结肠癌术后不同营养支持方式的对比研究

目的探讨结肠癌术后早期肠内营养支持对患者营养状况的改善及并发症发生率的影响。方法2002年1～12月收治的51例行结肠癌根治性手术的患者随机分组,即早期肠内营养支持(EN组)、胃肠外营养(PN组)及常规补液组。营养支持共5～7d,分别测定其术前及术后营养相关指标,并观察其并发症发生率。结果术后10d测定肠内营养支持组白蛋白为(35.2±5.8)g/L,前白蛋白(280.3±52.2)mg/L熏体重(59.9±5.0)kg熏均较常规补液组白蛋白穴31.6±4.2雪g/L,前白蛋白穴231.6±55.8雪mg/L,体重穴56.5±5.3雪kg明显升高穴P<0.05雪,与PN组眼白蛋白穴35.8±5.5雪g/L,前白蛋白穴289.3±49.2雪mg/L,体重穴60.2±4.7雪kg演差异无显著性,排气时间比PN组及对照组均缩短穴P<0.05雪,感染性并发症发生率较对照组及PN组明显降低穴P<0.05雪。结论术后早期肠内营养可改善结肠癌术后营养状况,降低感染性并发症发生率。     

肠内营养对重症急性胰腺炎预后的影响

目的探讨肠内营养对重症急性胰腺炎(SAP)预后的影响。方法选择1990年1月至2005年4月在我院接受分期营养治疗的SAP患者253例,其中154例接受全肠外营养(TPN),组成TPN组;99例同时接受肠外营养(PN)和肠内营养(EN),组成PN+EN组。比较两组患者感染率、并发症发生率、住院时间和死亡率的差异。结果与TPN组相比,PN+EN组患者的胰腺感染率(10.1%vs.14.9%,P>0.05),其他部位感染率(20.2%vs.36.4%,P<0.05),并发症发生率(40.4%vs.53.9%,P<0.05)和死亡率(17.2%vs.19.5%,P>0.05)降低,住院时间缩短[(31.61±22.85)天vs.(38.17±25.50)天,P<0.05]。结论PN和EN联合应用是SAP首选的合理营养方式。     

