To study the effects of early enteral nutrition and selective decontamination of digestive tract on the lipopolysacchride (LPS) translocation and cytokines and the developing of multiple organ dysfunction syndrome (MODS). Thirty six rabbits were divided into 3 groups: ①control group (CON group, n＝12), the rabbits were bled to shock state (MAP was 5.33 kPa) for 1 hour and then were resuscitated by with replacement of the lost blood and 2 volume of the equilibrium liquid, ②selective decontamination of digestive tract (SDD group, n＝12), the procedure was the same as the CON group but the rabbit was fed with the antibiotics 3 days before the experiment and all through the experiment, ③early enteral nutrition group (EN group, n＝12), treatment was the same as CON group. After resuscitation the feeding tube was placed into the stomach for enteral nutrition. On the 1st, 3rd, 5th and 7th day the blood samples were taken for testing the LPS, TNFα and the organs’ function. Results: The MODS incidence, the levels of LPS and TNFα of the EN group were obviously lower than those in SDD and CON groups; the levels of the LPS and TNFα of the SDD group remained high in the 5th day. SDD group had a higher incidence of the MODS and mortality than that of the EN group. Conclusion: Ischemiareperfusion damage can produce the LPS translocation, which causes the development of MODS. SDD can’t decrease the LPS translocation so that the incidence of MODS and mortality remain high. Early EN can inhibit LPS translocation and reduce the development of MODS.
Objective To investigate the influence of preoperative enteral nutrition with dietary fiber on the nutritional status of patients with colon colostomy diaplasis, and discuss its safety. Methods Forty preoperative colon colostomy diaplasis patients from West China Hospital treated between September 2013 and June 2014 were randomly assigned into trial group and control group with 20 in each. The baseline of the two groups was the same (all P > 0.05). The trial group was given enteral nutrition with dietary fiber before operation for seven days, while control group was given homogenate diet with equal quantity of energy and nitrogen content for the same period of time. All patients were being tested for nutritional indexes on the day of admission and on the fifth day after surgery. Meanwhile, other indexes such as the first time of flatus and defecation, abdominal distension, bellyache, and other adverse reactions were recorded too. Results There was no statistical difference in nutritional indexes on the day of admission and on the fifth day after surgery between two groups (P > 0.05). Patients with dietary fiber had significantly higher incidence of abdominal distension than the control subjects (P < 0.05), but other adverse reactions had no statistical differences between the two groups (P > 0.05). No anastomotic leakage occurred in both the two groups. Patients with dietary fiber had significantly earlier time of flatus than the control group (P < 0.05). Patients with dietary fiber had significantly lower incidence of diarrhea than the control subjects (P < 0.05). Conclusions The study suggests that it is safe and feasible to use enteral nutrition with dietary fiber for preoperative colon colostomy diaplasis patients. Using dietary fiber is helpful for intestinal function recovery and reduction of the occurrence of adverse reactions after surgery.
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.
Objective To investigate the effect of mesenteric lymphatic duct liagtion and glutamine enteral nutrition on intestine and distant organs in intestinal ischemia/reperfusion injury. Methods Forty male SD rats undergoing gastrostomy were randomly assigned into 5 groups (n=8): sham operation group, normal enteral nutrition group, normal enteral nutrition+lymphatic duct ligation group, glutamine group and glutamine+lymphatic duct ligation group. Sham operation group only received laparotomy after 7 days of full diet, the other four groups were subjected to 60 min of intestinal ischemia after 7 days of enteral nutrition, and the two lymphatic duct ligation groups were plus mesenteric lymphatic duct ligation. The original nutrition continued 3 days after reperfusion. Intestinal permeability was detected on day 1 before reperfusion, day 1 and 3 after reperfusion. Intestinal morphology was observed, endotoxin, D-lactate and diamine oxidase levels in serum, and apoptotic index in lung tissue were detected on day 3 after reperfusion. Results The intestinal permeability in each group was significantly increased on day 1 after reperfusion (Plt;0.05), and which in normal enteral nutrition+lymphatic duct ligation group and glutamine+lymphatic duct ligation group were significantly decreased on day 3 after reperfusion (Plt;0.05). The mucosal thickness and villus height of ileum and mucosal thickness of jejunium in glutamine+lymphatic duct ligation group were significantly higher than those in other groups (Plt;0.05), and villus height of ileum in glutamine group was higher than that in normal enteral nutrition group (Plt;0.05); those morphology indexes in normal enteral nutrition+lymphatic duct ligation group were higher than those in normal enteral nutrition group, but there was no statistical signification (Pgt;0.05). Apoptosis index of lung tissue in lymphatic duct ligation groups was significant lower than that in no-ligation groups (Plt;0.05). Levels of endotoxin, D-lactate, and diamine oxidase in lymphatic duct ligation groups had downward trends compared with no-ligation groups, but there was no statistical signification (Pgt;0.05). Conclusions Intestinal ischemia/reperfusion injury of rats can cause intestinal permeability increase, bacterial endotoxin translocation and systemic inflammatory response. Mesenteric lymphatic duct ligation and glutamine enteral nutrition intervention can weak lung tissue damage, increase thickness of intestinal mucosa, maintain intestinal barrier function, reduce endotoxin translocation and attenuate systemic inflammatory response. Enteral nutrition with glutamine was better than normal enteral nutrition.
