胃肠外科老人术后早期空肠输注肠内营养护理

目的: 对应用综合护理干预模式对接受胃肠外科手术治疗的老年患者在术后早期空肠输注肠内营养支持过程中实施护理的临床效果进行研究.方法:选择接受胃肠外科手术治疗的老年患者86例,随机分为对照组和观察组,每组43例,在术后均实施早期空肠输注肠内营养支持.采用综合护理干预模式对观察组患者在营养支持期间实施护理;采用常规护理模式对对照组患者在营养支持期间实施护理.结果:观察组患者对术后营养支持期间的护理服务满意度明显高于对照组;术后营养支持计划实施时间和住院时间明显短于对照组.结论:应用综合护理干预模式对接受胃肠外科手术治疗的老年患者在术后早期空肠输注肠内营养支持过程中实施护理的临床效果非常明显.     

A Novel Approach to Improving Fat Delivery in Neonatal Enteral Feeding

Continuous infusion systems used for enteral nutrition support in the neonatal intensive care unit deliver as little as 60% of the fat in human milk to the neonate. This study determined the effect of mixing common feedings for preterm infants in the feeding bag and tubing on fat losses during enteral feeding. Laboratory models were developed to assess the contribution of various mixing techniques to delivered fat content. Fat content was measured periodically during feeding and compared to baseline measurements. A multistage approach incorporating a feeding bag inverter and a tubing circulation loop delivered >90% of milk fat when used in conjunction with a commercial continuous infusion system. With unfortified human milk, this approach delivered 91.9% ± 1.5% of fat content over a one hour feed, significantly greater (p < 0.01) than 77.5% ± 2.2% delivered by continuous infusion controls (Mean ± SEM). With fortified human milk, this approach delivered 92.1% ± 2.4% of fat content, significantly greater (p < 0.01) than 79.4% ± 1.0% delivered by a non-adapted infusion system (Mean ± SEM). Mixing human milk during continuous infusion improves fat delivery, which may improve nutrition and growth outcomes in low birth weight neonates.     

A Comparison of Postoperative Early Enteral Nutrition with Delayed Enteral Nutrition in Patients with Esophageal Cancer

We examined esophageal cancer patients who received enteral nutrition (EN) to evaluate the validity of early EN compared to delayed EN, and to determine the appropriate time to start EN. A total of 208 esophagectomy patients who received EN postoperatively were divided into three groups (Group 1, 2 and 3) based on whether they received EN within 48 h, 48 h–72 h or more than 72 h, respectively. The postoperative complications, length of hospital stay (LOH), days for first fecal passage, cost of hospitalization, and the difference in serum albumin values between pre-operation and post-operation were all recorded. The statistical analyses were performed using the t-test, the Mann-Whitney U test and the chi square test. Statistical significance was defined as p < 0.05. Group 1 had the lowest thoracic drainage volume, the earliest first fecal passage, and the lowest LOH and hospitalization expenses of the three groups. The incidence of pneumonia was by far the highest in Group 3 (p = 0.019). Finally, all the postoperative outcomes of nutritional conditions were the worst by a significant margin in Group 3. It is therefore safe and valid to start early enteral nutrition within 48 h for postoperative esophageal cancer patients.     

Nutritional Interventions in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: A Narrative Review

The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC) and oral nutritional supplements (ONS) should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started), prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.     

