老年胃肠道手术后患者早期肠内肠外营养支持与肠外营养支持的疗效比较

目的探讨早期肠内肠外营养支持疗法(EEN+PN)与肠外营养支持(PN)对老年胃肠道手术后患者的疗效。方法将106例行胃肠道手术的老年患者随机分为EEN+PN组(n=53)和PN组(n=53),分别于术前1 d和术后第7天测定其相关营养、生化、免疫及炎症指标,比较两组患者胃肠道恢复、住院时间、营养相关费用及术后并发症情况。结果术后第7天EEN+PN组血清白蛋白(ALB)与前白蛋白(PA)水平均明显高于PN组(均P0.05);术后第7天EEN+PN组C反应蛋白(CRP)明显高于PN组,而淋巴细胞计数(LYM)明显低于PN组(均P0.05);EEN+PN组术后首次排气时间、住院时间及营养支持费用均明显低于PN组(均P0.05),EEN+PN组中有5例发生腹泻、腹胀及恶心等并术后发症,PN组3例。结论早期EEN+PN较PN可更有效改善机体营养状况,保护机体免疫能力及胃肠道功能,有助于患者术后恢复,缩短其住院时间,减少营养支持费用。     

胃癌术后早期不同营养支持方式的应用价值比较

胃癌疾病本身的因素、手术创伤、围术期的饮食控制以及低热卡摄入等不良因素的存在,常导致胃癌患者存在严重的营养不良[1].相关研究显示,早期肠内营养对于术后恢复起着相当重要的作用.本文对我院收治的行胃癌根治术的患者,术后早期分别给予全肠外营养(TPN)或肠内联合肠外营养(CEP),比较其疗效,探索合理有效的营养支持治疗方式.     

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。     

老年胃癌术后早期营养支持78例临床分析

资料显示,恶性肿瘤患者均存在不同程度的营养不良,其营养不良的发生率高达40.0%～80.0%[1].老年胃癌患者因其食欲影响以及肿瘤的高代谢,多于手术之前存在着不同程度的营养不良及免疫系统功能低下,因手术过程造成的创伤和术后应激导致的术后长时间禁食更加重了营养不良,使手术并发症发生率及病死率增加,对患者的预后有明显的影响.     

三种营养支持方法在胃癌术后的应用

将60例胃癌根治术后患者随机分为三组,分别进行肠外营养支持(PN组)、肠内营养支持(EN组)、肠内外联合营养支持(PN-EN组).观察三组患者并发症的发生率、术后肠功能恢复时间及术后各项参数的变化,进行对比分析.发现三组患者术后血清白蛋白、前白蛋白、转铁蛋自在营养支持后均明显升高,EN组、PN-EN组与PN间有显著差异.EN组患者术后肠功能恢复时间明显早于PN组和PN-EN组.认为三种营养支持方法均能明显改善胃癌术后患者营养状况,肠内外序贯营养支持符合患者的病理生理需求,具有安全、有效、合理的特点.     

术后早期肠内营养和肠外营养对肠道手术预后的影响

目的探讨肠道疾病患者手术治疗后行早期肠内营养(EN)和肠外营养(PN)的疗效。方法接受肠道手术治疗的患者根据营养支持方案分为全肠内营养支持(TEN)组和全肠外营养(TPN)组。比较两组患者的一般信息、营养状况、炎症指标、肝功能改变、胃肠道通气及排便情况、住院费用和住院时间等指标。结果术后第7天时,TEN组患者的体质量指数(BMI)、白蛋白(Alb)、总蛋白(TP)、前蛋白(PA)水平均显著高于TPN组(P<0.05);术后第1天两组患者的炎性指标均无统计学差异(P>0.05),TEN组术后第7天时的C反应蛋白(CRP)(P=0.002)和白细胞介素(IL)-6(P=0.007)水平显著低于TPN组;TPN组术后第7天时患者的谷丙转氨酶(ALT)(P<0.01)和谷草转氨酶(AST)(P<0.01)水平均高于TEN组;而TPN组患者的排气、排便时间、住院天数及住院总费用均显著高于TEN组(P<0.01)。结论肠道手术后早期EN能够改善患者营养指标、降低术后炎症水平、保护肝功能,促进胃肠功能恢复,加速患者康复。     

