目的:探讨合理的营养支持方式对重症急性胰腺炎(SAP)患者营养状况及预后的影响。方法:将60例SAP患者随机分为全胃肠外营养支持(对照组)和肠内与肠外相结合营养支持(实验组)两组,对比营养支持前后两组患者的血红蛋白、总蛋白、血清白蛋白、氮平衡、血脂等生化指标,每天观察相关并发症情况。结果:实验组血清白蛋白、总蛋白、血红蛋白、氮平衡方面明显优于对照组(Plt;0.05),且并发症少。结论:肠内与肠外结合的营养支持方式可以改善SAP患者的营养状况,对SAP患者治疗有积极的作用。
目的探讨两种不同途径的营养方式对食管癌患者术后恢复的影响。 方法选取浙江省台州医院心胸外科2007～2011年63例食管癌患者术后的不同营养支持，分为肠内营养（enteral nutrition，EN）组（33例）和肠外营养（parenteral nutrition，PN）组（30例），比较两组的术后胃肠功能恢复、营养指标、并发症情况、住院费用、住院时间及肝功能等影响。 结果EN组与PN组的排气时间[（42.30±6.70）h vs.（60.60±15.60）h，P＜0.01]、住院时间[（15.40±6.55）d vs.（21.00±10.57）d，P＜0.01]、住院费用[（4.49 ±1.28）万元vs.（4.73 ±1.18）万元，P＜0.01]差异均有统计学意义。两组术后均无吻合口漏等严重并发症，两组术后白蛋白水平较术前有不同程度下降，术后肝功能PN组较EN组变化大，两组差异有统计学意义（P＜0.01）。 结论两种营养方式均能改善患者的术后营养状况，但肠内营养更符合生理特点、廉价，适应现代营养支持，较静脉营养有优势。
Objective To promote the clinical application of parenteral and enteral nutrition preparations in hospitalized patients. Methods Domestic and foreign articles about parenteral and enteral nutrition support were enrolled to make a review. Results Nowadays, parenteral and enteral nutrition played an important role in the medical treatment of perioperative and critically ill patients. Rational nutrition support could improve the condition of patients with nutritional risk and result in better clinical outcomes. Different enteral nutrition formulations should be used according to the diseases. Supplementally parenteral nutrition may also be useful in combination with enteral nutrition to reach the required intake targets. We should pay attention to the application of glucose, lipid emulsion, amino acids, vitamins, and so on, when performed parenteral nutrition support. Conclusion It is necessary to standardize parenteral and enteral nutrition support in the work of clinical practice, including the application of nutrition support and selection of nutrition preparations.
ObjectiveTo systematically evaluate short-term efficacy of omega-3(ω-3) polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy. MethodsThe literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes ofω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. All the relevant studies were screened and the data were extracted before January 2015. The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman 5.3 software. ResultsSixteen RCTs involving 1019 patients (511 in the study group, 508 in the control group) were enrolled into the analysis. The results of meta analysis:①In the cell immunity:The proportions of CD3, CD4, CD4/CD8 in the study group were significantly higher than those in the control group[CD3:WMD=6.09, 95% CI (2.40, 9.77), P=0.001; CD4:WMD=5.25, 95% CI (3.30, 7.20), P < 0.00001; CD4/CD8:WMD=0.40, 95% CI (0.22, 0.58), P < 0.0001].②In the humoral immunity:The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA:WMD=0.56, 95% CI (0.36, 0.77), P < 0.00001; IgG:WMD=2.88, 95% CI (0.63, 5.13), P=0.01].③The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27, 95% CI (0.10, 0.43), P=0.002].④In the cytokines:The levels of interleukin-6 and tumor necrosis factor (TNF)-αin the study group were significantly lower than those in the control group[interleukin-6:WMD=-16.75, 95% CI (-25.00, -8.50), P < 0.0001; TNF-α:WMD=-6.25, 95% CI (-10.55, -1.95), P=0.004].⑤The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36, 95% CI (0.20, 0.66), P=0.0008]. ConclusionFor postoperative patients with gastrointestinal malignancy, ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function, decrease postoperative inflammatory reaction, and reduce rate of infective complications.
