摘要:

So that the efficacy of route of nutrient administration in thermal injury could be determined, a comparison was made between immediate enteral vs parenteral feedings in burned guinea pigs. Thirty‐five guinea pigs underwent both catheter gastrostomy and jugular vein catheterization. On postoperative day 8, burned animals [30% total body surface area (TBSA)] were divided into an intragastrically (ig) fed group (N = 14) and a parenterally (iv) fed group (N = 14). Animals in each group received 175 kcal/kg/day with a solution of identical nutrient value beginning 2 hr after burn. The body weight change until postburn day (PBD) 8 and the average nitrogen balance were significantly better in the ig group than in the iv group. Values were also higher for the iv group than for the ig group in the early postburn period for urinary vanillyl mandelic acid (VMA) (p less than 0.05), plasma cortisol (p less than 0.05), and plasma glucagon (p less than 0.05). Also, the iv group showed reduced mucosal weight and thickness compared to the ig group on PBD 1 (p less than 0.02). There were significant negative correlations between VMA excretion and body weight change, and between plasma cortisol and jejunal mucosal structure (thickness and weight). These findings suggest that immediate postburn enteral nutrition can provide better nutritional support than parenteral nutrition through the maintenance of gut mucosal integrity and the prevention of increased secretion of catabolic hormones.

ISSN:0148-6071    

DOI:10.1177/014860718701100101

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607187011001011

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.

ISSN:0148-6071    

DOI:10.1177/014860718701100108

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Rats with intravascular catheters connected to infusion systems are frequently used in the investigation of nutritional and metabolic problems. Although the animal is often referred to as “unrestrained,” there is no information on the effect of the catheter assembly or total parenteral nutrition (TPN) on total (TEE), activity (AEE), and resting (REE) energy expenditure (TEE = REE + AEE). Male Fischer 344 rats were studied in an analytical respiration calorimeter. Normal unoperated rats, aseptically catheterized orally fed rats from postoperative day 1 to 7, and TPN rats were studied. Orally fed catheterized rats had weight loss, negative nitrogen balance, negative energy balance, elevated REE, and normal AEE during the first 4 postoperative days. Their weight gain, positive nitrogen balance, AEE, and REE were almost identical to those of normal rats over postoperative days 5 through 7. REE and AEE in TPN rats were similar to values in normal rats. These data indicate that catheter operation and TPN cause no abnormality in AEE and REE if adequate time is allowed for recovery from catheter operation and strict attention is given to asepsis.

ISSN:0148-6071    

DOI:10.1177/014860718701100114

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

The relative importance of three nutritional variables, nonprotein energy level, glucose‐lipid calorie distribution and amino acid nitrogen level, in contributing to the steatosis that develops during a short course of parenteral nutrition was studied in intravenously fed rats. Eight infusates were tested that contained various combinations of glucose, lipid emulsion and amino acids. The infusate nonprotein energy level was the predominant effector of liver lipid content. The excessive energy level was associated with significant increments in steatosis, ranging from a 26% increase for high‐fat, adequate‐nitrogen infusates to a 95% increase for low‐fat, adequate‐nitrogen infusates. An interaction of amino nitrogen level and glucose‐lipid calorie distribution also affected the severity of steatosis. The steatosis observed with inadequate‐nitrogen infusates was accentuated in combination with the high‐fat calorie distribution and was attenuated with the low‐fat calorie distribution. The most striking effect of nitrogen inadequacy was a 3‐fold increase in liver lipid content with the excessive calorie, high‐fat infusates. The infusate that minimized steatosis provided energy and nitrogen at adequate levels and was low in fat content. This infusate also led to liver lipid composition and plasma lipid levels that most closely resembled those of rats fed stock diet.

