胃肠道术后早期行营养支持的方案对比

目的比较胃肠道疾病患者手术治疗后早期行全肠内营养和肠外营养的疗效差异。方法回顾性分析2011年2月-2013年3月在陕西宝鸡市中医院普通外科接受手术治疗的胃肠道疾病患者的临床资料。入组患者根据营养支持方案分为全肠内营养支持组(TEN组)和全肠外营养组(TPN组)。比较两组患者的一般资料、营养状况、炎症指标、胃肠道功能恢复、肝功能改变、住院时间及费用等指标。结果本研究共纳入研究对象120例,其中TEN组63例,TPN组57例。术后第1天两组患者的炎性指标差异均无统计学意义(P0.05)。术后第7天时,TEN组患者的BMI、Alb、TP、PA水平均显著高于TPN组(P0.05);术后第7天时TEN组的CRP(t=2.805,P=0.006)和IL-6(t=2.464,P=0.015)水平显著低于TPN组;术后第7天时TPN组患者的ALT(t=2.073,P=0.04)和AST(t=5.187,P0.01)水平均高于TEN组;TPN组患者的排气时间、排便时间、住院时间和住院费用均明显高于TEN组(P均0.01)。结论早期肠内营养在改善患者机体营养状况、术后炎性指标下降速度、肝功能保护、胃肠道功能恢复、住院时间和住院费用方面均显著优于肠外营养。     

老年胃癌患者术后早期肠内与肠外营养的比较

目的探讨老年胃癌患者术后早期肠内营养支持(EN)的可行性、安全性与临床效果及其与肠外营养支持(TPN)的比较。方法回顾性分析2008年7月至2011年7月在该院行胃癌根治术的老年患者60例,EN组和TPN组各30例。比较两组术后恢复情况、营养指标及并发症。结果 EN组患者术后恢复肛门排气时间提前,住院时间少于TPN组,有显著性差异(P<0.05)。两组患者术后第7天总蛋白、白蛋白和血红蛋白均较术后第1天显著升高(P<0.05),但两组比较无显著性差异(P>0.05);EN组并发症发生率(6.7%)明显低于TPN组(16.7%),有显著性差异(P<0.05)。结论肠内营养符合生理状态,可促进机体恢复,减少并发症,且价格低廉,可作为老年胃癌患者术后首选的营养支持方式。     

不同营养方式在腹腔镜远端胃癌根治术后的临床疗效

背景胃癌(gastric cancer, GC)在亚洲国家的发病率居高不下,手术是GC治疗最有效的方式, GC患者术后的营养支持方式主要有全肠外营养(total parenteral nutrition,TPN)、全肠内营养(total enteral nutrition, TEN)、肠内+肠外营养(enteral parenteral nutrition, EPN)但是对于GC患者术后具体采用何种营养方式仍是一个争议性的话题.目的分析不同营养方式在腹腔镜远端GC根治术后的临床疗效,为临床实践提供参考.方法将金华医院2017-01/2019-12接受腹腔镜远端GC根治术的患者随机分为3组,每组50例,分别给予TPN、TEN、EPN.比较三组临床疗效、并发症发生情况及术后住院时间、肛门排气时间及完全经口进食时间.结果术后第8天, TEN和EPN组血浆白蛋白和前白蛋白水平较TPN组升高(P0.05),而EPN组血浆白蛋白和前白蛋白水平较TEN组升高(P0.05).术后第8天, TEN和EPN组CRP水平较TPN组降低(P0.05), EPN组CRP水平较TEN组降低(P0.05). TEN和EPN组术后第8天淋巴细胞计数较术后第1天升高(P0.05), EPN组术后第8天淋巴细胞计数较TPN、TEN组升高(P0.05).TEN及EPN组的术后并发症发生率较TPN组降低(P 0.05). EPN组手术后患者住院时间(8.5 d±0.7 d)、肛门排气时间(3.1 d±0.3 d)及完全经口进食时间(6.1d±0.6 d)较TPN及TEN组均缩短(P 0.05).结论 EPN的营养方式在腹腔镜远端GC根治术后更能改善患者营养状态,减少并发症的发生,缩短住院时间,值得推广.     

