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.
Objective To evaluate the effectiveness and safety of total enteral nutrition (TEN) versus total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). Methods The databases such as Pubmed (1996 to June 2011), EMbase (1984 to June 2011), Cochrane Central Register of Controlled Trials of The Cochrane Library (Issue 6, 2011) and CBM (1978 to June 2011) were electronically searched, and the relevant references of the included papers were also manually searched. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. Meta-analyses were performed using the Cochrane Collaboration’s RevMan 5.1 software. Results Seven randomized controlled trials (RCTs) involving 379 patients with SAP were included. The results of meta-analyses showed that compared with TPN, TEN could significantly reduce the risk of mortality (RR=0.33, 95%CI 0.20 to 0.55, Plt;0.000 1), pancreatitis-related infections (RR=0.35, 95%CI 0.25 to 0.50, Plt;0.000 01), required rate of surgical intervention (RR=0.43, 95%CI 0.23 to 0.82, P=0.01), and incidence of multiple organ failure (MOF) (RR=0.28, 95%CI 0.17 to 0.46, Plt;0.000 01). There was no significant difference in the nutrition strategies associated complications between TPN and TEN (RR=1.16, 95%CI 0.42 to 3.22, P=0.78). Conclusion Meta-analyses show that compared with TPN, TEN can reduce the risk of mortality, pancreatitis-related infections, required rate of surgical intervention, and incidence of MOF; and it will not increase the nutrition strategies associated complications. Consequently, TEN should be considered a better choice for SAP patients as early as possible.
ObjectiveTo investigate the effect of early enteral nutrition (EEN) support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery (ERAS). MethodsThe children with perforated appendicitis were collected as an observation group, who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital. At the same time, the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender, age, disease course, pathological type, and body mass index with the observation group. The time of first exhaust or defecation and the hospital stay after surgery were compared. Meanwhile, the nutritional indexes [prealbumin (PA), albumin (ALB), hemoglobin (Hb)], immune indexes [immunoglobulin (Ig) A, IgM, IgG], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before surgery, on day 1 and 7 after surgery were compared. And the adverse effects were observed. ResultsThere were 40 children with perforated appendicitis in the observation group and the control group, respectively. There were no statistical differences in the baseline data such as the gender, age, course of disease, pathological type, and body mass index between the two groups (P>0.05). The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group (t=3.234, P=0.002; t=5.582, P<0.001). The levels of PA, ALB, Hb, IgA, IgM, and IgG in the observation group were higher than in the control group on day 7 after surgery (P<0.05). The levels of CRP, IL-6, and TNF-α in the observation group were lower than in the control group on day 7 after surgery (P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group [5.0% (2/40) vs. 22.5% (9/40), χ2=5.165, P=0.023]. ConclusionsFrom on the results of this study, EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function, correct nutritional status, improve immune function, and reduce inflammation, and which has a higher safety for children with perforated appendicitis.
Objective To explore method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal gastric cancer (GC). Methods The clinical data of 30 patients with distal GC underwent the total laparoscopic radical gastrectomy from October 2017 to March 2018 in the Departmeng of Tumor Surgery, Lanzhou University Second Hospital were retrospectively analyzed, the total laparoscopic radical distal gastrectomy were performed in all the patients and the jejunum nutrition tube were implanted during the operation. Results Thirty patients with distal GC were successfully treated with the total laparoscopic radical gastrectomy and the jejunum nutrition tubes were implanted into under the total laparoscopy through the intraoperative guidance by the gastric tube, firstly fastening the nutrition tube to the gastric tube in vitro, and then separating them in vivo, finally the nutrition tube was smoothly implanted into the jejunum under the direct vision. The implantation time was 10 to 15 min with an average of 13.5 min. The jejunal nutrition tube retention time was 5 to 7 d with an average of 6 d. There were no complications such as the bleeding, anastomotic leakage, anastomotic obstruction, stenosis, intestinal leakage, intestinal obstruction, and other complications after the operation in the 30 patients. Conclusions Method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal GC is easy to be performed. Intraoperative and postoperative complications are few. It provides a favorable guarantee for improving postoperative nutritional status of patient with distal GC.
ObjectiveTo investigate the clinical effects of early enteral nutrition in severe thoracic trauma patients requiring mechanical ventilation. MethodsWe randomly allocated 60 patients with thoracic trauma requiring mechanical ventilation into two groups by drawing lots including an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group in our hospital between January 2013 and September 2014 year. There were 30 patients in each group. We compared the recovery results of the patients between the two groups. ResultsAfter the treatment of 7 and 14 days, indicators in the EEN group were better than before significantly and better than those in the PN group; diarrhea rate average days of ICU and the average days of hospital decreased significantly with statistical differences (P<0.05). There was no statistical difference in ventilator-associated pneumonia or the incidence of stress ulcer between the two groups (P>0.05). ConclusionEarly enteral nutrition in severe chest trauma patients requiring mechanical ventilation may promote protein synthesis, improve the nutritional status of patients, correct negative nitrogen balance, reduce inflammation response, reduce the complications.
