强化谷氨酰胺及合生元的肠内营养对老年住院患者营养状况与胃肠道耐受性的影响

目的研究强化谷氨酰胺和合生元的肠内营养对老年住院患者营养状态与胃肠道耐受性的影响。方法选取2013年1月至2016年12月于广西医科大学第一附属医院住院并接受肠内营养支持治疗的老年住院患者182例,采用随机数字表法分为两组:治疗组(n=90)和对照组(n=92)。对照组接受常规肠内营养治疗;治疗组在常规肠内营养治疗基础上每天加用谷氨酰胺与合生元。治疗10 d后对比治疗前后两组患者血清白蛋白(ALB)、前白蛋白(PA)和血红蛋白(Hb)水平,同时比较两组患者的胃肠道耐受性。采用SPSS 17.0软件进行数据处理,依据数据类型,组间比较分别采用t检验或x~2检验。结果治疗后治疗组患者的ALB[(37.16±4.94)vs(33.10±4.97)g/L]、PA[(218.26±89.57)vs(175.12±88.42)mg/L]和Hb[(104.99±16.47)vs(97.04±16.86)g/L]值均显著高于治疗前,差异有统计学意义(P0.05)。治疗后治疗组的ALB[(37.16±4.94)vs(34.67±4.51)g/L]、PA[(218.26±89.57)vs(211.83±98.39)mg/L]和Hb[(104.99±16.47)vs(102.20±20.35)g/L]值均显著高于对照组,差异有统计学意义(P0.05)。治疗组腹泻(6.67%vs 16.30%)、腹胀(7.78%vs 20.65%)以及恶心和呕吐(3.33%vs 10.87%)的发生率均显著低于对照组(P0.05)。结论强化谷氨酰胺及合生元的肠内营养能够改善老年住院患者的营养状态,提高肠道耐受性。     

Medium-chain triglyceride-rich enteral nutrition is more effective than low-fat enteral nutrition in rat colitis, but is equal in enteritis

Background. Although enteral nutrition (EN) therapy for Crohn's disease has been confirmed to be as effective as steroid therapy, the precise mechanism responsible for the effects of EN remains unclear, although some of the therapeutic effects of EN are believed to be due to a low dietary fat content. In order to elucidate the influence of fat in EN, it is important to investigate not only the quantity of fat, but also the source of the fat. Methods. We compared two enteral nutritional formulae: Elental (Ajinomoto) (elemental diet; ED), which contains only 1.5% fat, provided as long-chain triglycerides (LCT), versus Twinline (Snow Brand Milk Products) (TL), which contains a high percentage of fat (20.4%), provided mainly as medium-chain triglycerides (MCT). These formulae were tested on rat enteritis and rat colitis induced by trinitrobenzene sulfonic acid (TNBS). Results. Both ED and TL reduced the manifestations of enteritis. TL had a stronger anti-inflammatory effect than ED for colitis. TL also had nutritional advantages as compared with ED, as shown by the total serum protein in the TL group being significantly higher than that in the ED group. Conclusion. The results indicate that intraluminal MCT is suitable as a fat energy source during intestinal inflammation in rats. We suggest that Twinline may be more useful to improve nutritional status and to re-duce the mucosal inflammation in rat colitis, but that Twinline is equal in effect to Elental for rat enteritis. Received: November 10, 2000 / Accepted: April 13, 2001     

食管癌术后早期肠内营养支持的疗效分析

目的分析食管癌患者术后早期进行肠内营养对患者免疫功能影响和应用效果。方法选取我院2017年1月至2019年6月收治的102例食管癌患者作为本次研究对象,将患者按随机数字法分为两组,每组患者均为51例。对其中一组食管癌患者使用早期肠内营养支持,设为研究组;另外一组患者进行标准的肠外营养支持,设定为对照组。对两组患者在术前1天(T0)、进行营养支持的第1天(T1)和1周时间(T2)的营养指标、细胞免疫指标以及体液免疫指标等情况做检测,记录检测数据并对比分析。结果两组患者T2时检测出的营养指标、细胞免疫指标以及体液免疫指标等水平都要高于T1。研究组患者T2时各项指标比对照组患者改善得更好,两组间对比有统计学差异(P<0.05)。结论早期肠内营养支持能够使食管癌患者营养指标、细胞免疫指标以及体液免疫等指标得到改善效果,值得临床大力推广。     

结直肠切除术后早期肠内营养的前瞻性研究

目的　探讨结、直肠手术后早期肠内营养的可行性，比较肠内与肠外营养的代谢效应，并观察肠内营养对结肠粘膜组织学的影响.     

