目的 观察十全大补汤辅助肠内营养支持治疗胃癌术后气血两虚证患者对营养状况及免疫功能的影响并探讨其作用机制.方法 患者64例随机分为两组,均给予胃癌术后规范化治疗,对照组于术后第2日肠功能恢复后给予肠内营养支持,观察组在对照组基础上加服中药十全大补汤.观察两组患者术前及术后第10日营养指标:血清白蛋白(ALB)、血清前白蛋白(PAB)、转铁蛋白(TRF)、红细胞计数(RBC)、血红蛋白(Hb)、三头肌皮褶厚度(TSF)、上臂肌围(AMC)和免疫指标(血清IgA、IgG、IgM、CD3+、CD4+)的变化情况.结果 治疗后两组血清ALB、PAB、TRF、血常规(RBC、Hb)、TSF、AMC、体液免疫指标(IgA、IgG、IgM)及细胞免疫指标(CD3+、CD4+)均高于治疗前(均P＜0.05),且观察组改善均较对照组明显(均P＜ 0.05).结论 十全大补汤辅助肠内营养支持治疗胃癌术后气血两虚证患者可以更加有效地改善机体营养状况及免疫功能,起到了提高临床疗效、促进患者早日康复的目的.

Objective To explore the significance of using enteral nutrition adding glutamine therapy in patients with hyperlipidemic acute pancreatitis.Methods A total of 86 patients with HAP from January 2012 to December 2015 were selected and randomly divided into observation group and control group,each group had 43 cases,all patients were treated with conventional treatment.Patients with bowel function after recovery,two groups were early given enteral nutrition therapy,observation group were received enteral nutrition adding glutamine.Compare two groups of patients before and after 10d treatment of immune status indicators and inflammatory status indicators,and compared two groups of patients with the average length of hospital stay and cost of hospitalization.Results Two groups of patients before treatment no obvious difference was found between the immune status indicators and inflammatory status indicators(P ＞ 0.05).Given different enteral nutrient solution treatment after 10d,the immune status indicators and inflammatory status indicators of observation group droped were better than the control group(P ＜ 0.05),at the same time observation group of patients with the average length of hospital stay and hospital costs were lower than the control group (P ＜ 0.05).Conclusion Enteral nutrition adding glutamine could more effectively improved the immune function of patients with HAP,reduced inflammation reaction,lower health care costs,shorten the hospitalization time,thus improving prognosis and promoting recovery of the patient.

高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HAP)是一种临床常见的急腹症,《急性胰腺炎诊治指南(2014)》中提出早期给予患者进行肠内营养支持(Enteral nutrition,EN),对临床预后意义重大[1].免疫营养组件强化的肠内营养治疗可改善患者营养状况,降低感染风险.同时中药大黄通里攻下,能恢复肠蠕动,治疗急性胰腺炎效果肯定.笔者联合使用免疫型肠内营养及大黄观察临床疗效.

Objective:To investigate the protective effect of hawthorn leaves favonoids on the kidneys of type 2 diabetic rats.Methods:Ninety-six experimental rats were randomly devided into 6 groups:normal control group,model group,HLF low (50 mg/kg),medium(100 mg/kg),high(200 mg/kg) dose groups and metformin hydrochloride 200 mg/kg treatment group;except the rats in normal control group,others were injected STZ to make type 2 diabetic model rats;the drugs were given by intragastric administration for 6 weeks,once a day.Six weeks later,the level of blood sugar was determined;the body weight was determined and the renal index(RI) was calculated;the urine volume and the UPro were determined;the contents of BUN,SCr,UA in serum were determined;the activity of SOD,GSH-Px,T-AOC and the content of MDA in renal tissue were determined;the histopathological changes of renal tissue were observed by HE staining and the apoptosis of renal tissue cells was observed by TUNEL;the levels of TNF-α,IL-1β,IL-6,ICAM-1 in plasma were determined.Results:Compared with the type 2 diabetic models in the control group,the blood sugar levels of HLF medium and high dose groups were significantly decreased;the body weight was significantly increased and the RI was significantly decreased;the urine volume and the UPro were significantly decreased,and the contents of BUN,SCr and UA in serum were significantly decreased;the activities of SOD were significantly increased and the contents of MDA were significantly decreased;the activities of GSH-PX and T AOC in HLF 200 mg/kg treatment group were significantly increased,and all of the above differences were significant(P ＜ 0.05,P ＜ 0.01);the histopathological changes and apoptosis were significantly improved,especially the HLF 200 mg/kg treatment group,and the AI of HLF medium and high dose groups was significantly decreased(P ＜ 0.01);the levels of TNF-α,IL-6 and ICAM-1 in plasma of medium and high dose groups were significantly decreased(P ＜ 0.05,P ＜ 0.01),and the level of IL-1β in HLF high dose group was significantly decreased(P ＜ 0.01).Conclusion:HLF has dose-dependent effects on improving renal function,reducing the damage of oxidative stress,depressing the apoptosis,lowering the level of inflammatory mediators and the level of ICAM-1 and improving the renal tissue histopathological changes,which suggests that HLF has dose-dependently protective effects on the kidneys in type 2 diabetic rats.