ObjectiveTo study the protective effect of hepatocyte growth factor(HGF) on grafted mucous membrane of transplanted small bowel.MethodsTotal small bowel transplantation was made in inbred Wistar (RT1k) rats heterotopically,either total parenteral nutrition (control group,n=10) or hepatocyte growth factor supplemented TPN (HGF group,n=10) was given to the recipients from the 2nd day to the 10th day postoperatively. Morphological parameters of the transplanted intestinal mucosa, such as mucosal villous height, villous width, crypt depth, mucosal thickness and villous surface area were observed. Variation of ultrastructure of transplanted epithelial cells was observed. Composition of mucosal protein and DNA content were tested. ResultsComparison between HGF group and the control group were as follows. Mucosal villous height (298.79±22.31） μm vs （176.45±14.62） μm, P=0.001, villous width (107.46±12.34） μm vs （74.20±16.85） μm, P=0.004, crypt depth (104.56±11.17） μm vs （74.45±8.34） μm, P=0.000 5, mucosal thickness (409.53±35.83） μm vs （259.38±24.65） μm, P=0.003, and villous surface area (0.101±0.011) mm2 vs (0.041±0.005) mm2, P=0.001 were found significantly increased in HGF group compared with control group, there were no obvious difference decrease as compared to pretransplant parameters.Mucosal protein composition was higher in HGF group than that in control group （89.65±9.28) mg/g wet wt vs (53.73±11.45) mg/g wet wt, P=0.012, baseline (92.64±10.52) mg/g wet wt, nearly equal to baseline; DNA composition was also high in HGF group （0.89±0.09) mg/g wet wt vs (0.51±0.06) mg/g wet wt, P=0.008, baseline (0.91±0.09) mg/g wet wt. Nearly normal ultrastructure of the graft was maintained in HGF group, atrophied microvilli and broken mitochondrial crista were observed in control group.ConclusionHepatocyte growth factor can improve mucosal structure, preserve enterocyte ultrastructure of isograft after small bowel transplantation in rat.
ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
Objective To explore the effects of early enteral nutrition therapy combined with micro-ecologicalpreparation on early intestinal function recovery in patients with severe acute pancreatitis (SAP). Methods The clinical data of 48 patients with SAP treated from January 2012 to January 2015 were retrospectively analyzed. Out of the 48 cases, 23 were treated with early enteral nutrition therapy (the control group), and 25 were treated with early enteral nutrition therapy combined with micro-ecologicalpreparation (the observation group). The counts of white blood cells (WBC), the levels of blood amylase, serum lipase, lactic dehydrogenase (LDH), and the scores of gastrointestinal function 1 day before treatment and on the 7th and 14th day of treatment were observed. The incidences of complications, case fatality rates, and lengths of hospital stay were recorded. Results One day before treatment, the differences in the counts of WBC, the levels of blood amylase, lipase, and LDH between the two groups were not statistically significant (P>0.05). On the 7th day of treatment, the counts of WBC, the levels of blood amylase, lipase, and LDH in the two groups decreased in varying degrees, and the decreasing in the observation group was more obvious (P<0.05). On the 14th day of treatment, the levels of blood amylase in the two groups were almost normal, and the difference between the two groups was not statistically significant (P>0.05); the levels of lipase, LDH and the counts of WBC in the observation group were lower than those in the control group (P<0.05). One day before treatment, the difference in the scores of gastrointestinal function between the control group (1.34±0.76) and the observation group (1.46±0.62) was not statistically significant (P>0.05); on the 7th and 14th day of treatment, the scores of gastrointestinal function in the observation group (0.37±0.18, 0.29±0.06) were lower than those in the control group (0.63±0.32, 0.47±0.08), and the differences were statistically significant (P<0.05). There were significant differences between the two groups in terms of the incidence of total complications and length of hospital stay (P<0.05), while the difference in the case fatality rate between the two groups was not statistically significant (P>0.05). Conclusion Early enteral nutrition combined with micro-ecological preparation is benefit to the intestinal function recovery in patients with SAP.
ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.
摘要:目的: 探討早期腸內營養支持在胃腸道惡性腫瘤術后患者中應用的臨床效果。 方法 :54 例胃腸道惡性腫瘤行根治手術的患者,隨機分為對照組和研究組,分別接受腸外營養支持(PN)和腸內營養支持(EN)。比較兩組治療前后的血清白蛋白、前白蛋白和轉鐵蛋白水平,肝腎功能指標,胃腸功能恢復時間以及并發癥的發生率。 結果 :經過術后7 d 的營養支持治療,EN組術后血清前白蛋白、轉鐵蛋白水平升高程度明顯大于PN組,胃腸功能較PN組更快恢復。在術后并發癥的發生率和肝腎功能指標方面兩組沒有顯著性差異。 結論 :早期腸內營養支持能夠安全有效地促進胃腸道腫瘤術后患者的恢復。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.