To study the effects of early enteral nutrition and selective decontamination of digestive tract on the lipopolysacchride (LPS) translocation and cytokines and the developing of multiple organ dysfunction syndrome (MODS). Thirty six rabbits were divided into 3 groups: ①control group (CON group, n＝12), the rabbits were bled to shock state (MAP was 5.33 kPa) for 1 hour and then were resuscitated by with replacement of the lost blood and 2 volume of the equilibrium liquid, ②selective decontamination of digestive tract (SDD group, n＝12), the procedure was the same as the CON group but the rabbit was fed with the antibiotics 3 days before the experiment and all through the experiment, ③early enteral nutrition group (EN group, n＝12), treatment was the same as CON group. After resuscitation the feeding tube was placed into the stomach for enteral nutrition. On the 1st, 3rd, 5th and 7th day the blood samples were taken for testing the LPS, TNFα and the organs’ function. Results: The MODS incidence, the levels of LPS and TNFα of the EN group were obviously lower than those in SDD and CON groups; the levels of the LPS and TNFα of the SDD group remained high in the 5th day. SDD group had a higher incidence of the MODS and mortality than that of the EN group. Conclusion: Ischemiareperfusion damage can produce the LPS translocation, which causes the development of MODS. SDD can’t decrease the LPS translocation so that the incidence of MODS and mortality remain high. Early EN can inhibit LPS translocation and reduce the development of MODS.
ObjectiveTo investigate the clinical advantages of enteral nutrition (EN) for acute pancreatitis（AP）comparing with parenteral nutrition (PN) and its prospect. MethodsLiteratures using MESH Browser in Medline were collected and reviewed. ResultsBeing of much higher cost and complications, total parenteral nutrition (TPN) ever regarded as most importantly for AP nutritional support, is now challenged by EN. Clinical evidence suggests enteral (jejunal) nutrition may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction, as well as achieving “pancreatic rest” equivalent to the TPN. Conclusion Early enteral nutrition should be used preferentially for patients with severe acute pancreatitis without paralytic ileus.
Methods Sixty-six postoperative patients with gastric cancer combined diabetes were divided into 3 groups according to the balanced principle. In the frist group (FD group), FD was the nutrition preparation for 21 patients. In the second group (fresubin group), fresubin and the ordinary insulin injection were the nutrition preparation for 21 patients. In the third group (TPN group), the nutrition preparation came from TPN and the ordinary insulin injection for 24 patients. FD, fresubin or TPN were given at 24 h after operation, the levels of blood glucose for empty stomach, after meal (enteral nutrition or TPN) and the common complications compared among 3 groups of postoperative patients. Results ① In FD group, the levels of blood glucose of postoperative empty stomach and after enteral nutrition were stable with little fluctuation and no insulin was needed with 1 case of hyperglycemia (4.8%). In fresubin group and TPN group, the levels of blood glucose of postoperative empty stomach and after enteral nutrition or TPN were unstable with big fluctuation, with 6 cases (28.6%) and 8 cases (33.3%) of hyperglycemia, 5 cases (23.8%) and 6 cases (25.0%) of hypoglycemia in fresubin group and TPN group, respectively. Compared with fresubin group and TPN group, the rate of pathoglycemia was lower in FD group, the difference had statistical significance separately (Plt;0.05); There was no significant difference between fresubin group and TPN group (Pgt;0.05). ② The rates of infection of incisional wound in FD group (4.8%) and fresubin group (23.8%) were lower than that of TPN group (33.3%), there was significant difference among 3 groups (Plt;0.05); The time of passage of gas by anus in FD group and fresubin group were shorter than that in TPN group (Plt;0.05); There was no significant difference between FD group and fresubin group (Pgt;0.05). There were no significant differences of the rates of abdominal distension or diarrhea among 3 groups (Pgt;0.05). Conclusion Regarding postoperative patients with gastric cancer combined diabetes, in the early time field test group of the nutrition preparation, FD is better than fresubin or TPN, which does not increase the risk of the blood glucose change and have few complications.
