To study the effects of arginine supplementation in total parenteral nutrition (TPN) on lymphocytic immune function in postoperative patients with gastric cancer. Thirty six patients with gastric cancer receiving TPN were eligible for entry into randomized and prospective clinical trial of the study. T cell subsets, NK cell activity, plasma IL-2 content and peripheral blood CD25 were measured in before and after parenteral nutrition of the patients. Results: usual TPN could not improve lymphocytic immunosuppression of postoperative patients with gastric cancer. The patients receiving arginine supplementation in TPN might enhance lymphocytic immune function by increasing CD4 level, IL-2 production and NK cell activity, but there was no significant effect of arginine on CD25 expression. Conclusion: there are some effects of supplement with arginine on releasing of the cellular immunosuppression and restoring of lymphocytic immune function.
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.
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.
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.
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.
ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
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.
ObjectiveTo systematically review the incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients. MethodsThe PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect observational studies on the early enteral nutritional feeding interruptions in critically ill patients from inception to January 2, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 17.0 software. ResultsA total of 12 studies including 1 121 patients were included. Meta-analysis showed that the incidence of early enteral nutritional feeding interruptions in critically ill patients was 75.0% (95%CI 64.0% to 84.0%). Influenced by feeding intolerance, airway management, tube problems, radiological examination, and endoscopy, surgery and so on, interruptions of early enteral nutritional feeding frequently occur in critically ill patients. ConclusionCurrent evidence shows that early enteral feeding interruptions in critically ill patients are affected by many factors, and the incidence is high. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
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 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.