肠内外营养在胃肠术后患者中的应用比较

目的:探讨胃肠手术后肠内营养(EN)与肠外营养(PN)对患者营养状况的改善及并发症发生率的影响。方法:将48例接受择期胃肠手术的患者随机分为PN组和EN组,两组患者于手术后第1天开始分别给予肠外或肠内营养支持。于术前1d、术后第8天检测体重、血生化、营养状态指标及肠道黏膜通透性,并观察并发症的发生率和平均住院费用。结果:EN组体重、白蛋白、转铁蛋白下降幅度少于PN组,但差异无统计学意义;EN组前白蛋白、纤维连接蛋白下降幅度明显少于PN组(P<0.05)。EN组C-反应蛋白升高幅度少于PN组(P<0.05)。EN组患者肠道通透性、平均住院费用及术后并发症发生率显著低于PN组(P均<0.01)。结论:胃肠术后早期肠内营养能改善患者的营养状况,降低并发症发生率,减少住院费用。     

早期免疫强化肠内-肠外联合营养对老年进展期胃癌患者术后恢复的影响

目的观察老年进展期胃癌患者腹腔镜根治术后早期应用免疫强化肠内-肠外联合营养支持的临床疗效。方法选取拟行腹腔镜根治术治疗的老年进展期胃癌患者100例,随机将其分为肠外营养组(TPN组)、常规肠内营养组(TEN组)、免疫强化肠内营养组(GEN组)、肠内-肠外联合营养组(EPN组)和免疫强化肠内-肠外联合营养组(GEPN组),各20例。GEN组和GEPN组分别在TEN组和EPN组肠内营养液的基础上加入谷氨酰胺12.5 g/L和精氨酸9.0 g/L。比较5组患者术前3 d、术后2 d及术后7 d患者的前蛋白(PA)、血清白蛋白(ALB)、转铁蛋白(TEN)、T淋巴细胞亚群CD3~+、CD4~+、CD8~+、CD4~+/CD8~+,观察各组术后肛门排气时间、术后在院康复时间及营养费用等。结果术后7 d,①5组患者TEN、ALB、PA值较术后2 d时均有明显上升(P<0.05),且EPN组、GEPN组TEN、ALB、PA水平明显高于TPN组(P<0.05);尤其以GEPN组TEN、ALB值升高最明显(P<0.05)。②5组患者CD3~+、CD4~+、CD4~+/CD8~+比例较术后2d时均有明显上升,而CD8~+比例有所降低(P<0.05);并且GEN组、GEPN组CD3~+、CD4~+、CD4~+/CD8~+比例明显高于TPN组和TEN组,CD8~+比例明显低于TPN组和TEN组(P<0.05)。③EPN组和GEPN组肛门排气时间、术后在院康复时间均明显短于TPN组、TEN组和GEN组患者(P<0.05);两组之间比较差异无统计学意义(P>0.05);但是GEPN组营养费用最高,与TPN组、TEN组和GEN组比较,差异有统计学意义(P<0.05)。④三组患者均未发生死亡、吻合口瘘等严重并发症。结论早期应用肠内-肠外联合营养可改善老年进展期胃癌患者腹腔镜根治术后营养状态低下情况,维持肠道黏膜功能;尤其是免疫强化肠内-肠外联合营养可显著提高机体的免疫功能。     

重症急性胰腺炎患者早期肠内营养的应用研究

背景:传统全胃肠外营养(TPN)对重症急性胰腺炎(SAP)的疗效不理想,早期肠内营养(EN)在SAP治疗中的作用越来越受到重视。目的:探讨早期EN在SAP治疗中的作用。方法:35例SAP患者随机分为TPN组(18例)和肠外营养(PN) EN组(17例),比较两组治疗前后生化指标、APACHEⅡ评分和临床指标的差异。结果:治疗2周后,PN EN组C反应蛋白和APACHEⅡ评分较治疗前和TPN组治疗后显著下降(P<0.05),血清白蛋白水平较治疗前和TPN组治疗后显著升高(P<0.05)。PN EN组的感染率、并发症发生率、手术干预率、平均住院天数和平均住院费用均显著低于TPN组(P<0.05),两组死亡率无显著差异。结论:早期EN在SAP的治疗中起重要作用,只要条件允许,应尽早开始EN。     

