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 approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
Malnutrition is associated with many adverse clinical outcomes, including increased deaths and complications in perioperative period. The immunonutrition support plays an important role in the recovery process of patients with nutritional risk. Reasonable support can efficiently improve the condition of these cases and strongly suppress the inflammatory response. The immuno-nutrients include glutamine, ω-3 polyunsaturated fatty acids, arginine, nucleotides and so on. More and more evidences show that different kinds of immuno-nutrients play a regulatory role in metabolism and inflammatory response in patients with different disease stages and courses, and affect clinical outcomes and prognosis. Nowadays, there is an urgent need to standardize immunonutrition support in clinical work. In this paper, the related literatures about immunonutrition in recent years were reviewed. Our goal is to reduce the number of irregularities in the nutrition support practice, and to help nutritional risk patients achieve better clinical outcomes.
ObjectiveTo investigate the clinical significance of abnormal confluence of common bile duct (CBD) and pancreatic duct. MethodsFortyfive cases of biliary pancreatic confluence portion of cadavers were dissected and observed with microscope. ResultsThe lower end of CBD inserted normally into the medial posterior portion of descending duodenum with oblique angle (41.4±5.3)° and safeguarded by the sidelong wrinkle formed by mucous membrane of duodenum. In common, pancreatic duct ampulla inserted into CBD with oblique angle (28.5±7.9)° and jointed CBD in the medial wall of dudenum. The length ampulla of Vater was about 0.5-1.5 cm. The Vater’s ampulla was dilated obviously. ConclusionThe result indicates that pancreatic duct and CBD joint with a sharp angle. A number of abnormal anatomic factors may change the relation of oblique angle, and lead to the pancreatitis.