自20世纪60年代中期，发现仅从静脉给予机体所必需的营养物质，就可以维持幼体动物的生存发育与成长以来，古老的营养支持疗法开始了一个新的辉煌时期。经过近30多年的研究与实践，其内涵得到更大的发展，80年代以后，营养支持在我国普外临床也有较快的进展，当前已成为临床重要的治疗手段。在提高危重患者的治愈率，降低外科手术后并发症，加速术后患者的恢复和减少住院时间起到了很重要的作用，无论在营养支持的基础理论或临床实践都有了更深入的认识。因此，它的应用范围在不断地扩大，其临床地位也日益显得重要。
目的:探讨益生菌联合营养支持对胃肠外科术后患者肠功能和肠道菌群的影响。方法:36例胃肠道中等以上手术的患者,随机分为研究组和对照组,每组18例。两组术后均接受等氮等能量的营养支持,研究组患者于术后第3天开始每天加用益生菌制剂(6.6 × 10.7 colony forming units),共7天。监测治疗期间患者的胃肠道症状、生命体征、腹泻情况和菌群比例等。结果:两组患者术后腹痛、腹胀、肠鸣音异常等胃肠道症状均无显著差异 (Pgt;0.05),两组患者在术后第8和9天的腹泻比例和腹泻评分差异有显著性意义(Plt;0.05)。治疗结束后,研究组患者肠道双歧杆菌和乳酸杆菌计数均较对照组高,两组间差异有显著性意义(Plt;0.05)。 结论:在胃肠外科术后患者中应用益生菌可改善胃肠道症状、减轻腹泻程度和纠正肠道菌群失调。
ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
Objective To assess the efficacy and safety of fat emulsion (FE) for acute pancreatitis (AP).Methods We searched the electronic biological databases: Cochrane Controlled Trials Register (Issue 2, 2007), Medline(1996 to April 2007), EMBASE (1984 to April 2007), Chinese biological medical database (1978 to April 2007). We alsodid handsearching to identify other published and unpublished data. Data collection and undertaken by two reviewersaccording to the Cochrane Handbook for Reviews of Intervention. Randomized controlled trials (RCTs) or quasi-RCTscomparing FE versus glucose in the treatment of AP were collected. Pooled estimates of overall treatment effect werecalculated using the RevMan 4.2.10 according to available data from included studies. Otherwise, qualitative descriptiveanalysis was performed. Results In total, 10 clinic control trials finally (include 314 participant) met the eligible criteria. ① To long chain triglyceride (LCT), the comparison of overall mortality (relative risk, 0.73; 95%CI, 0.34 to 1.58; P=0.26) and complications (Pgt;0.05) showed no significant difference. One study reported LCT cannot reduce hospital stay (Pgt;0.1). The effects of LCT on cholesterol and triglyceride were inconsistent with respect to the course of treatment. ② However, there were no changes of the cholesterol and triglyceride levels secondary to the medium chain triglyceride and long chain triglyceride (MCT/LCT) (Pgt;0.05, respectively) according to one study. ③ No severe adverse events were reported.Conclusions The evidence currently available cannot conclude that FE is safe and effective, though LCT may decreasethe mortality of AP. Therefore, more high-quality trails are needed.
ObjectiveTo systematically review the efficacy of enteral nutrition combined with parenteral nutrition (EN+PN) and enteral nutrition alone (EN) in gastric cancer patients undergoing gastrectomy. MethodsPubMed, EMbase, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of EN+PN and EN in gastric cancer patients undergoing gastrectomy from inception to September 25th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 23 RCTs were included. The results of meta-analysis showed that compared to EN group, EN+PN group had a shorter hospital stay (MD=−1.75, 95%CI −2.45 to −1.05, P<0.000 1) and a lower risk of postoperative complications (RR=0.55, 95%CI 0.46 to 0.66, P<0.000 1). However, there was no statistical difference in the first exhaust time between the two groups. ConclusionThe current evidence shows that EN+PN may contribute to reducing the incidence of postoperative complications and shortening the length of hospital stay in gastric cancer patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
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.
Sarcopenia is a syndrome associated with reduced strength, mass and function of skeletal muscles. Aging of gastric cancer patients, lack of nutritional intake, and pathological mechanisms of gastric cancer increase the likelihood of sarcopenia. Sarcopenia is associated with the development of gastric cancer and may be a risk factor for the formation of gastric cancer. Sarcopenia is closely related to the prognosis and treatment of gastric cancer. At present, the treatment of sarcopenia is still in the exploratory stage, and more research is needed to obtain better treatment plans and improve the quality of life of patients. This article reviews the research status of sarcopenia and gastric cancer in order to provide evidence for clinical research.
【摘要】 目的 观察慢性心力衰竭营养支持治疗的疗效。 方法 将2007年1月〖CD3/5〗2009年10月期间收治的56例慢性心力衰竭住院患者随机分为常规治疗组及强化营养支持治疗组,每组28例患者。其中,强化治疗组是在常规治疗的基础上,给与强化营养支持治疗。比较两组治疗前后6 min步行距离、NYHA心功能评级及射血分数。 结果 治疗后,患者6 min步行距离、心功能评级强化营养治疗组优于常规治疗组。左心室射血分数两组无差异。 结论 对慢性心力衰竭患者,营养支持治疗是重要的治疗手段。【Abstract】 Objective To study the efficacy of nutritional support treatment for chronic heart failure. Methods 56 patients with chronic heart failure hospitalized patients were randomly divided into conventional therapy group and enhanced nutritional support therapy group, 28 patients in each group. Where enhenced therapy group is on the basis of conventional therapy to give extra enhanced intensive nutrition support treatment. Before and after treatment were compared sixminutes walking distance, NYHA cardiac function class, ejection fraction, mortality. Results After treatment, patients with sixminutes walking distance, cardiac function class,enhanced nutritional support therapy group is better than conventional treatment group. Left ventricular ejection fraction was no difference. Conclusion Patients with chronic heart failure, nutritional support treatment is an important treatment.