ISSN:0148-6071    

DOI:10.1177/014860718701100118

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Fat emulsions are increasingly utilized as intravenous calorie sources in patients requiring total parenteral nutrition. In the United States, they are traditionally administered separate from the dextrose/amino acid solution because of concern regarding physical stability and clinical safety when fat emulsions are administered, having been mixed with the dextrose solution. The separate infusion entails multiple manipulations of the infusion system with increased risk of contamination and sepsis and increased cost in maintaining two infusion lines. This prospective sequential two‐phase clinical study evaluated solution compatibility and clinical safety of an admixture of fat emulsion (Intralipid 20%), dextrose, amino acids (Veinamine 8%), electrolytes, vitamins, and trace minerals. Continuous infusion of this solution in 25 adult patients from 2 to 35 days did not result in any adverse clinical reactions or abnormal laboratory parameters. Gross, visual examination and in vitro analysis of the admixture solutions revealed no physical instability or changes in fatty acid composition in admixture solutions stored at 4 degrees C for up to 6 weeks.

ISSN:0148-6071    

DOI:10.1177/014860718701100123

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Diamine oxidase (DAO) is an intestinal mucosal enzyme which serves as a marker of cellular maturity and integrity in ontogeny and after mucosal injury in the gastrointestinal tract. Since total parenteral nutrition is known to result in intestinal hypoplasia, this study was done to determine the effect of enteral and parenteral delivery of nutrients on gut structure and DAO levels. Central venous catheters were placed in 27 Sprague‐Dawley rats (180–260 g), which received nutrients for 12 days via parenteral nutrition (GpI n = 10), oral intake of the parenteral solution (GpII n = 8), or standard rat chow (GpIII n = 9). Gross and microscopic measurements were made at sacrifice. Mucosal DAO levels were determined by metabolism of [3H] putrescine. Group III animals had a greater caloric intake than groups I and II, and were the only group with a significant increase in body weight. Gut weight, mucosal weight, and villous height were significantly less in group I vs groups II and III; group II values were less than group III (p less than 0.05). Both DAO specific activity and total gut DAO were significantly less in group I and group II. Mucosal DAO content correlated with total gut and mucosal weight. DAO mucosal levels decrease with parenteral nutrition, reflecting the intestinal hypoplasia that occurs. Mucosal DAO content may be dependent on both caloric intake and diet composition. Since serum DAO levels are known to correlate with mucosal DAO content, DAO activity may prove useful as a circulating marker of the effect of nutritional therapy on the intestinal mucosa.

ISSN:0148-6071    

DOI:10.1177/014860718701100128

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

We examined whether metoclopramide would improve the success rate of transpyloric intubation of a weighted Corpak feeding tube when fluoroscopic guidance is not used. Seventy patients were randomized in a prospective, double‐blind fashion to receive either placebo (n = 35) or metoclopramide, 10 mg (n = 35) parenterally, administered immediately after the feeding tube was inserted. Tube location was determined independently by two observers who examined radiographs obtained after barium was instilled via the tube. There was no significant increase in the success rate of duodenal intubation in the total group following metoclopramide, 60%, compared to placebo, 49%. However, analysis of subgroups among the placebo‐treated patients revealed that diabetes mellitus, but not other medical conditions, decreased the success rate for duodenal intubation, 20 vs 60% (p less than 0.05). Among diabetic patients, metoclopramide resulted in a significant increase in duodenal placement compared to placebo (p less than 0.05). We conclude that parenteral metoclopramide significantly increases the frequency of transpyloric intubation with small feeding tubes without fluoroscopic guidance in diabetic patients but not in nondiabetic patients.

ISSN:0148-6071    

DOI:10.1177/014860718701100133

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860718701100502

出版商:SAGE Publications    

年代:1987

数据来源: WILEY

摘要:

Anthropometry is a technique in which simple measuring instruments are used to describe human form. By applying the measurement directly or through use of additional calculations, the practitioner can partition the body into fat and fat‐free components. Quantifying these two body spaces provides information on the amount and rate of change over time in whole body energy supply and protein mass. These data can then be used in association with other indices of energy and protein metabolism. Whereas anthropometry is simple, practical, and inexpensive, the technique is limited to a qualitative tool by several sources of error. A thorough understanding of the strengths, limitations, and appropriate applications of anthropometry is essential when applying the method in clinical practice. (Journal of Parenteral and Enteral Nutrition 11:36S‐41S,1987)

ISSN:0148-6071    

DOI:10.1177/014860718701100503

出版商:SAGE Publications    

年代:1987

数据来源: WILEY