老年重症急性胰腺炎早期肠内营养支持的临床意义

目的探讨早期肠内营养对老年重症急性胰腺炎(SAP)患者营养状态及其疾病转归的影响。方法回顾性分析该院45例老年SAP患者的相关临床资料,分为全胃肠外营养(TPN)组(n=20),肠内营养(EN)组加PN组(n=25,),检测两组入院第1、7、14、21天外周血淋巴细胞计数和血清总蛋白、白蛋白水平;对比分析两组并发症的发生率、胰周感染率、死亡率、住院时间和住院费用差异。结果两组淋巴细胞总数、血清白蛋白和总蛋白水平无显著差异(P>0.05)。与TPN组相比,EN+PN组胰周感染率(12%vs 20%)、并发症的发生率(20%vs 30%)和死亡率(20%vs 8%)均有降低趋势,但无统计学差异(P>0.05)。EN+PN组住院时间(25.6±11.4)d与TPN组(27±8.7)d比较无显著差异(P>0.05);EN+PN组住院费用〔(4.5±2.7)万元〕显著低于TPN组〔(8.6±6.0)万元〕(P<0.05)。结论 SAP早期肠内营养联合肠外营养与完全肠外营养均可支持和改善病人营养状态;但与TPN相比,EN+PN能显著降低住院费用。EN+PN是治疗SAP有效、经济的营养支持方式之一。     

不同营养方式对老年消化道恶性肿瘤病人术后免疫功能的影响

目的探讨不同营养方式对老年消化道恶性肿瘤病人术后免疫功能的影响。方法选择行消化道恶性肿瘤根治术老年病人,随机分为肠内营养组(EN)和肠外营养组(PN)。检测术前、术后不同时间段外周血补体及免疫球蛋白水平和各种淋巴细胞百分比的变化,并观察感染性并发症发生率及胃肠功能恢复时间。结果术后第1天两组补体、免疫球蛋白及淋巴细胞百分比均较术前均显著下降(P<0.05),而术后第8天两组免疫指标较术后第1天有所恢复,且改变量EN与PN组比较差异显著(P<0.05)。PN组术后感染性并发症的发生率高于EN组(P<0.05)。肠道功能恢复时间EN组早于PN组(P<0.05)。结论老年消化道恶性肿瘤病人根治术后肠内营养支持较肠外营养支持能更好的促进患者免疫功能的恢复,降低感染性并发症的发生率,并有利于胃肠功能的恢复。     

COPD急性呼衰期肠内外营养支持的研究

目的:探讨慢性阻塞性肺疾病合并急性呼吸衰竭患者行机械通气支持治疗时给予早期肠内营养的优点。方法:32例机械通气患者随机分成早期肠内营养(EN)组和早期完全胃肠外营养(TPN)组，在摄入同等热量、同等氮量的条件下对营养及免疫指标、严重感染发生率、感染持续时间、机械通气时间、住院时间、临床营养及相关费用等指标进行比较，研究期为10天。结果：EN组及TPN组给予营养支持治疗后的营养及免疫指标均高于营养支持治疗前；营养支持治疗后EN组营养及免疫指标均高于TPN组；严重感染发生率、感染持续时间、机械通气时间、住院时间、临床营养及相关费用均低于TPN组。结论：慢性呼吸衰竭急性加重期患者行机械通气支持治疗时早期给予高脂低糖肠内营养疗法(EN)较早期完全胃肠外营养(TPN)能更好地提供营养，提高免疫力，减少并发症，缩短机械通气的时间，降低临床营养及相关费用，值得推广。     

肠内外联合营养支持对急性重症脑卒中患者临床疗效的影响

目的:探讨肠内营养(EN)+肠外营养(PN)对急性重症脑卒中患者的营养状态和临床疗效的影响。方法:将60例急性重症脑卒中患者随机分为EN+PN组(32例)和EN组(28例)营养支持,住院第1天、14天分别检测2组患者血红蛋白、血清白蛋白,第1天、21天测美国国立卫生院卒中量表(NIHSS)评分,统计感染、肠道并发症,入院第90天时进行改良Rankin评分。结果:住院第14天2组患者各项营养指标均下降,EN组下降更为明显(P<0.05);EN组第14天低蛋白血症发生率及并发症发生率显著升高(P<0.05);EN+PN组第14天感染发生率显著低于EN组(P均<0.05)。第21天2组NIHSS评分均有明显改善,EN+PN组较对照组改善更为显著(P均<0.05),第90天时改良Rankin评分显著高于EN组(P<0.01)。结论:早期EN+PN营养支持可明显改善重症脑卒中患者的营养状况,降低并发症,改善临床预后。     

