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.
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.
【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.
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。
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.
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 investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy. Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed. Results There were no significant differences between two groups (Pgt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004). Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.
Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.