的营养状况相关指标的变化,评价营养支持的效果.结果 在入院后第3天前后,营养相关指标急速下降,与其余各组指标差异有显著性,第7天之后,营养相关指标逐步回升,与入院时差异无显著性.结论 早期、及时、合理的营养支持对改善气管切开患者的营养状况是必要的,可以帮助患者尽早恢复,减少并发症的发生.

营养支持是烧伤救治的重要措施之一,对烧伤的预后有重要的影响[1].2011年4月本院同时抢救大火烧伤患者25 例,入院时他们除烧伤外,均伴有不同程度吸入性呼吸道损伤,对患者采用了简单、有效的营养风险筛查方法,准确判断营养状况,再采取个体化的营养支持等综合救治,25 例均获成功救治.报道如下.