Objective To study the current clinical application and advancement of microbioecological preparation. Methods Literatures about microbioecological preparation published in China and abroad were collected and reviewed. Results The microbioecological preparation has been widely used at present. It is used to rebuild a balanced microbial population in human body, particularly in intestinal, to promote the stability of internal environment, control dysbacteriosis and to treat a variety of gastrointestinal diseases associated with ectopic microbial population. Conclusion Although microbioecological preparation has been widely used in clinical settings, its effect yet should be further supported and evaluated both by large sample research in randomized double-blind control trails and evidence-based medicine.
To evaluate the feasibility, safety and effectiveness of enteral nutrition (EN) via jejunostomy in the early postoperative period in patients with acute hemorrhagic necrotizing pancreatitis (AHNP), 38 patients were divided into the early group (start EN 3 or 4 days after operation) and the later group (start EN 7 days after operation). All patients received parenteral nutrition at first, then were transited to EN. The enteral nutrition liquid was transfused by continuous drip via jejunostomy in both groups. Levels of serum amylase, blood glucose, as well as the liver function were used as indices of tolerance. Symptoms and physical signs of abdominal pain as well as the level of serum albumin were used as the indices of effectieness. Patients tolerated the therapy well in both groups. Moreover, they enjoyed an earlier correction of hypoalbuminemia with more quickly improved serum albumin and no abdominal pain. Starting enteral nutrition in the early postoperative period is feasible, safe and efficacious for acute hemorrhagic necrotizing pancreatitis patients. It plays an important role in treating AHNP and improving curing rate.
ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.
ObjectiveTo compare the clinical effects of enteral nutrition via stoma of jejunum or nasal-jejunum tube after Whipple procedure. MethodsEighty-seven patients performed Whipple procedure were divided into nasaljejunum tube group(n=47)and stoma of jejunum group(n=40)according to the different enteral nutrition methods. The adverse reactions such as vomiting, abdominal distension, pharyngeal pain, and hypostatic pneumonia, anastomotic leakage, hospital stay, hospitalization expenses, and serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were compared between two groups. ResultsCompared with the nasal-jejunum tube group, the rates of adverse reactions and hypostatic pneumonia were more lower(P < 0.05), the hospitalization expense was more less (P < 0.05) in the nasal-jejunum tube group. The rate of anastomotic leakage and hospital stay had no significant differences between the nasal-jejunum tube group and stoma of jejunum group(P > 0.05). The differences of serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were not statistically significant between two groups(P > 0.05). ConclusionsEnteral nutrition via the stoma of jejunum after Whipple procedure has some better clinical effects in reducing adverse reactions such as vomiting, abdominal distension, pharyngeal pain, hypostatic pneumonia. The hospitalization expenses are decreased. There are no obvious effects on the hospital stay, blood glucose and electrolyte concentration on day 1, 3, 5 after operation.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
Objective To evaluate the effectiveness of enteral immunonutrition for patients with acute pancreatitis. Methods The randomized controlled trials (RCTs) about enteral immunonutrition for patients with acute pancreatitis were searched in following databases: PubMed (1966 to August 2012), MEDLINE (Ovid, 1946 to August 2012), CENTRAL (Issue 3, 2012), CBM (1978 to August 2012), CNKI (1979 August 2012), VIP (1989 to August 2012), and WanFang Data (1977 to August 2012). The relevant materials and each reference of literature were also searched manually. Two reviewers independently screened the literature according to the predefined inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 197 patients were included. The results of meta-analysis showed that there were no significant differences between the enteral immunonutrition group and the routine enteral nutrition group in following aspects: infectious complications and mortality rate, length of stay, level of C-reactive protein and numeration of leucocyte after treatment, and APACHE II score. Conclusion At present, no evidence shows enteral immunutrition is superior to routine enteral nutrition in acute pancreatitis. For the quantity and quality limitation of the included studies, more high-quality and large-sample RCTs are required to investigate the proper ingredients and dosage of enteral immunonutrition suitable for patients with acute pancreatitis.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.