胃肠道恶性肿瘤术后早期肠内营养的临床观察

对２８例胃肠恶性肿瘤患者,术后２４小时开始经鼻肠营养管给予百普素,持续１０天。结果经过１０天的早期肠内营养,患者血浆中ＰＡ、ＴＦ有明显增高（Ｐ〈０．０１）,免疫功能方面ＮＫＣ及ＣＤ４＾＋亦有明显增高（Ｐ〈０．０５及Ｐ〈０．０１）。因此认为,早期肠内营养符合生理要求,是安全可行的;可改善患者的营养状况,提高免疫力,降低术后并发症。     

重症脑卒中患者早期肠内和肠外营养支持的疗效对比

重症脑卒中患者早期给予营养支持已成为临床学者的共识〔1〕。本文对重症脑卒中患者采取不同的营养支持治疗方法,对比分析其临床疗效。1资料与方法1.1一般资料2008年1月至2011年8月我院重症医学科诊治的重症脑卒中患者96例,均经颅脑CT及MRI检查确诊,重症脑卒中的诊断符合全国第四届脑血管病学术会议修订的诊断标准,排除恶性肿瘤、严重肝肾功能障碍,蛛网膜下腔出血     

老年患者术后肠内营养与肠外营养支持的临床效果对比

伴随着社会经济的发展,人们生活水平的逐渐提高,导致一些疾病的发生率有逐年上升的趋势,恶性肿瘤即为该疾病之一.恶性肿瘤中有60.50％以上为消化系统肿瘤[1],其中胃癌在临床治疗的恶性肿瘤中最为常见,而老年患者发病率已达到50.0％以上,有67.0％以上的老年患者经病理学切片确诊为进展期[2].     

肠内外营养支持对肝衰竭病人肝移植术后营养状况、肝功能及炎性反应的影响

目的探究肠内营养(EN)与肠外营养(PN)联合支持对肝衰竭病人肝移植术后营养状况、肝功能及炎性反应的影响。方法选择2012年1月至2015年1月该院收治肝衰竭行肝移植患者70例;采用随机数字法分为研究组(37例)和对照组(33例),研究组患者给予EN联合PN支持,对照组患者仅给予PN;在术后第1天和第10天观察并比较两组患者临床指标、实验室检查指标及全身炎性反应综合征的发生情况。结果治疗10d后,研究组患者体重、上臂围明显高于对照组,术后住院时间明显低于对照组(P0.05);术后第10天相对于术后第1天,两组患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、C反应蛋白(CRP)水平均出现显著降低,血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)水平出现显著上升(P0.05);术后10 d研究组ALT、TBIL、DBIL与CRP水平均显著低于对照组(P0.05),PA水平显著高于对照组(P0.05);两组全身炎性反应综合征的发生率无统计学意义(χ~2=1.004;P=0.316)。结论肝衰竭患者肝移植术后给予EN与PN联合支持,能够明显改善患者营养状态、降低炎性反应、促进肝功能恢复,是一种方便、安全、有效的临床营养支持方法。     

