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.
Forty critical patients with respiratory failure in the intensive care unit were randomly divided into two groups,Group A with administration of parenteral nutritino(PN) and Group B,no parenteral nutrition given.Blood gas analysis and respiratory monitoring showed that the respiratory rate,pH、PaO2、PaCO2 and HCO3- had no marked difference between the two groups.But in Group A there was a slight decrease of Pao2/FiO2 and a marked increase of A-aDO2 and the pulmonary shunt.This study indicates that the content of fat emulsion and hydrocarbon in PN may be the main factor that affects the respiratory function.
Experienc of nurtitional treatment to 7 patients with acute renal failure (ARF) and nitrogemia after biliarty (tract) surgery is reported in this article. Nittrogen source inn all cases was obtained from "Renal Amine" and "7% Vamin" etc,which are composed of 8 essential amino acids (EAA), and the nergery sources are mainly supplyed by Intralipid (20 or 10%) and suitable amount of glucose. The nutritional admicture of "all in one" were employed as parenteral nutrition (PN). Satisfactary curative effecs in these patients were obtained. The suthors consider that (a) the nutritional treatment of different casuses of ARF should be providing enough energy and more EAA requirments than in normal need to synthesizw non-essential amino acide (NEAA) and protein from excessive blood urea nitrogen (BUN) for redcuing pritein breakdown and nitrogemia, and (b) 20% Intralipid is an effective low-volume, highly calories nutritional agent specially in ARF patients with restiction of waterr.
Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.
Objective To research the effect of ω-3 polyunsaturated fatty acid (PUFA) on promoting the postoperative rehabilitation of patients with gastrointestinal malignancies in order to decrease the incidence of postoperative complications and the days of postoperative hospital stay. Methods Forty patients with gastrointestinal malignancies in West China Hospital of Sichuan University from February 1st, 2009 to June 1st, 2009 were included and allocated to experimental group (20 cases) and control group (20 cases) randomly. Seven days parenteral nutrition was provided to them after operation. Compared with control group, ω-3 PUFA with a dose of 10 g was given to experimental group every day additionally. Blood samples were gained before operation, on the morning of day 2 and day 8 after operation respectively to measure hepatorenal and immune indexes. Temperature before and 1-7 d after operation, time of passing flatus to normal, postoperative complications and the postoperative hospital stay were recorded. Results There was no statistical difference in the baselines between experimental group and control group （Pgt;0.05）. The level of total bilirubin in experimental group was lower and the levels of NK cell and B cell in experimental group were higher than those in control group on day 2 after operation, there were statistical differences between them (Plt;0.05). The levels of ALT, AST and blood urea mitrogen in experimental group were lower and the levels of CD4+ cell and NK cell in experimental group were higher than those in control group on day 8 after operation, there were statistical differences between them, too (Plt;0.05). The time of passing flatus to normal and days of staying in hospital after operation in experimental group were shorter than those in control group, there were statistical differences between them (Plt;0.05). There was no statistical difference in postoperative average temperature and incidence of complications between two groups （Pgt;0.05）. Conclusions ω-3 PUFA has positive influence on the recovery of hepatorenal, immune and gastrointestinal function, and can shorten the days of postoperative hospital stay; but there is no effect on incidence of complications after operation.
【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.
ObjectiveTo explore the clinical efficacy and security of early enteral nutrition (EN) on patients with gastric cancer after radical operation. MethodsSeventy cases who treated in Affiliated Hospital of Inner Mongolia Medical University from Dec. 2008 to Apr. 2013 were randomly divided into EN group (n=35) and parenteral nutrition (PN) group (n=35), analysis and comparison of nutrition indicators and recovery indicators between 2 groups were performed. ResultsThere were no significant differences on levels of count of white blood cell (WBC), serum albumin (ALB), prealbumin (PA), and transferring (TRF) before operation between the 2 groups (P > 0.05). On 3 and 7 days after operation, the levels of ALB, PA, and TRF were all higher in EN group (P < 0.05) besides level of count of WBC. In addition, hospital stay and hospitalization cost were both lower in EN group (P < 0.05), but there was no significant difference on postoperative exhaust time and complication incidence (P > 0.05). ConclusionsEN is a safe, effective, and economical method of nutritional supplements, and it is a preferred method of nutritional support for patients with advanced gastric cancer after operation at prophase, which is worthy to apply widely in clinical.
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.
ObjectiveTo systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy. MethodsThe following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06). ConclusionThe early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.
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.