个性化营养支持对高龄顽固性心力衰竭患者近期结局的影响

目的观察和比较单纯肠内营养（EN）、单纯肠外营养（PN）、肠内肠外联合营养（EN+PN） 3种营养支持方式对高龄顽固性心力衰竭患者近期结局的影响及其安全性。方法 选取2004年1月至2012年9月在北京军区总医院263临床部住院的247例高龄顽固性心力衰竭患者,采用随机数字表法分为EN+PN组（n=87）、EN组（n=76）、PN组（n=84）。随机分组后根据患者耐受情况,EN组2例转入EN+PN组,PN组3例转入EN+PN组。于营养支持前和营养支持7 d后检测血清学指标和心脏超声血液动力学指标,根据全身症状计算营养支持后好转率,记录不良事件发生情况进行安全性评价。结果 研究过程中共8例患者退出,其中EN组4例,PN组1例,EN+PN组3例。与营养支持前比较,各组营养支持7 d后血清前白蛋白［EN组,（0.17±0.01）g/L比（0.11±0.02）g/L;PN组,（0.19±0.01）g/L比（0.09±0.02）g/L;EN+PN组,（0.24±0.04）g/L比（0.10±0.02）g/L］、白蛋白［EN组,（34.14±1.00）g/L比（31.25±1.02）g/L;PN组,（33.89±1.20）g/L比（30.99±1.07）g/L;EN+PN组,（36.66±1.36）g/L比（31.00±1.01）g/L］、转铁蛋白［EN组,（1.99±0.39）g/L比（1.86±0.36）g/L;PN组,（2.01±0.41）g/L比（1.89±0.34）g/L;EN+PN组,（2.58±0.47）g/L比（1.92±0.33）g/L］均显著升高(P均=0.008);EN+PN组的前白蛋白（P=0.007、0.008）、白蛋白（P=0.041、0.040）、转铁蛋白（P=0.007、0.008）均显著高于EN组和PN组。PN组营养支持后血糖显著升高［（8.06±2.35）mmol/L比（5.81±2.21）mmol/L,P=0.009］,其余两组营养支持前后差异无统计学意义。与营养支持前比较,3组营养支持7 d后每搏输出量（SV)［EN组,（60.91±7.26）ml比（45.09±6.42）ml;PN组,（61.01±7.29）ml比（45.19±6.39）ml;EN+PN组,（65.42±7.43）ml比（46.11±6.41）ml;P均=0.008］、左心室射血分数（LVEF）［EN组,（45.78±0.09）%比（34.61±0.09）%;PN组,（45.11±0.11）%比（34.55±0.08）%;EN+PN组,（49.79±0.11）%比（34.42±0.09）%;P均=0.008］、左心室舒张末期内径（LVEdd）［EN组,（60.22±2.42）mm比（63.20±2.19）mm,P=0.008;PN组,（60.28±2.44）mm比（62.98±2.11）mm,P=0.044;EN+PN组,（57.43±2.40）mm比（63.09±2.08）mm,P=0.008］、左心室收缩末期内径（LVEsd）［EN组,（54.08±6.06）mm比（56.15±6.03）mm,P=0.044;PN组,（54.42±6.10）mm比（56.31±6.11）mm,P=0.044;EN+PN组,（51.48±5.27）mm比（56.32±6.13）mm,P=0.008］均明显改善;EN+PN组的SV（P=0.003、0.004）和LVEF（P均=0.004）均显著大于EN组和PN组,LVEdd（P=0.004、0.005）和LVEsd（P=0.004、0.005）均显著小于EN组和PN组。EN组、PN组、EN+PN组的好转率分别为75.71%（53/70）、75.00%（60/80）、83.15%（74/89),异常状况评分与营养支持前比较均显著改善（P均=0.000）;EN+PN组的好转率显著高于EN组和PN组（P均=0.005）,PN组与EN组的好转率差异无统计学意义（P=0.059）。PN组的恶化率为15.00%,明显高于EN组（12.85%,P=0.048）和EN+PN组（6.74%,P=0.045）。营养支持期间EN+PN组不良事件发生率显著低于EN组［22.47%（20/89）比37.14%（26/70）,P=0.005］,与PN组比较差异无统计学意义［35.00%（28/80）,P=0.057］。结论 对于高龄顽固性心力衰竭患者, EN+PN可提高血清前白蛋白、白蛋白、转铁蛋白水平,缓解临床症状,改善血液动力学,且不良事件发生率较低,是优于单纯EN或PN的营养支持方式。     

肠内营养对术后病人营养支持疗效的前瞻、随机、对照临床研究

目的 :观察肠内营养 (EN)、肠外营养 (PN)支持对维持或改善手术创伤后病人营养状态及肠粘膜屏障功能的影响。　方法 :选择腹部手术后需行营养支持的 6 0例成年病人随机进入EN组及PN组。两组营养支持均等热量、等氮量。分别于营养支持前、中、后检测营养状态指标及肠道粘膜通透性。营养支持期间每天测定氮平衡 ,并计算累计氮平衡。　结果 :①EN组体重、白蛋白、转铁蛋白高于PN组 ,但无显著差异。EN组前白蛋白、纤维连接蛋白在术后第 7、12天显著高于PN组 ;②EN组累计氮平衡为正氮平衡 ,而PN组为负氮平衡 ,二者之间差异非常显著 ;③研究期间EN组肠道通透性显著低于PN组。　结论 :与PN支持相比 ,EN可有效地改善术后病人的营养状态 ,促进肠粘膜屏障功能的恢复。     

食管癌术后病人两种营养支持治疗的比较

目的:观察食管癌术后病人两种营养支持疗法的效果。方法:将80例食管癌术后病人随机分为肠外营养(PN)组和肠内营养(EN)组,所有病人在手术前1 d和术后第8天检测血红蛋白(Hb)、血清清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)、体质指数(BMI)以及肛门排气时间、住院时间和营养费用等指标。结果:两组病人术后血清ALB,住院时间、BMI、Hb比较无显著性差异(P>0.05)。EN组病人血清PA,TF明显高于PN组(P<0.05),术后肛门排气时间明显早于PN组(P<0.05),所用营养费用低于PN组。结论:两种营养支持治疗均可改善食管癌病人的营养状况,但EN与PN比,更具有符合生理、安全、价廉的优点。     