重症急性胰腺炎肠内、外营养研究进展

重症急性胰腺炎有较高的病死率,营养支持是重要的治疗措施。肠内营养和肠外营养各有其优缺点。肠内营养在维护肠道屏障功能、减少细菌移位方面具有独特的作用。     

胃次全切除术后早期肠内营养对胃肠动力的影响

目的 观察胃次全切除术后早期给予肠内营养对胃肠动力的影响。方法 将1999年12月至2001年2月接受手术治疗的进展期胃癌患者共18例随机分成肠内营养组和对照组各9例，分别给予术后早期肠内营养和普通治疗。应用Synectics MicroDigitrapper动态测压仪及配套的Polygram软件记录、分析、比较两组术后胃肠动力波形的变化，记录术后并发症等情况。结果 胃切除术后早期所有患者的移行性复合运动(MMC)均消失，术后第一个MMC出现的时间为34min～4h不等，两组相比差异无显著性。术后早期MMC的表现与正常MMC有明显不同：缺乏MMCⅡ相，仅由Ⅰ相和Ⅲ相构成；72h内MMC的周期变异逐步趋于一致。观察期内偶见逆向传导的MMC。肠内营养组的MMCⅢ相持续时间(TIME)、曲线下面积(AREA)、传导速度(V)、动力指数(MI)四项指标均高于对照组，两组比较差异有显著性。两组的术后并发症比较差异无显著性。结论 胃次全切除术后早期实施肠内营养可加速MMC的传导，改善MMC的收缩活动，促进胃肠动力的恢复。     

重症急性胰腺炎鼻空肠内营养支持的护理

目的：探讨重症急性胰腺炎(severe acute pancreatitis，SAP)鼻空肠内营养支持的方法。方法：65例SAP患者胃肠功能恢复后，使用聚氨酯材料的Folcare螺旋形鼻肠管进行营养支持，置管时间平均8．6d。置管期间每8h冲洗管道，保持营养液在36～41℃，加强口鼻腔护理，经常巡视观察。结果：所有患者无1例因鼻空肠内营养的使用而使血、尿淀粉酶升高，从而降低了SAP患者感染性并发症的发生和死亡率，治疗费用明显减少，缩短了住院天数。结论：鼻空肠内营养是SAP治疗的重要手段，选择合适的鼻空肠管，合适的肠内营养(enteral nutrition，EN)制剂是治疗的前提，做好鼻空肠管的日常护理工作是置管营养治疗成功的有力保证。     

术前合理营养支持对胃癌及结直肠癌患者术后恢复的影响

目的：探讨术前合理的营养支持对胃癌及结直肠癌患者术后恢复的影响．方法：消化道恶性肿瘤手术并存在营养不良的患者69例,分为肠外营养组(PN组,24例)、肠内肠外营养结合组(EN-PN组,23例)和常规治疗组(NN组,22例),PN组和EN-PN组均于术前7d开始营养治疗,3组患者均于术后24 h开始肠内和肠外相结合的营养方式．分别于术前7d和术后7d测定血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TFN)、血清内毒素水平及细胞因子IL-6、TNFα,测定血清IgA,IgG,IgM,NK细胞活性及CD4/CD8值评价免疫功能,比较3组患者并发症的发生率及平均住院时间．结果：EN-PN组在术后7 d血清内毒素水平(4．23±2．01 ng/L)、IL-6(40．22±7．43 ng/L)及TNF-α(33．04±4．56 ng/L)均明显低于PN(分别为8．23±3．65,55．21±9．32,47．22±8．45 ng/L,P＜0．01)和NN组(10．66±5．23,67．01±10．21,56．43±9．67,ng/L P＜0．01)．而EN-PN组在术后7 d PA(0．27±0．06 g/L),TFN(2．81±0．65 g/L),IgG(10．43±0．86 g/L),NK细胞活性(18．04%±4．56%)及CD4/CD8值(4．98±1．21)明显高于PN组(分别为0．19±0．04,2．01±0．32,8．76±0．65 g/L,11．01%±3．01%,2．11±0．65,P＜0．05)和NN组(分别为0．15±0．03,1．32±0．27,9．05±0．79 g/L,6．45%±2．23%,1．22±0．79,P＜0．05)．与PN和NN组相比,患者并发症发生率(11．3% vs 16．4%,21．6%)和住院时间(7．0±1．4d vs 11．0±2．4,13．0±2．8 d)EN-PN组亦明显降低(P＜0．01)．结论：存在营养不良的消化道恶性肿瘤患者术前应用肠内和肠外营养相结合的营养方式是安全有效的,可促进患者恢复．     