目的:观察临床护理路径联合全程心理护理干预对结肠癌手术患者术后护理的临床效果.方法:选取本院2015年1月至2017年7月实施结肠癌根治术患者90例,根据随机数表法分为观察组及对照组,各45例.对照组行常规护理,观察组在对照组基础上加入临床护理路径并联合全程心理干预.观察并比较两组术后胃肠功能、负性心理情绪、术后并发症、患者护理满意度.结果:观察组术后消化道症状、感染等并发症总发生率(4.44%)明显低于对照组,差异有统计学意义(P<0.05);观察组术后肛门排气时间、肠鸣音恢复时间、排便时间分别为(3.51±1.21)d、(1.24±0.57)d、(4.02±1.37)d,均少于对照组,差异有统计学意义(P<0.05);干预后,对照组SAS、SDS评分均高于观察组,差异有统计学意义(P<0.05);观察组患者护理总满意率(95.56%)明显高于对照组,差异有统计学意义(P<0.05).结论:结肠癌手术患者实施临床护理路径联合全程心理干预,患者术后负性情绪明显缓解,胃肠功能快速恢复,术后并发症少,患者护理满意度高,临床护理效果显著.

目的:研究山楂叶总黄酮(Hawthorn Leaves Favonoids,HLF)对2型糖尿病大鼠调节血脂和抗氧化能力的改善作用.方法:采用腹腔注射链脲佐菌素(STZ,60mg/kg)破坏胰岛β细胞的方法诱导制备实验性2型糖尿病大鼠模型,取80只模型大鼠根据血糖水平随机分为模型组、盐酸二甲双胍(200mg/kg)治疗组和HLF低、中、高剂量(50、100、200mg/kg)组,并另设正常对照组.认定造模成功后,各治疗组大鼠每天灌胃给药1次,疗程6周.给药前和给药后每2周测定血糖;6周后,检测血清血脂指标;通过苏木精-尹红(HE)染色观察肝脏和心肌组织形态结构变化,测定肝脏和心肌组织中抗氧化酶活性和丙二醛(MDA)含量.结果:与模型组比较,治疗后BLF中、高剂量组大鼠空腹血糖水平显著降低(P<0.05,P<0.01),血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)含量明显降低(P<0.05,P<0.01),肝脏和心肌组织中超氧化物歧化酶(SOD)、过氧化氢酶(CAT)活性明显提高(P<0.05,P<0.01),MDA含量明显降低(P<0.05,P<0.01);治疗后BLF高剂量组大鼠血清高密度脂蛋白(HDL-C)含量显著升高(P<0.05),肝脏和心肌组织中GSH-Px活性显著提高(P<0.05);治疗后HLF各剂量组大鼠肝脏和心肌组织病变呈不同程度减轻,其中以HLF高剂量组效果最为显著.结论:HLF能够有效改善2型糖尿病大鼠血糖血脂和抗氧化能力.

目的 研究经鼻空肠营养管给予中药复方大柴胡汤联合生大黄外敷治疗高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)的临床疗效.方法 选择2012年1月-2014年12月收治的80例HLAP患者作为研究对象,随机分为对照组和治疗组各40例.对照组给予急性胰腺炎(acute pancreatitis,AP)规范化治疗,治疗组在对照组的基础上经鼻空肠营养管注入复方大柴胡汤煎剂75 ml/次,2次/d,同时给予生大黄30 g外敷治疗,2次/d,两组均治疗7d.比较两组临床疗效及患者腹痛、腹胀缓解时间、首次排便时间及血、尿淀粉酶恢复时间、血TG浓度.计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用x2检验,P＜0.05为差异有统计学意义.结果 治疗组总有效率为95.0％,高于对照组的72.5％,两组比较差异有统计学意义(P＜0.05).治疗组腹痛、腹胀缓解时间、首次排便时间及血、尿淀粉酶恢复时间分别为[(2.9±0.5)、(3.3±0.7)、(3.8±0.6)、(6.6±0.6)、(8.8±1.2)d],均短于对照组的[(4.8±0.9)、(5.0±1.3)、(4.9±0.8)、(7.3±1.1)、(10.2±1.5)d],差异均有统计学意义(均P＜0.05).治疗后,对照组与治疗组血TG浓度分别为(2.20±0.39)、(3.10±1.66)mmol/L,均低于治疗前的(9.91±3.90)、(10.06±4.28)mmol/L,差异均有统计学意义(均P＜0.05),两组治疗后比较差异有统计学意义(P＜0.05).结论 经鼻空肠营养管给予复方大柴胡汤联合生大黄外敷治疗能有效控制HLAP患者的全身炎症反应,促进胃肠道功能恢复,缩短病程,疗效满意.