肠内和肠外营养支持在老年重症肺炎病人中的应用

目的研究老年重症肺炎病人肠内和肠外营养支持效果。方法对呼吸重症监护病房38例老年重症肺炎病人的营养支持情况进行分析，其中肠内营养支持组20例，完全肠外营养支持组18例，摄入同等热量和同等氮量，营养支持时间〉10d。结果经肠内营养支持后，血红蛋白、白蛋白和血清前白蛋白明显升高（P〈0．05），免疫球蛋白显著升高（P〈0．01）；而完全肠外营养支持后，各指标差异无显著性。结论老年重症肺炎病人救治中，根据病人的不同情况，选择合适的营养支持方式，肠内营养有更好的代谢效应及营养效果，并能改善病人的免疫功能。     

老年重症肺炎病人肠内外营养治疗的效果观察

目的研究老年重症肺炎病人肠内和肠外营养支持的效果。方法将40例老年重症肺炎病人随机分为肠内营养（EN）组和肠外营养（PN）组,每组20例,在摄入同等热量和氮量的条件下比较。对比营养支持前后两组患者的血红蛋白、总蛋白、血清白蛋白、氮平衡、血脂等生化指标,每天观察相关并发症情况。结果EN组血清白蛋白、总蛋白、血红蛋白、氮平衡方面明显优于PN组（P〈0．05）,且并发症少。结论老年重症肺炎病人给予早期肠内营养支持,可改善病人营养状况,促进病人康复。     

肠内营养治疗急性胰腺炎切人时机的临床研究

[目的]探讨急性胰腺炎肠内营养治疗的最佳切人时机。[方法]将诊断为急性胰腺炎的200例患者随机分为3组：ENl组、EN2组和EN3组,分别于入院后2～3d、4～6d和7～9d开始肠内营养,并于人院后第10天测定各组患者的血液淀粉酶、脂肪酶、c-反应蛋白、胰蛋白酶原激活肽、D-fL酸水平及二胺氧化酶活性,并将其与治疗前进行比较。[结果]除EN3组G反应蛋白水平与治疗前无明显差异,其余各组Amy、LPS、CRP及TAP水平均显著降低;ENl组D-fL酸水平及DAO活性均较治疗前显著降低,EN2组D-fL酸水平最著降低。ENl组改善以上指标的程度最著高于EN3组。[结论]入院后2～3d是急性胰腺炎患者肠内营养的最佳切人时机,治疗效果优于后期切入点。     

Effect of enteral nutrition on dextran sulfate sodium-induced colitis in rats

OBJECTIVE: To study the effect of enteral nutrition (EN) on dextran sulfate sodium (DSS)‐induced colitis in rats. METHODS: Eighty‐four Sprague–Dawley rats were divided into 7 groups (12 rats in each group). The blank control group was given ordinary laboratory feed and drinking water. The experimental groups received 5% DSS as drinking water for 7 days. Of the experimental groups, the model control group received ordinary laboratory feed, protein based enteral nutrition (PEN) was fed in the PEN group, while other groups received ordinary laboratory feed plus 5‐aminosalicylic acid (5‐ASA), methyl‐prednisolone, Lactobacillus or glutamine, respectively. On the 8th day, all the rats were sacrificed. Inflammatory scores were assessed from colonic mucosa. Blood culture from inferior vena cava, fecal culture and secretary immunoglobulin‐A (S‐IgA) levels from colonic contents were determined. RESULTS: Colon inflammatory scores of Lactobacillus, PEN, glutamine and drug‐treated groups were lower than that of the model control group (P < 0.01). The ratios of bacteria translocation in the EN (PEN, Lactobacillus and glutamine) groups were lower than that in the model control group (P < 0.0083). Fecal Lactobacilli in the Lactobacillus and glutamine groups were higher than that in the model control group (P < 0.05). S‐IgA levels in colonic contents of the PEN and 5‐ASA group were lower than that in the model control group (P < 0.05). CONCLUSIONS: EN is an effective therapy for treating DDS‐induced colitis. EN could alleviate damage, promote the repair of colonic epithelial cells and inhibit bacterial translocation. Lactobacillus and glutamine could also increase the Lactobacilli in colon.     

