In order to investigater the effect of nutritional support on nutrients metabolism after liver resection,we researched into the hepatectomy and total parenteral nutrition model in rats.The features of the model were no fasting before surgery,10% glucose subcutaneous injection prior to operation avoiding of blood loss and shortening of the surgical process.The 7-day mortality was markedly decreased.Anesthetized with phenobarbital(25mg/kg) injection in combination of ether inhalation,the rats recovered quickly from anesthesia and developed almost no infection of the respiratory tract after hepatectomy.The rats were supplied parenterally energy of 573kJ/kg and a marked improvement in survival was achieved after liver resection.By applying dual preventive rotation equipment of protective spring and IN-Stopper,nutrient solution could be safely infused.
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.
Thirty two surgical patients with liver disease (hepatocelluar carcinoma 16, liver cirrhosis 8, obstructive jaundice 8) were studied. All of them were randomly divided into three groups for administration of different kinds of TPN during the postoperative period [group Ⅰ (TPN without fat emulsion), group Ⅱ (TPN with fat emulsion, 1g/kg body weight/day of fat), group Ⅲ (TPN with fat emulsion 2g/kg body weight/day of fat )]. Their liver function test, glucose, lipid metabolism were examined and compared during the period of TPN. Result: ①TB, ALT and AST decreased in group Ⅱ and group Ⅲ (Plt;0.05), but increased in group Ⅰ (Plt;0.05). ②The blood glucose and insulin levels were normal in group Ⅱ and groupⅢ, but showed hyperglycemia and hyperinsulinemia in group Ⅰ (Plt;0.05). ③The serum lipid, lipoprotein, apoliprotein level and LCAT activity returned to normal 6 days after operation in group Ⅱ (Plt;0.05), but not in group Ⅰ and groupⅢ (Plt;0.05). Conclusion: ①TPN with fat emulsion for surgical patients with liver disease can make more improvement on hepatic functions than TPN without fat emulsion. ②1g/kg body weight/day of fat dosage may be suitable for the patients during the period of postoperative TPN.
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 explore influence of different nutritional approaches on liver function in patients after esophagectomy. MethodsA total of 160 patients with esophageal cancer who underwent surgical treatment were divided into a enteral nutrition (EN) group and a total parenteral nutrition (TPN) group according to different medical staff. There were 80 patients in each group. Two and 7 days postoperatively, albumin (ALB), prealbumin (PA), alanine aminotransferase (ALT) and total bilirubin (TB) of the 2 groups were examined to evaluate liver function. ResultsAbnormities in liver function (ALB, PA, ALT, TB) was common phenomenon in esophageal cancer patients, but there was no statistical difference in ALB, PA, ALT, TB on the 2nd postoperative day between the EN group and the TPN group (P > 0.05). On the 7th postoperative day, liver functions were improved than those on the 2nd postoperative day in the two groups. And frequencies of liver function abnormity in the EN group were significantly lower than those in the TNP group (P < 0.05). ConclusionCompared with TPN, EN has advantages in facilitating hepatic protein synthesis and recovery of liver function after esophagectomy.
Objective To study glutamine (GLN) and cholecystokinin (CCK) effects on prevention of cholestasis in total parenteral nutrition (TPN). Methods White rabbits were choosed as TPN models, which were divided into four groups, group 1, TPN only (n＝10); Group 2, TPN plus GLN administration (n＝10); Group 3, TPN plus CCK (n＝10); Group 4, TPN plus GLN and CCK administration. Bile components were assayed and the structural change in gallbladder and liver were observed under light and election microspes at the forth and eighth week. Results Increasing of bilirubin and cholesterol was observed in the 1st and 2nd groups at the forth week, but increasing in the 3rd group was observed at the eighth week. The 4th group was normal. Changes of gallbladder and liver structure in 1st and 3rd group occured at the forth week. Changes of 2nd group occured at the eighth week. No structural change was found in the 4th group. Conclusion The test prove that cholestasis would occure during TPN and become serious with time prolonging. Integrity and function of gallbladder-wall tissue cell could be defended and sustained by applying GLN, but there is no direct preventing action. There is apparent cholecy stokinetic and cholagogic fundations by applying CCK. But CCK would lose its function if gallbladderwall was damaged. The test prove that TPN+GLN+CCK is the best way to prevent cholestasis during TPN.
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.