喉癌患者早期肠内营养支持的临床观察

目的探讨喉癌患者术后早期肠内营养(EN)对其蛋白质营养状况的影响及临床意义,并与胃肠外营养(PN)支持效果进行比较。方法将喉癌手术患者随机分为EN组和PN组,于术后24小时开始营养治疗,营养支持时间平均15天。两组患者分别于术前及术后15天测量体质量;术前及术后1、7、15天测定血清前白蛋白(PA)、白蛋白(ALB)、血红蛋白(Hb);记录营养治疗费用、并发症、拔除气管导管时间。结果两组患者术后体质量、血清PA、ALB均较术前降低(P<0.05);Hb水平在术前、术后及两组间比较,差异均无显著性(P>0.05);EN组的治疗费用显著低于PN组(P<0.01);EN组与PN组拔除气管导管时间差异无显著性(P>0.05)。结论术后早期EN支持是喉癌等非腹部手术患者安全、有效、经济的营养支持方式。     

术后早期肠内营养对胃肠肿瘤患者体液免疫的影响

目的探讨术后早期肠内营养对胃肠肿瘤患者体液免疫的影响。方法将2003年6～12月本科收治的30例胃肠道肿瘤患者均分为肠内营养(EN)和肠外营养(PN)两组。EN组术后24小时内经鼻空肠管输注肠内营养液,PN组经外周静脉输注营养液,两组热卡、氮量相同。于术前(营养支持前)、术后第7天(营养支持后)检测体液免疫指标IgA、IgG、IgM、C3、C4和CH50。结果EN组体液免疫指标较营养支持前差异无显著性(P>0.05)。PN组IgA、IgG、IgM差异无显著性;但C3、C4、CH50营养支持前分别为(1.091±0.227)、(0.221±0.051)和(40.950±11.400)g/L,营养支持后分别为(0.782±0.233)、(0.162±0.058)和(32.440±9.355)g/L,支持后较支持前明显降低,差异具有显著性(P=0.002,0.009,0.049)。结论胃肠肿瘤术后早期肠内营养对改善机体体液免疫有一定作用。     

营养支持治疗在老年危重患者救治中的应用

目的探讨不同营养支持方式在老年危重患者救治中的作用。方法选择老年危重患者98例,根据不同营养支持方式分为肠外营养(PN)组30例,肠内营养(EN)组32例,PN+EN组36例。摄入同等总热量和同等氮量,营养支持治疗时间14 d。治疗0 d和连续营养支持治疗14 d后,检测血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞总数(TLC)、免疫球蛋白(IgA、IgG、IgM)值并进行回顾性对比分析。结果 3组患者Hb均较治疗前增高。EN+PN组患者Alb、PA较PN组及EN组治疗后增高。营养支持治疗后,3组患者TLC明显增高。EN组IgA、IgM,EN+PN组IgA、IgG、IgM均较PN组增高。PN+EN组并发症低于PN组及EN组。结论老年危重患者救治中应根据老年人特点及疾病不同情况合理选择营养支持方式,PN+EN联合应用更有利于改善老年危重患者营养状况及免疫功能,减少并发症发生,促进疾病的康复。     