Objective To explore the effect of early enteral nutrition in the clinical treatment of severe acute pancreatitis (SAP). Methods Forty-two SAP patients who improved with non-surgical treatments between January 2012 and December 2014 were selected and randomly divided into control group and study group with 21 patients in each. Patients in the control group accepted whole venous nutrition, while those in the study group had early enteral nutrition. Nutrition indexes, blood biological indexes, and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score on day 7 and 14 after treatment, and average hospital stay of the two groups of patients were recorded and compared. Results No differences in body weight reduction, lymphocytes, serum albumin, calcium, glucose, APACHE Ⅱ score between the two groups after 7 days of treatment were observed (P>0.05). But there were significant differences in body weight, lymphocytes, serum albumin, and APACHE Ⅱ score between these two groups after 14 days of treatment (P<0.05). Hospital stay of the study group was obviously shorter (P<0.01). Conclusions Early enteral nutrition support for patients with severe acute pancreatitis can improve nutritional status and shorten hospital stay. It is worthy of wider clinical application.
Objective To study effects of enteral immunonutrition and econutrition on intestinal mucosa barrier function in wounded rats. Methods Forty Wistar rats were randomly divided into four groups, with ten rats in each group 〔ie.control group, enteral nutrition (EN) group, enteral immunonutrition (EIN) group and enteral econutrition (EEN) group〕. After gastrostomy, rats in each group were treated with the isocaloric and isonitrogenous nutritional formulas for 7 days, respectively. The morphology of ileum membrane was studied, and the quantities of IgA+, CD3+, CD4+ and CD8+ cells (each HP) of ileum membrane were determined. Results The villus height, crypt depth, mucosal thickness (except EN group) and villus surface area of ileum were increased in EN, EIN and EEN group compared with control group (P＜0.05), but there was no significant difference among the former three groups (Pgt;0.05). The numbers of IgA+, CD3+, CD4+ and CD8+ cells were increased in EN, EIN and EEN group compared with control group (P＜0.05), and those numbers in EN group were lower than those in EIN and EEN group (P＜0.05). Conclusion EIN and EEN may improve intestine mechanical barrier function and promote restoration of small intestine mucous membrane barrier function in rats. EIN and EEN also improve intestine immune barrier function and strengthen its immune function.
Objective To study the current clinical application and advancement of microbioecological preparation. Methods Literatures about microbioecological preparation published in China and abroad were collected and reviewed. Results The microbioecological preparation has been widely used at present. It is used to rebuild a balanced microbial population in human body, particularly in intestinal, to promote the stability of internal environment, control dysbacteriosis and to treat a variety of gastrointestinal diseases associated with ectopic microbial population. Conclusion Although microbioecological preparation has been widely used in clinical settings, its effect yet should be further supported and evaluated both by large sample research in randomized double-blind control trails and evidence-based medicine.
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.
Objective To evaluate the clinical curative effect of early enteral nutrition （EN） in gastric cancer patients after operation and its safety. Methods One hundred and eighty patients with gastric cancer diagnosed and underwent surgical treatment in gastrointestinal surgery center， West China Hospital from February 2011 to December 2011 were studied prospectively， who were randomly divided into EN group （n=91） and parenteral nutrition （PN） group （n=89）. The nutrition state， rehabilitation， hospital stay， cost of nutrition in hospital， and complications were observed. Results ①According to the postoperative serum nutrition index， there were no significant differences in the prealbumin， hemoglobin， and ratio of albumin to globulin in two groups （P＞0.05）， but the albumin level in the EN group was significantlyhigher than that in the PN group （P=0.047）. ②According to the postoperative rehabilitation index， the first ambulation time （P=0.011）， first intake time （P=0.000）， first nasogastric tube away time （P=0.013）， first drainage tube away time （P=0.021）， and first urinary catheter away time （P=0.002） in the EN group were significantly shorter than those in the PN group. The difference of the first anus exhaust time was not statistically significant in two groups （P=0.083）. ③The cost of nutrition in hospital in the EN group was significantly less than that in the PN group （P=0.017）. The postoperative hospital stay and total complication rate were not significant differences in two groups （P＞0.05）. Conclusion Early postoperative EN is effective， economic， practical， which might be superior to PN.
【Abstract】ObjectiveTo generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. MethodsThe published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. ResultsEEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. ConclusionEEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.