早期肠内营养对老年胃癌患者术后免疫功能的影响

目的研究早期肠内营养对老年胃癌患者术后免疫功能的影响。方法将64例老年胃癌患者随机均分为早期肠内营养组(EEN组)及肠外营养组(PN组)。两组患者于术后第1天开始营养支持。EEN组采用早期肠内营养,PN组采用肠外营养方式。营养支持共7 d。分别于术前1 d,术后1 d及术后第14天检测两组患者细胞免疫、体液免疫、肿瘤标志物水平。结果两组患者术前及术后第1天在细胞免疫、体液免疫及肿瘤标志物检测结果差异无统计学意义(P>0.05)。两组患者术后第1天细胞免疫及体液免疫较术前均有所下降,术后第14天EEN组细胞免疫及体液免疫水平均明显高于PN组(P<0.01),而EEN组肿瘤标志物水平明显低于PN组(P<0.01)。结论 EEN可改善老年胃癌患者术后营养状态,促进机体免疫功能恢复,提高机体抗肿瘤能力。     

早期肠内营养对胃癌胰腺癌术后免疫功能的影响

对96例胃癌、胰腺癌术后患者,分为早期肠内营养（EEN）组52例、肠外营养（PN）组24例和常规补液（对照组）20例。术后24h给予EEN或PN,检测术前和术后第9天免疫指标,观察术后严重并发症及肠功能恢复情况。结果：EEN组和PN组术后CD3＋、CD^＋4、CD^＋4／CD^＋8均显著高于对照组（P〈0．01）,EEN组术后CD^＋4、CD^＋4／CD^＋8亦显著高于PN组（P〈0．05）。认为EEN可明显改善胃癌、胰腺癌患者术后的免疫状况,在术后细胞免疫和肠功能恢复方面明显优于PN。     

早期肠内营养对胃大部切除术后患者营养状态、肝功能及并发症的影响

目的探讨早期肠内营养（EEN）对胃大部切除术后患者营养状态、肝功能及并发症的影响。方法将531例胃大部切除术后患者随机分为EEN组和延迟肠内营养（DEN）组,EEN组在术后24 h给予肠内营养,DEN组在术后1~7 d内给予全胃肠外营养,7 d后给予肠内营养,比较两组患者术后营养状态、肝功能及并发症。结果EEN组的肛门平均排气时间和平均住院天数均少于DEN组。术后第10天,EEN组的ALB水平高于DEN组（P〈0.01）;TBIL、ALT、AST水平低于DEN组（P〈0.01）。EEN组并发症的发生率也低于DEN组。结论EEN可显著改善胃大部切除术后患者的营养状态及肝功能,减少胃大部切除术后并发症的发生。     

早期肠内营养预防脑出血术后应激性溃疡的临床研究

目的探讨早期肠内营养对脑出血术后应激性溃疡的预防作用。方法将108例脑出血术后昏迷患者随机分为早期肠内营养组(EEN组)和延迟肠内营养组(DEN组),各54例。EEN组患者在脑出血术后24 h内给予肠内营养,DEN组患者72 h内给予静脉营养,72 h后无消化道出血方给予肠内营养,观察并比较两组患者应激性溃疡的发生率。结果 EEN组应激性溃疡的发生率低于DEN组(P0.05)。结论对脑出血术后昏迷患者给予早期肠内营养可减少应激性溃疡的发生,改善疾病预后。     

早期肠内营养对老年胃癌患者术后营养状况和免疫功能的影响

目的探讨早期肠内营养(EEN)对老年胃癌患者术后营养状况和免疫功能的影响。方法选取2013年8月至2015年8月我院收治的80例老年胃癌患者(60~80岁)为研究对象,随机分为EEN组和全肠外营养组(TPN组),每组各40例。2组病例分别于术前1 d和术后第1、3、7天早晨检测营养学指标,包括血清白蛋白和前白蛋白水平,并检测CD3~+、CD4~+、CD8~+水平及CD4~+/CD8~+比值等免疫学指标,同时记录2组病例首次排气排便时间,术后住院时间及术后并发症发生情况。结果术后第3天和第7天EEN组患者血清白蛋白和前白蛋白水平,CD3~+、CD4~+水平及CD4~+/CD8~+比值均明显高于TPN组,差异具有统计学意义(P0.05)。EEN组和TPN组患者术后首次排气时间、术后住院时间、并发症发生率比较,差异均有统计学意义(P0.05)。结论 EEN应用于老年胃癌术后患者可以改善患者的营养状态,调节免疫功能,促进胃肠道早期恢复,加速患者的康复。     