食管癌术后早期肠内营养的临床应用

目的:探讨食管癌术后早期肠内营养的安全性、可行性和临床疗效。方法:选择86例食管癌手术患者。随机分为肠内营养组(EN组n=55)和肠外营养组(PN组n=31),所有病例在术前及术后第1、8天分别测血清总蛋白、白蛋白、前白蛋白、转铁蛋白、淋巴细胞计数、尿素氮、肌酐、血糖、谷丙转氨酶、血红蛋白和电解质(K+、Na+)。临床观察营养支持后有无消化道症状,胃肠功能恢复情况,有无吻合口瘘及测体质量。结果:所有病例在研究期间无死亡、无明显肝肾功能改变、无吻合口瘘。营养支持后EN组白蛋白、前白蛋白、转铁蛋白等水平明显升高(P<0.01)。营养支持后EN组与PN组对比,白蛋白、前白蛋白、转铁蛋白和淋巴细胞计数明显增高(P<0.01)。临床观察生命体征及肛门恢复排气时间较PN组显著缩短时间(P<0.01)。结论:食管癌术后早期肠内营养安全可行,既能改善营养状态,维护和促进胃肠道功能,又能提高机体免疫功能,减少术后并发症的发生。     

重度烧伤患者早期肠内营养支持的经济学评价

目的研究重度烧伤患者早期肠内营养支持的疗效及费用。方法采用随机临床分组试验,将41例烧伤面积超过30%的患者分为肠内营养组(enteral nutrition,EN,n=21)和肠外营养支持为主的常规治疗组(conventionaltherapy,CONT,n=20)。治疗7天后观察两组内脏蛋白水平和预后炎症营养指数(prognostic inflammatory and nutritionalindex,PINI)等的变化及不良反应。结果治疗7天后EN组的前白蛋白水平显著高于CONT组[(115.8±31.0)mg/Lvs.(69.4±17.3)mg/L,P<0.01];PINI显著低于CONT组(162.9±89.4vs.343±149,P<0.01);EN组治疗7天的费用比CONT组节约382.06元(P=0.00)。结论早期肠内营养支持改善营养状况的疗效优于常规治疗,且费用低,具有良好的成本效果比。     

Effect of Early Full‐Calorie Nutrition Support Following Esophagectomy: A Randomized Controlled Trial

Background: Early use of enteral nutrition (EN) is indicated following surgical resection of esophageal cancer. However, early EN support does not always meet the optimal calorie or protein requirements, and the benefits of supplementary parenteral nutrition (PN) remain unclear. We aimed to evaluate the efficacy and safety of early supplementary PN following esophagectomy. Materials and Methods: We enrolled 80 consecutive patients who underwent esophagectomy. Resting energy expenditure and body composition measurements were performed in all patients preoperatively and postoperatively. EN was administered after surgery, followed by randomization to either EN+PN or EN alone. The amount of PN administered was calculated to meet the full calorie requirement, as measured by indirect calorimetry, and 1.5 g protein/kg fat‐free mass (FFM) per day was added as determined by body composition measurement. The clinical characteristics were compared between the 2 groups. Results: Patients in the EN+PN group but not in the EN group preserved body weight (0.18 ± 3.38 kg vs ?2.15 ± 3.19 kg, P < .05) and FFM (1.46 ± 2.97 kg vs ?2.08 ± 4.16 kg) relative to preoperative measurements. Length of hospital stay, postoperative morbidity rates, and standard blood biochemistry profiles were similar. However, scores for physical functioning (71.5 ± 24.3 vs 60.4 ± 27.4, P < .05) and energy/fatigue (62.9 ± 19.5 vs 54.2 ± 23.5, P < .05) were higher in the EN+PN group 90 days following surgery. Conclusion: Early use of supplemental PN to meet full calorie requirements of patients who underwent esophagectomy led to better quality of life 3 months after surgery. Moreover, increased calorie and protein supplies were associated with preservation of body weight and FFM.     