摘要:目的: 探讨早期肠内营养支持在胃肠道恶性肿瘤术后患者中应用的临床效果。 方法 :54 例胃肠道恶性肿瘤行根治手术的患者,随机分为对照组和研究组,分别接受肠外营养支持(PN)和肠内营养支持(EN)。比较两组治疗前后的血清白蛋白、前白蛋白和转铁蛋白水平,肝肾功能指标,胃肠功能恢复时间以及并发症的发生率。 结果 :经过术后7 d 的营养支持治疗,EN组术后血清前白蛋白、转铁蛋白水平升高程度明显大于PN组,胃肠功能较PN组更快恢复。在术后并发症的发生率和肝肾功能指标方面两组没有显著性差异。 结论 :早期肠内营养支持能够安全有效地促进胃肠道肿瘤术后患者的恢复。Abstract: Objective: To investigate the clinical effect of early enteral nutrition (EN) support on postoperative patients with gastrointestinal malignancy. Methods : A total of 54 postoperative patients with gastrointestinal malignancy were randomly divided into EN group and parenteral (PN) group. Both groups received isocaloric and isonitrogen nutrition support. The serum albumin, transferrin, prealbumin and liver and renal function were measured using standard techniques. The gastrointestinal function and postoperative complications were evaluated. Results : After nutrition support, serum albumin was not significantly different between two groups. Compared with PN group, serum transferrin and prealbumin level significantly increased in EN group (P＜005). The gastrointestinal function in EN group resumed earlier than that in PN group. There was also no difference in liver and renal function and postoperative complications between two groups. Conclusion : The application of early enteral nutrition support is beneficial to the recovery of the gastrointestinal cancer patients after surgery.
Objective To compare the clinical efficacy between total enteral nutrition and enteral nutrition combined with parenteral nutrition after pancreaticoduodenectomy. Methods A total of 70 patients who underwent pancreaticoduodenectomy in our hospital from July 2012 to July 2015 were collected prospectively, and all patients were divided into 2 groups randomly: enteral nutrition group and combined nutrition group. Patients in enteral nutrition group received total enteral nutrition, and patients in combined nutrition group received enteral nutrition combined with parenteral nutrition. Compared the nutritional indicators, other related indexes, and morbidity between the 2 groups. Results ① The nutritional indexes. Compared with before treatment, the body mass index (BMI), white blood cell count, serum albumin level, serum albumin level, and total lymphocyte count at 1 week and 2 weeks after treatment improved (P<0.05). At the same time point (before treatment, 1 week after treatment, and 2 weeks after treatment), there was no significant in the BMI, white blood cell count, serum albumin level, serum albumin level, and total lymphocyte count between the 2 groups (P>0.05). ② Other related indexes. The anal exhaust time, defecation time, and hospital stay of the patients in the combined nutrition group were shorter than those of enteral nutrition group, and the cost of treatment in combined nutrition group was less than that of the enteral nutrition group (P<0.05). ③ Morbidity. There was no significant difference in the total morbidity between the combined nutrition group〔11.4% (4/35)〕 and enteral nutrition group 〔20.0% (7/35)〕,P>0.05. Conclusion Total enteral nutrition and enteral nutrition combined with parenteral nutrition after pancreaticoduodenectomy both can obtain well curative effect, but enteral nutrition combined with parenteral nutrition can make the patients recover faster with lower cost, which is suitable for promotion.
【Abstract】ObjectiveTo explore the mechanisms of anabolism intensified by recombination human growth hormone (GH) on the basis of total parenteral nutrition (TPN) during postoperative in gastrointestinal carcinoma patients. MethodsNinety-four gastrointestinal carcinoma patients undergone operation were randomly divided into TPN group and TPN+GH group. The levels of TNF-α, IL-1, IL-6 and CRP were detected in the first, third, seventh postoperative day. ResultsThe levels of TNF-α, IL-1, IL-6 and CRP were significantly lower in TPN+GH group than those in the TPN group at the first, third, seventh postoperative day （P＜0.01）. The levels of TNF-α, IL-1, IL-6 and CRP were significantly higher at the indicated time of postoperative days than the pre-operative days in the two groups (P＜0.01）. ConclusionBy inhibiting TNF-α, IL-1, IL-6 and CRP production in gastrointestinal carcinoma patients undergone operation and blocking high catabolism induced by inflammatory cytokines, GH promotes the synthesis of anabolism.