老年胃癌病人术后早期肠内营养支持的临床研究

目的　研究老年胃癌病人术后营养支持对机体营养状况、细胞免疫功能及手术并发症的影响。方法　将 57例老年进展期胃癌病人随机分为两组 (肠内营养组和肠外营养组 ) ,进行临床对照研究。结果　肠内营养组术后病人胃肠道功能恢复时间、术后并发症较对照组明显减少。T细胞亚群活性恢复到术前水平 ,与对照组比较有显著性差异 (P <0 0 5)。结论　术后早期肠内营养可改善老年胃癌病人的营养状况 ,减少并发症 ,在增强细胞免疫功能方面优于肠外营养     

谷氨酰胺强化早期肠内营养对胃癌患者术后营养及免疫功能的影响

目的研究胃癌术后早期应用含谷氨酰胺的肠内营养对患者营养、免疫功能的影响。方法进展期胃癌根治性切除患者66例随机分为谷氨酰胺强化肠内营养组（GLN组）、常规肠内营养组（EN组）和肠外营养组（PN组）,各22例。检测术前、术后第1、8天患者的营养指标、细胞免疫指标及体液免疫指标。结果术后第1天三组患者营养指标及细胞免疫指标和体液免疫指标均较术前明显下降,术后第8天三组的各项营养指标及免疫指标均有所恢复。术后第8天GLN组、EN组的体质量、前白蛋白、转铁蛋白较PN组增高（P均〈0.05）。GLN组术后免疫指标较EN组升高（P=0.000）。结论早期应用谷氨酰胺强化的肠内营养能有效促进胃癌患者术后营养及免疫功能的恢复。     

老年食管癌患者术后早期肠内营养对预后影响的临床研究

目的 研究老年食管癌患者术后早期肠内营养(EEN)对预后的影响. 方法 将我院2006年1月至2011年6月收治老年食管癌手术患者120例,按不同的营养方式分为2组,EEN组60例,给予EEN支持;肠外营养(PN)组60例,常规深静脉PN,对2组老年患者术后肠功能恢复时间、住院时间、并发症的发生率以及术后1周营养、免疫等相关指标进行统计学分析. 结果 EEN组在术后患者肛门排气时间[(44.3±12.5)h比(73.6±11.8)h]、肛门排便时间[(81.5±15.1)h比(138.1±13.2)h]和住院时间[(14.0±1.9)d比(16.2±3.0)d]均短于PN组(P＜0.05);EEN组术后1周的血清白蛋白(ALB)、外周血淋巴细胞、转铁蛋白、24h尿素氮(BUN)均高于PN组;EEN组患者的IgG、IgA、IgM及CD3+、CD4+、CD8+、CD4+/CD8+外周血T淋巴细胞亚群等免疫指标较PN组均显著改善,差异均具有统计学意义(P＜0.05);2组间术后并发症发生方面比较,EEN组明显优于PN组(P＜0.05). 结论 老年食管癌患者术后EEN能促进术后代谢和免疫功能恢复、减少并发症,对患者的预后具有重要的临床意义,值得进一步推广和应用.     