When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study

Background: Early enteral nutrition (EN) is the preferred strategy for feeding the critically ill; however, it is not always possible to initiate EN within the recommended 24 to 48 hours. When these situations arise, controversy exists whether to start feeding early via the parenteral route or to delay feeding until EN can be provided. Methods: A multicenter, international, observational study examined nutrition practices in intensive care units (ICUs). Eligible patients were critically ill patients with a medical diagnosis who remained in the ICU for >72 hours and received EN >48 hours after admission. Data were collected on site, including patient characteristics, daily nutrition practices, and outcomes at 60 days. Nutrition and clinical outcomes were compared between 3 groups of patients: (1) early parenteral nutrition (PN) (<48 hours after admission) and late EN (>48 hours after admission), (2) late PN and late EN, and (3) late EN and no PN. Results: Of the 703 patients who met our inclusion criteria, 541 (77.0%) medical patients received late EN and no PN. In patients receiving late EN and PN, 83 (11.8%) received early PN and 79 (11.2%) received late PN. Adequacy of calories and protein from total nutrition was highest in the early PN group (74.1% ± 21.2% and 71.5% ± 24.9%, respectively) and lowest in the late EN group (42.9% ± 21.2% and 38.7% ± 21.6%) (P < .001). The proportion of patients dead or remaining in hospital was significantly higher for early PN compared with late EN and PN (unadjusted hazard ratio for early PN = 0.55; 95% confidence interval, 0.37–0.83, P = .015). However, this difference did not remain significant (P = .65) after adjustment for baseline characteristics. Conclusions: The results suggest that initiating PN early, when it is not possible to feed enterally early, may improve provision of calories and protein but is not associated with better clinical outcomes compared with late EN or PN.     

Oleanolic Acid Improves Gut Atrophy Induced by Parenteral Nutrition

Background: Nutrition support with parenteral nutrition (PN) is associated with gut atrophy. Prior studies have shown improvement with enteral chenodeoxycholic acid, a dual agonist for the farnesoid X receptor (FXR) and bile acid receptor TGR5. We hypothesized that gut growth is induced by TGR5 activation, and gut atrophy during PN administration could be prevented with the TGR5‐specific agonist oleanolic acid (OA). Methods: Neonatal pigs were implanted with duodenal and jugular vein catheters. Animals were provided equi‐nutritious PN or enteral swine milk. A PN subgroup received enteral OA at 50 mg/kg/d. Results: PN caused marked gut atrophy compared with enterally fed (EN) control animals. OA treatment led to preservation of gut mass demonstrated grossly and histologically. The mean ± SD gut weight as a percentage of body weight was 4.30 ± 0.26 for EN, 1.92 ± 0.06 for PN (P < .05, EN vs PN), and 3.39 ± 0.79 for PN+OA (P < .05, PN+OA vs PN). Mean ± SD gut density (g/cm) was 0.31 ± 0.03 for EN, 0.18 ± 0.03 for PN (P < .05 EN vs PN), and 0.27 ± 0.01 for PN+OA (P < .05 PN+OA vs PN). Histologically, a markedly decreased villous to crypt ratio was noted with PN, and OA significantly prevented this decrease. The mean ± SD v/c ratio was 3.51 ± 0.59 for EN, 1.69 ± 0.10 for PN (P < .05, EN vs PN), and 2.90 ± 0.23 for PN+OA (P < .05, PN+OA vs PN). Gut TGR5 messenger RNA expression was significantly elevated with OA treatment compared with both PN and EN. Conclusion: The bile acid–activated G protein–coupled receptor TGR5 agonist OA prevented gut atrophy associated with PN.     

The effect of early enteral nutrition on hyperthermic intraoperative intraperitoneal chemotherapy-induced mucosal permeability following gastrectomy

Aim: To investigate (1) the effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) on intestinal permeability of patients with advanced gastric cancer and (2) the protective effect of postoperative enteral nutrition (EN) on patients. Methods: >All patients were divided randomly into 3 groups: the EN group, treated with EN during postoperative period; the EN+HIIC group, treated with HIIC and postoperative EN; and the PN+HIIC group, treated with HIIC and postoperative parenteral nutrition. The lactulose/mannitol (L/M) ratio was used to evaluate the permeability of intestinal mucous. Results: Compared with the ratio of L/M on the day before operation (POD‐1), the ratio of L/M on POD+3 increased significantly in all 3 groups (P < .0001) and then decreased gradually. The L/M ratio of the EN and EN+HIIC groups recovered to the baseline on POD+12. In contrast, the PN+HIIC group still had an elevated L/M ratio until POD+12. The ratios of L/M in the EN+HIIC group on POD+7 and POD+12 were significantly different from those of the PN+HIIC group (0.0855 ± 0.0462 vs 0.1298 ± 0.063, P = .007; 0.0336 ± 0.0235 vs 0.0616 ± 0.0430, P = .038, respectively). Conclusion: Gastric cancer radical resection resulted in a significant increase in intestinal permeability. HIIC aggravated the injury of intestinal mucous permeability, which could be reversed by EN.     