肠内免疫微生态营养对重症急性胰腺炎肝损害的影响

目的:探讨不同营养支持对重症急性胰腺炎肝损害的影响.方法:86例重症急性胰腺炎肝损害患者在入院48 h内随机分为3组,即肠外营养(PN)组28例,肠内营养(EN)组29例和免疫微生态肠内营养(EIN)组29例,分别行PN,EN和EIN支持14 d.检测其内毒素、细胞因子及肝功能的改变.结果:入院时EIN组内毒素、TNF-α、IL-6及肝功能与PN组、EN组比较无显著差异.营养支持14 d后,EIN组内毒素、TNF-α和IL-6分别为1.28 ng/L±0.17 ng/L,30.13 ng/L±8.12ng/L.36.43 ng/L±8.24 ng/L,上述指标均较PN组及EN组明显下降(P＜0.01或0.05).EIN组14 d后肝功能各项指标均恢复正常,与PN组、EN组比较有统计学意义(P＜0.01或0.05).结论:肠内免疫微生态营养,可以补充肠道正常菌群,减少细菌易位,减少内毒素血症及炎症因子的发生,从而减轻重症急性胰腺炎肝损害.     

营养治疗与呼吸机相关性肺炎发生情况的关系研究

目的：研究呼吸重症监护病房（RICU）营养治疗与呼吸机相关性肺炎（VAP）发生情况的关系.方法：将61例气管插管使用有创呼吸机患者分为VAP组和非VAP组.记录入院时白蛋白水平、APACHEⅡ评分、住RICU时间及合并症情况,第1～7天摄入热量以及供能方式.分析能量供给与VAP发生率的关系 结果：第1天完成总能量供给≥50％和＜50％的患者,发生VAP的比例分别是52.3％与11.8％,差异具有统计学意义（P ＜0.05）7d内完成总能量供给50％～100％患者发生VAP是32％（8/25）,而总能量供给＞100％的患者中发生VAP是61.5％（16/26）,具有统计学意义（P＜0.05）.Logistic回归显示：第1天完成＞100％能量供给和APACHEⅡ评分增加是VAP的危险因素（均P＜0.05） 7d内完成全肠内营养50％ ～ 100％能量供给是降低VAP发生风险的因素.结论：不同营养方式间,发生VAP的差异不显著.7d内完成总能量供给50％ ～ 100％有利于预防VAP的发生.     

Effects of enteral nutrition support combined with enhanced recovery after surgery on the nutritional status,immune function,and prognosis of patients with esophageal cancer after Ivor-Lewis operation

BackgroundEsophageal cancer (EC) with a high incidence of malnutrition is a highly malignant digestive tract tumor. We investigated the effect of enteral nutrition (EN) support combined with enhanced recovery after surgery (ERAS) on the nutritional status, immune function, and prognosis of patients with EC after Ivor-Lewis operation.MethodsOne hundred patients were randomly divided into the observation group (n=42) and the control group (n=58). The patients in observation group were treated with EN combined with ERAS intervention after Ivor-Lewis operation, and the patients in control group were treated with conventional postoperative EN intervention. The situation of operation, nutritional status, immune function recovery and prognosis between the two groups were compared.ResultsThere was no statistically significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The chest tube removal time and oral feeding time of the observation group after operation were shorter than those of the control group (P<0.05). After intervention, serum albumin (ALB), transferrin (TF), pre-albumin (PA) and hemoglobin (Hb) levels in both groups were significantly decreased. These indexes were significantly higher in the observation group than in the control group (P<0.05). There were no significant changes in the levels of immunoglobulin (Ig) A, IgG, and IgM, or the numbers of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ T cells in the observation group before and after intervention (P>0.05); however those indexes were significantly decreased in the control group after the intervention (P<0.05). Interestingly, the levels of IgA, IgM, IgG, CD3⁺ T cells, CD4⁺ T cells and CD4⁺/CD8⁺ T cells in the observation group were significantly higher than those in the control group after intervention (P<0.05). The incidence of pulmonary infection in the observation group was significantly lower than that in the control group. The postoperative exhaust time, postoperative defecation time and postoperative hospital stay were shorter in the observation group than in the control group (P<0.05). There was no significant difference in hospitalization cost between the two groups (P>0.05).ConclusionsEN combined with ERAS was more beneficial to the improvement of nutritional status and immune function recovery of patients with EC after Ivor-Lewis operation. It also shortened the length of hospital stay.     