肠内营养支持对老年慢阻肺急性加重期合并呼吸衰竭患者心肺功能及免疫功能的影响

目的探讨肠内营养支持对老年慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭患者的心肺功能及营养免疫状况等的影响。方法 127例机械通气AECOPD并呼吸衰竭的老年患者随机分为两组,肠内营养组68例和对照组59例(常规饮食),两组患者均给予抗感染、相关对症治疗,营养支持治疗期为2周。结果肠内营养组治疗后,营养指标较治疗前及对照组明显提高(P0.05)。肠内营养组治疗后心肺功能及免疫功能指标均较治疗前及对照组显著改善,hs-CRP和TNF-α等炎症指标提前降低(P0.05)。结论老年AECOPD合并呼吸衰竭患者,在常规治疗的同时给予早期肠内营养治疗,可以改善患者营养状况、心肺功能、免疫功能。     

免疫增加型肠内营养支持对老年胃癌术后患者的应用价值

目的探讨免疫增加型肠内营养支持在老年胃癌患者术后的价值。方法将46例行手术治疗的老年胃癌患者随机分为两组,对照组术后给予常规肠内营养支持,观察组采用免疫增加型肠内营养支持,比较两组患者的恢复情况。结果观察组营养指标及免疫指标优于对照组,且并发症发生率低于对照组（P〈0．05）。结论免疫增加型肠内营养支持对老年胃癌术后患者效果良好,有利于患者的康复。     

Is postoperative early enteral nutrition with regular or disease-specific enteral formula really beneficial in patients undergoing esophagectomy?

Although recent studies have shown that early enteral nutrition (EEN) has certain advantages over parenteral nutrition for preventing postoperative complications, few previous studies have examined the effects of enteral nutrition in patients undergoing esophagectomy. Here we review the effects of EEN with regular polymeric or other disease-specific enteral formulas in patients undergoing esophagectomy. Previously reported data suggest that nutritional management with early enteral feeding may be beneficial and that an appropriate selection of specific enteral formula enriched with disease-specific nutrients is important to prevent postoperative complications in patients undergoing radical esophagectomy. The use of immune-enhancing enteral formula (IEF) showed a certain benefit to enhance postoperative immunological function after esophagectomy. The use of IEF in the critically ill condition is still controversial, however, and thus the indication for using IEF in patients with septic complications after surgery should be considered carefully. IEF without the enrichment of arginine may be another option for patients with septic complications. EEN with a specific enteral formula may be important for patients with esophageal cancer after neoadjuvant chemotherapy or radiation therapy and salvage surgery to prevent postoperative complications and to improve nutritional status. Appropriate perioperative enteral formula enriched with disease-specific nutrients may be an important target of future clinical research for patients undergoing esophagectomy.     

Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy

AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery.The assessment of clinical outcome was based on postoperative complications.Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge.Readmission within 30 d afterdischarge was also recorded.RESULTS:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN group.Total bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our study.Compared with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN group.The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.     

Perioperative immunonutrition ameliorates the postoperative immune depression in patients with gastrointestinal system cancer (prospective clinical study in 42 patients)

Cancer surgery is a major challenge for patients to develop immune depression in postoperative period. Several cytokines can depress immune cell subpopulations. Increased cytokine response after surgery is assumed to arise mainly from lipooxygenase pathway acting on membrane arachidonic acid. Therefore; investigators focused their efforts to alter the membrane fatty acid profile by changing the nutritional regimen with epsilon-3 fatty acid supplementation and encouraging results were obtained after surgery. Despite the theoretical and clinical advantage of enteral nutrition many surgeons remain committed to parenteral nutrition for feeding of patients due to maintain bowel rest and fear of anastomosis leakage at the postoperative period. Several studies investigating role of the postoperative immunonutrition reported that beneficial immunological changes were associated with reduction of infectious complications. Interestingly; these findings were observed at least five days after the surgery in which the highest incidence of complications was seen. In this prospective study including 42 patients eligible for curative gastric or colon cancer surgery; we investigated the beneficial effect of enteral immunonutrition (EEN) compared to total parenteral hyperalimentation (TPN) beginning from the preoperative period. Cortisol and CRP levels as stress parameters significantly increased one day after surgery in both groups but they rapidly returned to (on POD1) preoperative baseline level in EEN group whereas these values remained high in the TPN group. Additionally a significant decrease in natural killer (NK) cells and CD8+ levels were observed in both groups. However they recovered on POD3 in EEN group and on POD6 in TPN group. CD4+ subset remained almost same as preoperative value in the TPN group whereas it increased from (%) 40.14 to 46.40, 51.29 and 54.7 on PO 6th hr, POD3 and POD6 in the EEN group. Our findings suggest that preoperative nutrition via the enteral route provided better regulation of postoperative immune system restoration than parenteral nutrition. On the basis of our findings we recommend enteral immunonutrition to be started at the preoperative period rather than postoperatively before a major operation whenever the enteral route is feasible.     