胰腺癌术后肠内营养与肠外营养的Meta分析

[目的]系统评价胰腺癌切除术后肠内营养(enteral nutrition,EN)与肠外营养(parenteral nutrition,PN)支持治疗的疗效.[方法]计算机检索国外Pubmed、西文生物医学期刊文献数据库,国内检索CNKI、维普和万方数据库,收集相关随机对照试验(randomized control trials,RCTs),并利用RevMan 5.1软件进行Meta分析.[结果]共纳入6项研究,包括411例研究对象.EN组比PN组术后住院时间短(WMD=1.44; 95％ CI:-2.04、-0.83),术后并发症的发生率低(OR=0.66;95％CI:0.42、1.05).然而,术后营养指标白蛋白PN组高于EN组(WMD=4.41;95％CI:-7.55、-0.73),而2组间血红蛋白比较差异无统计学意义(WMD=0.58;95％CI:-5.62、6.78).[结论]EN支持胰腺癌术后患者能有效缩短患者住院时间,降低并发症的发生.胰腺癌术后EN是一种有效的营养支持方式.     

肠内营养对梗阻性黄疸幼鼠肠屏障功能损害的保护作用

目的探讨肠内营养对梗阻性黄疸(OJ)幼鼠肠屏障损害的保护作用。方法48只Wistar幼鼠随机分为正常对照组,假手术组,OJ组和OJ+能全素组。OJ+能全素组给予肠内营养10d,总热量为610kJ/(kg.d),氮量1.0g/(kg.d)。实验结束时检测其血清内毒素(LPS)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平,取腹腔液做细菌培养。结果OJ组血清LPS、TNF-α、IL-6水平显著高于正常对照组和假手术组,LPS、TNF-α水平显著高于OJ+能全素组,OJ+能全素组上述指标与正常对照组和假手术组间差异无显著性。对照组细菌培养阳性1例(1/12)、假手术组2例(2/10)、OJ组7例(7/8)、OJ+能全素组4例(4/8),OJ组与对照组、假手术组相比,P<0.05,差异有显著性。结论肠内营养有助于减轻OJ幼鼠肠屏障功能的损害。     

腹部手术后早期肠内营养对患者肝功能及肠黏膜屏障功能的影响

[目的]探讨早期肠内营养应用在腹部手术患者中对肝脏功能与肠黏膜屏障功能的影响.[方法]选择2011年5月～2014年5月我院行腹部手术的患者90例,采取随机数字表法分为观察组和对照组,对照组给予肠外营养支持,观察组给予肠内营养支持,观察2组肝功能与肠黏膜屏障功能的变化.[结果]观察组干预后丙氨酸氨基转移酶（20.93±10.73）U/L,门冬氨酸氨基转移酶（24.46±11.54） U/L,总胆红素（36.85±17.03）μmol/L;对照组干预后丙氨酸氨基转移酶（21.61±11.65） U/L,门冬氨酸氨基转移酶（24.78±11.94） U/L,总胆红素（36.98±17.21）上mol/L,组间比较差异无统计学意义（t=0.2880、0.1293、0.0360;P＞0.05）.观察组干预后内毒素（0.22±0.05） EU/ml,D-乳酸（8.23±2.01）mg/L,尿L/M比值（0.06±0.01）;对照组干预后内毒素（0.35±0.14） EU/ml,D-乳酸（12.31±3.14）mg/L,尿L/M比值（0.13±0.05）,干预后组间比较差异有统计学意义（t=5.8662、7.3411、9.2091;P＜0.05）.观察组术后排气时间（20.38±4.15）h,住院时间（13.26±1.89）d,并发症发生率为4.44％;对照组术后排气时间（29.67±6.92）h,住院时间（19.75±2.86）d,并发症发生率为17.78％,干预后组间比较差异有统计学意义（t或x2=7.7233、12.6999、4.0500;P＜0.05）.[结论]对腹部手术患者早期应用肠内营养可以防止患者肠通透性降低,保护患者肠黏膜,减少手术并发症发生,值得在临床上大力推广使用.     

