In order to investigater the effect of nutritional support on nutrients metabolism after liver resection,we researched into the hepatectomy and total parenteral nutrition model in rats.The features of the model were no fasting before surgery,10% glucose subcutaneous injection prior to operation avoiding of blood loss and shortening of the surgical process.The 7-day mortality was markedly decreased.Anesthetized with phenobarbital(25mg/kg) injection in combination of ether inhalation,the rats recovered quickly from anesthesia and developed almost no infection of the respiratory tract after hepatectomy.The rats were supplied parenterally energy of 573kJ/kg and a marked improvement in survival was achieved after liver resection.By applying dual preventive rotation equipment of protective spring and IN-Stopper,nutrient solution could be safely infused.
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.
摘要:目的: 探讨早期肠内营养支持在胃肠道恶性肿瘤术后患者中应用的临床效果。 方法 :54 例胃肠道恶性肿瘤行根治手术的患者,随机分为对照组和研究组,分别接受肠外营养支持(PN)和肠内营养支持(EN)。比较两组治疗前后的血清白蛋白、前白蛋白和转铁蛋白水平,肝肾功能指标,胃肠功能恢复时间以及并发症的发生率。 结果 :经过术后7 d 的营养支持治疗,EN组术后血清前白蛋白、转铁蛋白水平升高程度明显大于PN组,胃肠功能较PN组更快恢复。在术后并发症的发生率和肝肾功能指标方面两组没有显著性差异。 结论 :早期肠内营养支持能够安全有效地促进胃肠道肿瘤术后患者的恢复。Abstract: Objective: To investigate the clinical effect of early enteral nutrition (EN) support on postoperative patients with gastrointestinal malignancy. Methods : A total of 54 postoperative patients with gastrointestinal malignancy were randomly divided into EN group and parenteral (PN) group. Both groups received isocaloric and isonitrogen nutrition support. The serum albumin, transferrin, prealbumin and liver and renal function were measured using standard techniques. The gastrointestinal function and postoperative complications were evaluated. Results : After nutrition support, serum albumin was not significantly different between two groups. Compared with PN group, serum transferrin and prealbumin level significantly increased in EN group (P＜005). The gastrointestinal function in EN group resumed earlier than that in PN group. There was also no difference in liver and renal function and postoperative complications between two groups. Conclusion : The application of early enteral nutrition support is beneficial to the recovery of the gastrointestinal cancer patients after surgery.
Thirty two surgical patients with liver disease (hepatocelluar carcinoma 16, liver cirrhosis 8, obstructive jaundice 8) were studied. All of them were randomly divided into three groups for administration of different kinds of TPN during the postoperative period [group Ⅰ (TPN without fat emulsion), group Ⅱ (TPN with fat emulsion, 1g/kg body weight/day of fat), group Ⅲ (TPN with fat emulsion 2g/kg body weight/day of fat )]. Their liver function test, glucose, lipid metabolism were examined and compared during the period of TPN. Result: ①TB, ALT and AST decreased in group Ⅱ and group Ⅲ (Plt;0.05), but increased in group Ⅰ (Plt;0.05). ②The blood glucose and insulin levels were normal in group Ⅱ and groupⅢ, but showed hyperglycemia and hyperinsulinemia in group Ⅰ (Plt;0.05). ③The serum lipid, lipoprotein, apoliprotein level and LCAT activity returned to normal 6 days after operation in group Ⅱ (Plt;0.05), but not in group Ⅰ and groupⅢ (Plt;0.05). Conclusion: ①TPN with fat emulsion for surgical patients with liver disease can make more improvement on hepatic functions than TPN without fat emulsion. ②1g/kg body weight/day of fat dosage may be suitable for the patients during the period of postoperative TPN.
Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
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.
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.
【Abstract】ObjectiveTo explore the mechanisms of anabolism intensified by recombination human growth hormone (GH) on the basis of total parenteral nutrition (TPN) during postoperative in gastrointestinal carcinoma patients. MethodsNinety-four gastrointestinal carcinoma patients undergone operation were randomly divided into TPN group and TPN+GH group. The levels of TNF-α, IL-1, IL-6 and CRP were detected in the first, third, seventh postoperative day. ResultsThe levels of TNF-α, IL-1, IL-6 and CRP were significantly lower in TPN+GH group than those in the TPN group at the first, third, seventh postoperative day （P＜0.01）. The levels of TNF-α, IL-1, IL-6 and CRP were significantly higher at the indicated time of postoperative days than the pre-operative days in the two groups (P＜0.01）. ConclusionBy inhibiting TNF-α, IL-1, IL-6 and CRP production in gastrointestinal carcinoma patients undergone operation and blocking high catabolism induced by inflammatory cytokines, GH promotes the synthesis of anabolism.
ObjectiveTo investigate the effects of total parenteral nutrition in neonatal patients and study the nursing methods for these neonates. MethodsWe retrospectively analyzed the clinical data of 70 neonatal patients who accepted total parenteral nutrition in our hospital from October 2010 to October 2011. Physiological indexes were compared before and after total parenteral nutrition. ResultsSignificant improvements in the nutritional status of all children were observed. All patients achieved good efficacy and effective care. ConclusionTotal parenteral nutrition support for critically ill newborns is of great significance, and good caring also plays an important role.