机械通气患者早期肠内营养支持的应用研究

目的:探讨早期肠内营养对机械通气患者营养状态和预后的影响.方法:机械通气患者30例,随机分为2组:早期肠内营养(EEN)组15例和早期完全胃肠外营养(TPN)组15例,在摄入相当热量和氮量的情况下,比较2组治疗前后营养状态、1周内撤机成功率、呼吸机相关性肺炎(VAP)发生率、平均营养费用、机械通气时间及平均住院天数.结果:治疗2周后,EEN组血清总蛋白、清蛋白、血红蛋白水平和氮平衡较治疗前明显升高(均P＜0.05),且均高于TPN组治疗后水平(均P＜0.05).上臂肌围、肱三头肌皮褶厚度2组无差异(P＞0.05).EEN组1周内撤机成功率明显高于TPN组(P＜0.05),机械通气时间、平均住院天数则明显低于TPN组(均P＜0.05).2组1周内VAP发生率差异无统计学意义(P＞0.05).结论:EEN能改善机械通气患者的营养状况和预后.只要患者胃肠道功能正常,应尽早实施肠内营养支持.     

An experimental study of emodin assisted early enteral nutrition for the treatment of severe acute pancreatitis

BACKGROUND/AIMS: Both emodin and early enteral nutrition (EEN) have been affirmed as effective means to restore the intestinal mucosal function and abate the severity of severe acute pancreatitis (SAP). However, whether a combined strategy applying both is more effective than either one alone is still undetermined. In this study, we investigated the feasibility and efficacy of emodin assisted early enteral nutrition (EAEEN) for the treatment of SAP. METHODOLOGY: Sixty male Wistar rats were randomly divided into four groups (n=15). SAP was induced in all the rats by a retrograde infusion of 5.0% sodium taurocholate into the pancreatic main duct. Rats in group A received no further intervention, group B with emodin alone, group C with early enteral nutrition (EEN) alone, and group D with emodin assisted early enteral nutrition (EAEEN), respectively, all through an enteral nutrition tube incubated after the induction of SAP. 72 hours after SAP induction, all surviving animals were sacrificed to collect blood and tissue samples for the following measurements: serum amylase, tumor necrosis factor-alpha (TNF-alpha), angiotensin II (AngII) and maleic dialdehyde (MDA), intestinal mucosal secretory IgA (SIgA), pancreatic myeloper oxidase (MPO) activity, and the wet-dry weight ratio of pancreatic tissue (pww/dw). The severity of pancreatic destruction was analyzed by pathological grading and scoring. The severity of intestinal mucosal damage was assessed by the wet-dry weight ratio of ileum (iww/dw), plasma D-lactate and plasma endotoxin. RESULTS: The results of every index in group B, C and D were significantly better than those in group A (P<0.05). Compared with group B and C, group D had significantly reduced levels of serum amylase, TNF-alpha, Ang-II and MDA (P<0.05). Group D also had significantly lowered plasma D-lactate and endotoxin, and decreased pancreatic MPO activity (P<0.05). The pww/dw and iww/dw ratios were decreased, while the SIgA level increased in this group, both with statistical significance (P<0.05). Furthermore, group D had significantly better pancreatic pathologic scores over group B and group C (P<0.05). CONCLUSIONS: Our results suggested that EAEEN could obviously abate the severity of experimental SAP in rats. This combined strategy was rational, safe and more effective than either EEN or emodin used alone, and has a broad potential for future clinical application.     

Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition(TPN) and early enteral nutrition supplemented with parenteral nutrition(EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy(PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group(n = 87) and a TPN group(n = 253). Demographic characteristics, comorbidities, preoperative biochemicalparameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings(P 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying(16.1% vs 6.7%, P = 0.016), pulmonary infection(10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection(18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time(9 d vs 5 d, P = 0.006), postoperative hospital stay(25 d vs 20 d, P = 0.055) and higher hospitalization expenses(USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.     