The right nutrition for the nutrition related diseases

Reviews in Endocrine and Metabolic Disorders -     

Enteral nutrition

Enteral nutrition is an integrated part of the therapy in several diseases and clinical conditions. It is used to improve the clinical course and prognosis of patients with inadequate oral nutritional intake or with malnutrition. In addition, enteral nutrition may act in modulating the metabolic state of patients. Enteral diets are industrially made and have a defined composition and consistency. Enteral nutrition is provided as an oral supplement, via nasogastric/nasointestinal tubes or via gastro- or enterostomy, and requires a well functioning intestinal tract. Enteral nutrition is frequently used supplementary to oral or parenteral nutrition. In most patients standard diets can be used. Diet modifications include the energy density, the relation of carbohydrates, fat and nitrogen source and the content of specific nutrients, i. e. specific amino acids, nucleotides or fatty acids to improve the immune function. These modified diets are used for specific indications which are highlighted in this article.     

Holobiont nutrition

Intake of whole grains and other food products high in dietary fiber have long been linked to the prevention of chronic diseases associated with inflammation. A contribution of the gastrointestinal microbiota to these effects has been suggested, but little is known on how whole grains interact with gut bacteria. We have recently published the first human trial that made use of next-generation sequencing to determine the effect of whole grains (whole grain barley, brown rice or a mixture of the two) on fecal microbiota structure and tested for associations between the gut microbiota and blood markers of inflammation, glucose and lipid metabolism. Our study revealed that whole grains impacted gut microbial ecology by increasing microbial diversity and inducing compositional alterations, some of which are considered to have beneficial effects on the host. Interestingly, whole grains, and in particular the combination of whole grain barley and brown rice, caused a reduction in plasma interleukin-6 (IL-6), which was linked to compositional features of the gut microbiota. Therefore, the study provided evidence that a short-term increased intake of whole grains led to compositional alterations of the gut microbiota that coincided with improvements in systemic inflammation. In this addendum, we summarize the findings of the study and provide a perspective on the importance of regarding humans as holobionts when considering the health effects of dietary strategies.     

Geriatric nutrition

The aging process alters body composition so that nutritional status changes as we get older. The aging process shows interindividual variability in its rate of development. Determinants of the rates of aging of systems and tissues are largely genetic. Premature aging of cells and tissues is due to genetic factors and to long-term exposure to physical or chemical environments that cause irreversible tissue damage. Whereas maximal lifespan is fixed for us all, individuals vary in life expectancy both because of variability in the risk of genetic disease which shortens life and because of variable capability for avoidance of those factors in our environment which cause early aging. Early aging as well as geriatric disease foreshorten life, but both can be prevented to some extent by diet or by diet and exercise. Diseases that can be nutritionally prevented, giving us a greater chance of achieving our genetically determined lifespans, include nutritional deficiency states and chronic diet-related diseases such as non-insulin-dependent diabetes, hypertension, coronary artery disease, and cancer. Disabilities resulting from these diseases and from degenerative arthritis are also subject to modulation by diet. The nutritional requirements of the elderly are mostly similar to those of younger people. Elderly usually need fewer calories and similar nutrient intakes compared with those of younger people. Elderly with higher needs for specific nutrients include homebound or institutionalized people who lack sunlight exposure and therefore require more vitamin D. Nutritional requirements to promote longer life expectancy and freedom from disabilities that result from chronic disease include restriction of food energy and fat. Nutritional assessment of the elderly is aimed at identifying not only the presence of deficiency states but also states of nutrient excess and chronic diet-related diseases. There are certain problems in carrying out nutritional assessment in the elderly, but techniques are now available which make valid assessment possible even in the oldest old. Those who live longest have less genetic risk of premature aging, but as a result of native intelligence, education, coping skills, and higher socioeconomic status, they also have a greater likelihood of eating a diet that best meets their long-term nutritional needs. Those most at risk for developing malnutrition as they get older are those who lack food access because of poverty, because of disability resulting from chronic geriatric disease, or because of a combination of these factors. Malnutrition is found in elderly in our society who live in their own homes if they are indigent, isolated, and homebound because of disability.(ABSTRACT TRUNCATED AT 400 WORDS)