Experienc of nurtitional treatment to 7 patients with acute renal failure (ARF) and nitrogemia after biliarty (tract) surgery is reported in this article. Nittrogen source inn all cases was obtained from "Renal Amine" and "7% Vamin" etc,which are composed of 8 essential amino acids (EAA), and the nergery sources are mainly supplyed by Intralipid (20 or 10%) and suitable amount of glucose. The nutritional admicture of "all in one" were employed as parenteral nutrition (PN). Satisfactary curative effecs in these patients were obtained. The suthors consider that (a) the nutritional treatment of different casuses of ARF should be providing enough energy and more EAA requirments than in normal need to synthesizw non-essential amino acide (NEAA) and protein from excessive blood urea nitrogen (BUN) for redcuing pritein breakdown and nitrogemia, and (b) 20% Intralipid is an effective low-volume, highly calories nutritional agent specially in ARF patients with restiction of waterr.
Objective To research the effects of recombinant growth hormone (rhGH) with total parenteral nutrition (TPN) on nitrogen balance and nutritional state of the patients following major abdominal surgery. Methods We randomly selected 45 patients receiving TPN after major abdominal surgery and distributed them to study group (rhGH+TPN, n＝30) and control group (TPN only, n＝15). For 7 days after operation, every one was given rhGH 4u or replaced by hypodermic injection of normal saline (control group). Results TPN+rhGH promoted the rehabilitant of nitrogen balance, heightened the level of plasma albumin and transferrin and increased the weight and creatinin/height index (CHI), but the thickness of triceps skin fold (TSF) had no significant change in patients following major abdominal surgery. Conclusion The rhGH can improve the effects of TPN.
ObjectiveTo summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis. MethodsThe clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group). ResultsThe APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05). ConclusionThe combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.
ObjectiveTo systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy. MethodsThe following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06). ConclusionThe early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.
【Abstract】ObjectiveTo investigate the effects of rhGH on hypoalbuminemia in cirrhotic rats after partial hepatectomy. MethodsThirty rats were randomly divided into normal control group (n=6), liver cirrhosis group (LC group, n=6), liver cirrhosis and hepatectomy group (LCH group,n=6), PN (parenteral nutrition) group (n=6， given PN after hepatectomy) and rhGH+PN group (n=6,given rhGH and PN after hepatectomy). Liver function and blood glucose were measured. The expression of ALB mRNA was detected by RTPCR. Liver Ki67 immunohistochemistry was studied. ResultsCompared with PN group, serum ALP was lower; serum ALB and blood glucose were higher in rhGH+PN group. The expression of hepatic ALB mRNA was higher, and hepatic Ki67 labeling index was higher as well in this group. ConclusionrhGH can improve hypoalbuminemia after partial hepatectomy in cirrhotic rats with partial hepatectomy.
ObjectivesTo systematically review the efficacy and safety of enteral nutrition (EN) for severe acute pancreatitis (SAP) patients within 48 hours after admission.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on early EN (starting within 48 hours after admission) in SAP from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 RCTs involving 1 074 patients were included. The results of meta-analysis showed that: compared to patients with EN after 48 hours or parental nutrition, the patients given EN within 48 hours after admission had lower mortality (RR=0.53, 95%CI 0.29 to 0.96, P=0.036) and morbidity of multiple organ dysfunction syndrome (MODS) (RR=0.58, 95%CI 0.44 to 0.77, P<0.001). However, no significant differences were found in systemic inflammatory response syndrome (SIRS) (RR=1.00, 95%CI 0.86 to 1.16, P=1.00).Conclusions The current evidence shows that EN within 48 hours after admission can reduce the mortality and morbidity of MODS in SAP patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.