Benefits of early postoperative jejunal feeding in patients undergoing duodenohemipancreatectomy

AIM:To study whether early postoperative enteralnutrition reduces the incidence of complications and/orimproves nutritional status following duodenohemipancreatectomy (DHP).METHODS:We studied 39 patients who underwentDHP for a peri-ampullary mass.Twenty-three patientsreceived total parental nutrition and then started tohave an oral intake of nutrition between postoperativeday (POD) 7 and 14 [late postoperative enteral nutrition(LPEN) group].Sixteen patients started to have enteralfeeding through a jejunostomy catheter the day after theoperation [early postoperative enteral nutrition (EPEN)group].The incidence of complications and laboratorydata at the early postoperative stage were studied incomparison between LPEN and EPEN groups.RESULTS:Serum levels of albumin and total proteinin the EPEN group were significantly higher than thosein the LPEN group.The loss of body mass index wassignificantly suppressed in the EPEN group as comparedto the LPEN group.The lymphocyte count decreasedimmediately after the operation was restored significantlyfaster in the EPEN group than in the LPEN group.TheEPEN group showed significantly fewer incidences ofpostoperative pancreatic fistulas,as well as a significantlyshorter length of hospitalization than the LPEN group.There were no significant differences in the incidencesof other postoperative complications between the twogroups,such as delayed gastric emptying,surgical siteinfection,cholangitis,and small bowel obstruction.CONCLUSION:EPEN is a safe and beneficia opportunity for patients who have undergone DHP for aperi-ampullary mass.     

空肠营养性造口与鼻肠管早期肠内营养在胃癌术后的应用比较

目的探讨空肠营养性造口与鼻肠管早期肠内营养在胃癌术后的临床应用效果比较。方法选取延安大学附属医院2011年6月-2013年6月收治的76例行肠内营养的胃癌患者,A组42例采用空肠营养性造口,B组34例采用鼻肠管。分析比较两组患者实施肠内营养后通气时间、术前术后营养状况变化、并发症(呼吸道症状、消化道症状及其他各类不适)、住院时间等。结果73例胃癌术后患者实施肠内营养效果较好,3例患者未完成肠内营养,两组患者在术前术后营养状况变化、住院时间、住院费用上比较差异无统计学意义(P0.05),A组患者在通气时间、并发症发生率上优于B组(P0.05)。结论与鼻肠管比较,空肠营养性造口能减少并发症的发生率,使患者胃肠功能恢复更快,但应根据具体情况合理选择肠内营养方式。     

高血压脑出血术后早期鼻饲肠内营养的合理应用

目的观察早期肠内营养支持对高血压脑出血(HICH)术后病人在预后、营养状况、高代谢反应和胃肠道功能等方面的影响,探讨其作用机制和临床应用。方法36例病人随机分为早期肠内营养(EEN)、肠外营养(TPN)两组。EEN组经鼻胃管持续滴注瑞素;TPN组静脉输注肠外营养液。测定观察氮平衡、肌酐升高指数、血浆皮质醇、血糖、血浆胰岛素、胃肠道功能、体重及意识状态变化。结果两组2周内均为负氮平衡,EEN组6d的氮平衡优于TPN组(P<0.05);肌酐也呈下降趋势,但EEN组在术后14d、28d仍明显优于TPN组(P<0.01);两组血糖、血浆胰岛素和皮质醇术后显著上升,第6天达高峰,此时,EEN组三项指标水平显著低于TPN组(P<0.05或P<0.01);EEN组的皮质醇在28d时恢复正常,TPN组仍高于正常;6d时EEN组的反流、误吸无明显增加,研究期胃肠道症状发生率显著减少(P<0.05或P<0.01);28d神经功能缺损(GCS)评分EEN组高于TPN组两组间有统计学意义(P<0.05)。结论通过鼻胃管持续滴注喂养方法提供HICH病人有良好的耐受性。EEN支持对改善HICH术后全身营养状态和神经功能的恢复大有裨益。