复合乳酸菌对不同营养治疗途径的重症急性胰腺炎大鼠肠屏障功能的影响

目的:观察复合乳酸菌对早期肠内营养(EEN)和肠外营养(PN)治疗的重症急性胰腺炎(SAP)大鼠肠屏障功能的影响.方法:♂ SD大鼠胰腺被膜下均匀注射38 g/L牛磺胆酸钠制作SAP模型,96只大鼠随机分为假手术早期肠内营养治疗组(Sham-EEN)、早期肠内营养治疗组(EEN)、早期肠内营养联合复合乳酸菌治疗组(EEN Lac);假手术肠外营养治疗组(Sham-PN)、肠外营养治疗组(PN)、肠外营养联合复合乳酸菌组(PN Lac),每组16只,分别于第4和7天随机取8只大鼠,预处理后取材,检测肝和肠系膜淋巴结(MLN)肠道菌群易位(BT)、血浆内毒素(ET)、肠转运指数,TUNEL法检测肠上皮细胞凋亡、BCA法测定小肠黏膜蛋白含量、ELISA法测定小肠黏液SIgA含量.结果:PN组大鼠的BT率高于EEN组和PN Lac组(14/16 vs 9/16,10/16,均P＜0.05);4 d EEN组高于EEN Lac组(12/16 vs 9/16,P=0.026).PN组血浆ET高于EEN组(276.83±30.81 EU/Lvs 138.52±22.56 EU/L,P＜0.05);不加用Lac组高于加用Lac组(均P＜0.05).PN Lac组肠转运系数高于PN组(0.70±0.08 vs 0.59±0.05,P＜0.01).PN组小肠上皮细胞AI高于EEN组和PN Lac组(22.67%±4.97% vs 15.31%±4.18%,18.40%±2.01%,P＜0.01).加用Lac组空肠黏膜蛋白含量高于不加用Lac组(均P＜0.05);EEN Lac组高于PN Lac组(56.91±3.73 mg/gvs 44.69±2.99 mg/g,P＜0.01).EEN Lac组小肠黏液SIgA含量高于EEN组和PN Lac组(82.17±6.02 μg/g vs 69.26±5.66 μg/g,59.87±5.54μg/g,P＜0.05及P＜0.01).结论:加用复合乳酸菌可改善EEN和PN治疗的SAP大鼠肠屏障功能,其中EEN Lac的作用最为显著,EEN在维护SAP大鼠肠屏障方面的作用优于PN.     

Multivariate analysis of the risk for pulmonary complication after gastrointestinal surgery

AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery. METHODS: A total of 1 002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied. RESULTS: The overall incidence of PPC was 22.8% (228/ 1 002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR = 1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) =q/[1+e-(-3.488+0.039×+1.090×Rd+0.001×Rbc-0.0047×Alb+0.002×Lii+ 0.049×Lni+0.630×Lmv+0.070×Dat+1.168×a)].     

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

BACKGROUNDIntestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIMTo investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODSPatients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded.RESULTSA total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) (P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A (P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B (P < 0.05) on the 7^th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSIONEarly moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.