Early enteral nutrition after cardiopulmonary bypass (CPB) has been shown to have beneficial effects on intestinal integrity, lower mortality and also on the patient’s immunocompetence. Even in critical patients after CPB, enteral nutrition should be reasonable to start early and also be supplemented by parenteral nutrition in order to meet energy requirement. We conclude that enteral nutrition is preferable in the majority of patients with severe hemodynamic failure, but gastrointestinal complication and hypocaloric feeding should be simultaneously noticed. This paper comprehensively described enteral nutrition’s protective mechanism and effects on digestive system, enteral nutrition’s implementing methods after CPB, and problems or prospects needing attention in execution.
肠内或称经肠营养(enteral nutrition)是经胃肠道用口服或管饲来提供可满足、超过或补充代谢需要的营养基质及其他各种营养素的营养方式［1］。经过漫长的临床实践与技术发展，肠内营养的优越性越来越为人们所重视。“如果肠道有功能，就应使用肠道”的原则已为大多数临床医师所接受。近年来外科术后早期肠内营养（early enteral nutrition）的研究亦有较多的进展。
目的探讨肝脏移植术后早期肠内营养支持的价值。方法在术中将鼻肠管放置至屈氏韧带或空肠输出袢下30 cm， 术后第2天开始恒速灌注瑞素，量由500 ml/d逐渐增加到1 200 ml/d，速度由20 ml/h增至100 ml/h。分别于术后第2天及第8天观察患者的白蛋白、前白蛋白、转铁蛋白、尿尿素氮和氮平衡。结果前白蛋白、转铁蛋白和氮平衡均有显著改善，白蛋白无明显变化。结论肝脏移植术后早期肠内营养支持可以有效改善患者的营养状况和促进患者的恢复，并且可以减少患者的营养支持费用。
ObjectiveTo evaluate the effect of the early enteral nutrition（EEN） on the natural course in dogs with severe acute pancreatitis（SAP）.MethodsSAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000-10 000 BAEE units trypsin/ml into pancrease via pancreatic duct.Fifteen dogs were divided into parenteral nutrition(PN) group and EEN group.Two groups were isonitrogenous and isocaloric.EEN was used at postoperative 24 h.Systemic plasma endotoxin level was quantified by the chromogenic limulus amebocyte lysate technique.Both portal and systemic blood sample were obtained before and 1，4，7 d following SAP, and cultured for aerobic as well as anaerobic bacterial.Serum glucose, calcium,amylase and lysosomal enzymes were determined.All dogs were injected with 1.85×106 Bq 125IBSA 4 h before sacrificed.The 125IBSA index of the pancreas/muscle and pancreas/blood was measured,and pancreas pathology was observed.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenata were cultured as blood mentioned above.The thickness of mucosa,the whole gut layer,the height of intestinal villi and their protein and DNA contents in the intestinal and transverse colon were determined.ResultsThe study showed that EEN significantly reduced the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ,serum glucose in PN group was higher than that in EEN after SAP 4 d.There were no difference between two groups in the data of serum calcium,amylase and lysosomal enzymes,pathologic index and 125IBSA index of pancreas/muscle and pancreas/blood.EEN improved the gut barrier function by increasing the thickness of mucosa,the whole gut layer and the height of intestinal villi,increasing its protein and DNA contents in the bowel.ConclusionOur results suggest that EEN is safe and effective,and can decrease the rate of intestinal bacterial translocation.
Objective To explore the clinical value of early enteral nutrition in severe acute pancreatitis （SAP） by percutaneous endoscopic gastrostomy/jejunostomy （PEG/J）.Methods Treatment condition of nighty patients with SAP were retrospectively analysed.The 90 patients were collected peripheral venous blood respectively on 1， 12， and 18 d after admission to hospital.Forty-five of them were in PEG/J group， the others were in control group. Serum IL-6，TNF-α and endotoxin were detected by enzyme-linked immunosorbent assay （ELISA），CD4 /CD8 was determinated by indirect immunofluorescence staining method （FITC-labeled）.Results On 12 d and 18 d，the levels of serum IL-6， TNF-α， and endotoxin in PEG/J group were lower than those in control group （P＜0.01）.The CD4 /CD8 was significantly higher than that in control group （P＜0.01）.In control group， 2 cases complicated upper gastrointestinal haemorrhage，4 cases complicated pancreatic pseudocysts， and 2 cases complicated double infection， the temperature became normal after about 13.5 d.In PEG/J group， there were not upper gastrointestinal haemorrhage and double infection，but 2 cases also complicated pancreatic pseudocysts， the temperature became normal after about 10.5 d.Conclusion The clinical effectiveness of early enteral nutrition in SAP by PEG/J is satisfactory.
Objective To analyze clinical value of early enteral nutrition following radical resection of gastric cancer. Methods Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed. Results ① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05). Conclusion Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.
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 explore the effect of early enteral nutrition (EEN) on immune status of patients in intenseive care unit (ICU). MethodsA prospective control study was conducted from July 2011 to December 2012, and 80 patients after trauma and surgery were admitted to ICU. The Patients were divided into EEN group and normal enteral nutrition (NEN) group randomly. Enteral nutrition in EEN group began within 24 hours after admitted to ICU, while within 48 hours in NEN group. ResultsIn 80 patients, 78(37 in EEN group and 41 in NEN group) completed the end point. The baseline in two groups was consistent (P>0.05). The indicators of lymphocyte, IgA, IgG, IgM and CD4+, CD8+, natural kill cell and pre-albumin values in EEN group were higher than those in NEN group (P<0.05). The incidence of diarrhea (8.1%, 26.8%) and infection of wound (2.7%, 17.1%) in EEN were less than those in NEN group. The hospitalization duration in ICU in EEN group[(7.94±3.72) days] was also shorter than that in NEN group[(10.62±3.14) days]. ConclusionEarly enteral nutrition improves immune function and nutrition status in ICU patients; it also protects gut barrier function and reduces the ICU hospitalization duration.
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.
ObjectiveTo research and summarize the best evidences of probiotic-riched early enteral nutrition for postoperative liver transplantation, and provide references for precise and individual clinical nutrition and probiotics usage management in patients with liver transplantation.MethodsThe scientific problem was established according to the PIPOST. The British Medical Journal Best Practice, Cochrane Library, Jonna Briggs Institute, Guidelines International Network, National Guideline Clearinghouse, etc. were used to search the papers or relative data recordings. The evidence evaluation and summary were carried out based on the previous documents.ResultsOne evidence summary, 2 systematic reviews, and 5 randomized controlled studies were included. Based on the specific questions, 6 dimensions (24 evidences) were extracted and summarized: the early enteral nutrition was used within postoperative 24 h, starting with 20 mL/h, but not more than 125 mL/h, essential nutrients would be fine and tube feeding would be converted to oral feeding as soon as possible; Lactobacillus 20 mg and Bifidobacterium 15 mg were suggested, 3 times/d, probiotic-riched early enteral nutrition for postoperative liver transplantation should be lasted for at least 14 d.ConclusionsEvidence-based medicine is used to collect the best evidence of probiotic-riched early enteral nutrition for postoperative liver transplantation, there are few studies on early enteral nutrition after liver transplantation in China. Application of the best evidence needs to be analyzed and constructed according to current situation of liver transplantation in China.