危重症病人肠内与肠外营养支持的对比观察

目的:对比研究危重症病人EN与PN支持的效果.方法:将48例危重症病人随机分为EN组和PN组,对比观察营养支持后两组病人的Hb、PA、血清总蛋白(TP)、ALB等营养指标以及腹泻、腹胀、胃肠道出血、肝功能损害、高血糖等并发症的发生率.结果:经EN支持后,病人的Hb、TP和PA明显升高(P<0.05);而PN组与营养支持前比较,病人各指标无显著性差异.PN组并发症的发生率高于EN组.结论:EN支持可较好地改善病人的营养状况,并发症少,是危重症病人较好的营养支持方式.     

营养支持对重型颅脑损伤病人营养指标和肺部感染的影响

目的:探讨肠内营养(EN)与肠外营养(PN)支持对重型颅脑损伤病人营养指标和肺部感染的影响。方法:将62例重型颅脑损伤病人分为PN组(n=30)和EN组(n=32)。比较两组病人在营养支持后第1和第2周的营养指标及肺部感染的发生率。结果:EN组病人的血清清蛋白和前清蛋白较PN组有明显改善,而PN组病人的谷丙转氨酶较EN组有明显升高。EN组病人肺部感染发生率明显低于PN组。结论:EN支持可改善重型颅脑损伤病人的营养指标,减少肺部感染的发生率,有利于病人康复。     

肠内营养和肠外营养对全身炎性反应综合征患者炎性因子及免疫功能影响的比较

目的 比较肠内营养（EN）和肠外营养（PN）对全身炎性反应综合征（SIRS）患者炎性因子和免疫功能的影响.方法 以2006年4月至2010年4月在山西医科大学第一医院、山西省人民医院和太原市中心医院收治的85例SIRS患者为研究对象,根据营养支持方式分为EN组（n=49）和PN组（n=36）,比较两组患者营养支持前后炎性和免疫指标的变化情况.结果 全热量营养支持后第7、14天,两组患者的体重、上臂周径、三头肌皮褶厚度及血清总蛋白和白蛋白水平均明显高于支持前（P均＜0.05）;全热量营养支持后第14天,EN组患者的血清总蛋白和白蛋白水平明显高于PN组患者（P均＜0.05）.全热量营养支持后第7、14天,EN组患者的血清肿瘤坏死因子α、白细胞介素（IL）-8、IL-l β水平均明显低于支持前和PN组患者（P均＜0.05）;血CD4/CD8及IgG水平均明显高于支持前和PN组患者（P均＜0.05）.结论 PN和EN均可有效改善SIRS患者的营养状态.EN在改善患者营养状况、提高免疫功能和降低炎性介质释放方面的效果优于PN.     

肠内和肠外营养支持方式对胃癌术后营养状况的影响分析

目的：研究胃癌术后肠内肠外营养支持对患者营养况的影响。方法：将需要营养支持的胃癌患者78例,随机分为两组,分别为肠内组（EN）和肠外组（PN）,两组营养支持均等热量、等氮量。记录两组患者手术前和手术后的基本营养状况,及两组患者手术后并发症的情况。结果：（1）EN组体重、上臂围（MAC）、上臂肌围（AMC）、三头肌皮褶厚度（TSF）和、血红蛋白（Hb）均高于PN组,但差异无统计学意义（P〉0.05）;（2）PN组血浆白蛋白（ALB）、总淋巴细胞（LYM）下降较EN组明显（P〈0.05）;（3）术后并发症发生率EN组为10.52%,PN组为23.68%;两组比较差异有统计学意义（P〈0.05）。结论：胃癌术后EN在改善患者营养方面优于PN,并且EN可降低胃癌手术后并发症的发生率,提高手术后的疗效。