肠内营养喂养不耐受与慢阻肺急性加重期机械通气患者并发ICU获得性衰弱的相关性研究

目的探讨肠内营养喂养不耐受(FI)与慢性阻塞性肺疾病(简称慢阻肺)急性加重期机械通气患者并发ICU获得性衰弱(ICU-AW)的相关性。方法收集254例慢阻肺急性加重期患者作为观察对象,根据是否发生FI分为FI组132例和非FI组122例,统计肠内营养FI和ICU-AW发生情况。采用生存分析中的Kaplan-Meier(K-M)生存曲线,分析肠内营养FI对慢阻肺急性加重期机械通气患者并发7d ICU-AW的影响。采用Logistic回归分析慢阻肺急性加重期机械通气患者发生FI的影响因素。结果慢阻肺急性加重期机械通气患者肠内营养FI和ICU-AW的发生率分别为52.0%和59.8%。K-M分析显示,FI组患者7d内ICU-AW发生率高于非FI组(P<0.05)。Logistic回归分析显示,年龄≥65岁(OR=5.998,95%CI:3.057~11.766)、APACHEⅡ评分(OR=1.150,95%CI:1.080~1.225)、高血糖(OR=2.090,95%CI:1.091~4.005)、放置鼻胃管(OR=2.098,95%CI:1.097~4.015)、床头未抬高≥30°(OR=4.151,95%CI:1.951~8.832)和营养液输注速度(OR=1.049,95%CI:1.019~1.080)均是慢阻肺急性加重期机械通气患者发生FI的危险因素(P均<0.05)。结论慢阻肺急性加重期机械通气患者肠内营养FI和ICU-AW发生率高,FI会增加其ICU-AW发生风险。年龄≥65岁、APACHEⅡ评分、高血糖、放置鼻胃管、床头未抬高≥30°和营养液输注速度均是慢阻肺急性加重期机械通气患者发生FI的危险因素,应根据危险因素进行针对性干预。     

Modulation of postoperative immune and inflammatory response by immune-enhancing enteral diet in gastrointestinal cancer patients

AIM To evaluate if the administration of anenteral diet supplemented with glutamine,arginine and ω-3-fatty acids modulatesinflammatory and immune responses aftersurgery.METHODS A prospective randomized double-blind,clinical trial was performed.Forty-eightpatients with gastrointestinal cancer wererandomized into two groups,one group wasgiven an isocaloric and isonitrogenous standarddiet and the other was fed with the supplementeddiet with glutamine,arginine and ω-3-fattyacids.Feedings were started within 48 hoursafter operation,and continued until day 8.Allvariables were measured before operation andon postoperative day 1 and 8.Immune responseswere determined by phagocytosis ability,respiratory burst of polymorphonuclear cells,total lymphocytes lymphocyte subsets,nitricoxide,cytokines concentration,andinflammatory responses by plasma levels of C-reactive protein,prostaglandin E_2 level.RESULTS Tolerance of both formula diets wasexcellent.There were significant differences inthe immunological and inflammatory responsesbetween the two groups.In supplementedgroup,phagocytosis and respiratory burst aftersurgery was higher and C-reactive protein levelwas lower(P<0.01)than in the standard group.The supplemented group had higher levels ofnitric oxide,total lymphocytes,T lymphocytes,T-helper cells,and NK cells.Postoperativelevels of IL-6 and TNF-α were lower in thesupplemented group(P<0.05). CONCLUSION It was clearly established in thistrial that early postoperative enteral feeding issafe in patients who have undergone majoroperations for gastrointestinal cancer.Supplementation of enteral nutrition withglutamine,arginine,and ω-3 fatty acidspositively modulated postsurgicalimmunosuppressive and inflammatoryresponses.     

A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test

Treatment of small intestinal bacterial overgrowth is frustrated by the low efficacy of antibiotics. Elemental diets have been shown to reduce enteric flora. In this study, we evaluate the ability of an elemental diet to normalize the lactulose breath test (LBT) in IBS subjects with abnormal breath test findings. Consecutive subjects with IBS and abnormal LBT suggesting the presence of bacterial overgrowth underwent a 2-week exclusive elemental diet. The diet consisted of Vivonex Plus (Novartis Nutrition Corp., Minneapolis, MN) in a quantity based on individual caloric requirement. On day 15 (prior to solid food), subjects returned for a follow-up breath test and those with an abnormal LBT were continued on the diet for an additional 7 days. The ability of an elemental diet to normalize the LBT was determined for days 15 and 21. A chart review was then conducted to evaluate any clinical benefit 1 month later. Of the 93 subjects available for analysis, 74 (80%) had a normal LBT on day 15 of the elemental diet. When those who continued to day 21 were included, five additional patients normalized the breath test (85%). On chart review, subjects who successfully normalized their breath test had a 66.4 +/- 36.1% improvement in bowel symptoms, compared to 11.9 +/- 22.0% in those who failed to normalize (P < 0.001). An elemental diet is highly effective in normalizing an abnormal LBT in IBS subjects, with a concomitant improvement in clinical symptoms.     

全肠内营养对儿童克罗恩病诱导缓解疗效研究北大核心CSCD

目的观察全肠内营养(exclusive enteral nutrition,EEN)对克罗恩病(Crohn’s disease,CD)患儿诱导缓解的疗效。方法回顾性收集2013年3月至2021年8月在浙江大学医学院附属儿童医院接受EEN治疗的62例CD患儿的临床资料,包括一般资料,治疗前及治疗8周后患儿的身高、体重、儿童CD活动指数、CD内镜严重程度指数、C反应蛋白水平、红细胞沉降率、血清白蛋白水平。比较治疗前后上述指标的变化。结果62例患儿中,男39例(63%),女23例(37%),确诊年龄(11.9±3.0)岁。55例完成至少8周EEN治疗的患儿中,87%(48/55)的患儿在治疗第8周获得临床缓解。第8周儿童CD活动指数显著低于治疗前(P<0.001)。除去17例单纯累及小肠患儿及3例未行结肠镜复查的累及结肠患儿,剩余35例累及结肠患儿在8周EEN治疗后进行了结肠镜复查,83%(29/35)的患儿达到黏膜愈合。在第8周达到临床缓解的48例患儿中,年龄别身高Z评分及年龄别体重指数Z评分较治疗前均显著改善(P<0.01)。在第8周未达到临床缓解的7例患儿中,年龄别身高Z评分和年龄别体重指数Z评分与治疗前比较差异均无统计学意义(P>0.05)。结论8周EEN治疗对儿童CD的诱导缓解及黏膜愈合的疗效良好。对于成功诱导缓解的CD患儿,EEN可改善其身高和体重指数。     

Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) tube placement is the preferred method for long-term enteral feeding of patients who are unable to take food by mouth. Despite the widespread acceptance of the procedure, no large-scale study of the long-term outcomes of patients receiving PEG tubes has been reported. The objective of this study was to determine the survival of patients in whom PEG tubes are placed. DESIGN: Retrospective cohort study using data obtained from two computerized databases. SETTING: Department of Veterans Affairs hospitals. PATIENTS: Seven thousand three hundred sixty-nine patients who received a PEG tube in fiscal years 1990 through 1992. RESULTS: For the 7,369 patients, the mean age was 68.1 years and 98.6% were men. PEG tubes were most commonly placed in patients with cerebrovascular disease (18.9%), other organic neurologic disease (28.6%), or head and neck cancer (15.7%). Although the complication rate of the procedure itself was low (4%), because of the severity of their underlying disease, 1,732 patients (23.5%) died during the hospitalization in which the PEG tube was placed. The median survival of the full cohort was 7.5 months. CONCLUSIONS: This study documents the widespread placement of PEG tubes in severely ill patients, half of whom are in the terminal phase of their illness. Further study is needed to determine whether these patients benefit from PEG tube placement in terms of their quality of life and survival. From the Department of Veterans Affairs Health Services Research and Development (HSR&D) Field Program, and the Department of Medicine, Baylor College of Medicine, Houston, Tex. Supported by the Department of Veterans Affairs Health Services Research and Development Houston Field Program. Presented at the 95th annual meeting of the American Gastroenterological Association, New Orleans, La., May 15–18, 1994.     

不同肠内营养对儿童重症病毒性脑炎治疗过程中的辅助作用

目的探讨不同肠内营养（EN）在儿童伴有意识障碍的重症病毒性脑炎（SVE）中的应用效果。方法将42例SVE患儿分为观察组（n=20）和对照组（n=22）,两组入院后均给予常规的综合治疗,对照组EN给予儿童配方奶粉,分4～6次鼻饲注入,观察组EN早期予以短肽型、再过渡到整蛋白型肠内营养液喂养泵输注,两组分别于治疗前及治疗后14d采集静脉血测定视黄醇结合蛋白（RBP）、前白蛋白（PA）、转铁蛋白（TRF）和血清白蛋白（ALB）,测量其体重,并观察胃肠道、相关肺炎并发症及住院天数。结果治疗后两组间RBP、PA、TRF、体重增长值、住院天数以及胃肠道、相关肺炎并发症的比较差异均有统计学意义（P〈0.05）,而两组间ALB比较差异无统计学意义（P〉0.05）。结论 SVE意识障碍期间早期应用短肽型＋整蛋白型肠内营养液喂养泵输注,可减少患儿体重的消耗,减少胃肠道及相关肺炎并发症,改善营养状态,缩短住院时间。