Pilot study investigating the effect of enteral and parenteral nutrition on the gastrointestinal microbiome post-allogeneic transplantation

Nutrition support is frequently required post-allogeneic haematopoietic progenitor cell transplantation (HPCT); however, the impact of mode of feeding on the gastrointestinal microbiome has not been explored. This study aimed to determine if there is a difference in the microbiome between patients receiving enteral nutrition (EN) and parenteral nutrition (PN) post-allogeneic HPCT. Twenty-three patients received either early EN or PN when required. Stool samples were collected at 30 days post-transplant and analysed with shotgun metagenomic sequencing. There was no difference in microbial diversity between patients who received predominantly EN (n = 13) vs. PN (n = 10) however patients who received predominantly EN had greater abundance of Faecalibacterium (P < 0·001) and ruminococcus E bromii (P = 0·026). Patients who had minimal oral intake for a longer duration during provision of nutrition support had a different overall microbial profile (P = 0·044), lower microbial diversity (P = 0·004) and lower abundance of faecalibacterium prausnitzii_C (P = 0·030) and Blautia (P = 0·007) compared to patients with greater oral intake. Lower microbial diversity was found in patients who received additional beta lactam antibiotics (P = 0·042) or had a longer length of hospital stay (P = 0·019). Post-HPCT oral intake should be encouraged to maintain microbiota diversity and, if nutrition support is required, EN may promote a more optimal microbiota profile.     

The effect of minimum luminal nutrition on mucosal cellularity and immunity of the gut

Many catabolic patients can only consume small volumes of enteral nutrients. The aim of this study was to evaluate markers of cellularity and immunity in the small intestine of rats randomized to receive 6 days of parenteral nutrition, 25% enteral and 75% parenteral nutrition (i.e. minimum luminal nutrition) or enteral nutrition. The same glutamine-enriched solution was used for both parenteral and enteral nutrition. Enteral nutrition was associated with the least amount of jejunal atrophy ( P < 0.01), with the results from the minimum luminal nutrition group approximating those of the parenteral nutrition group. Parenteral nutrition was associated with the greatest number of CD2+ cells ( P < 0.05) and the lowest CD4/CD8 cell ratio ( P < 0.01) in the jejunal mucosa. In essence, we failed to demonstrate that there are any appreciable benefits associated with the enteral consumption of 25% of a nutrient load.     

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.     

Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta‐analysis

Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta‐analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta‐analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed‐ and random‐effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22–0.62, P = 0.00, test for heterogeneity: I² = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22–0.96, P = 0.04, test for heterogeneity: I² = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47–3.21, P = 0.01, test for heterogeneity: I² = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63–22.29, P = 0.01, test for heterogeneity: I² = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79–2.13, P = 0.30, test for heterogeneity: I² = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support.     

肠内营养对肠道恶性肿瘤老年患者术后免疫功能及肠功能恢复的影响

[目的]探讨肠内营养应用在肠道恶性肿瘤老年患者中的治疗效果和临床价值。[方法]选择在我院行手术治疗的肠道恶性肿瘤老年患者108例,随机分为观察组和对照组,对照组术后给予肠外营养,观察组采用肠内营养支持,观察2组术后免疫功能以及胃肠功能恢复情况。[结果]与对照组比较,观察组术后第7天CD4＋（34.08±8.17）%、CD8＋（25.98±7.21）%、CD4＋/CD8＋（1.49±0.41）回升较对照组明显,组间比较差异有统计学意义（t=2.0206、2.2346、2.9389,均P〈0.05）。观察组术后IgA（3.61±0.97）IU/ml与对照组术后IgA（2.01±0.71）IU/ml比较,差异有统计学意义（t=9.7810,P〈0.05）。观察组肛门或造口排气时间（1.47±0.42）d,拆线时间（8.16±1.32）d、住院时间（18.64±2.88）d、发生感染3例,上述指标同对照组比较差异有统计学意义（t或χ2=7.9550、5.1669、8.9172、5.2523,均P〈0.05）。[结论]肠内营养应用在肠道恶性肿瘤老年患者中可以改善患者术后免疫功能状态,缩短患者肛门或造口排气时间、拆线时间和住院时间,降低感染发生率,值得在临床上推广使用。     

早期胃肠内营养支持对重型颅脑损伤患者预后的影响

目的探讨对重型颅脑损伤患者行早期胃肠内营养支持的临床价值。方法将同期收治的104例重型颅脑损伤患者随机分为观察组与对照组各52例,两组入院后均根据病情行常规治疗,在此基础上观察组于伤后24h内经十二指肠置管行早期胃肠内营养支持,24 h内予米汤或鸡蛋糊,48 h后予能全力;对照组入院至伤后1周行完全胃肠外营养,伤后约1周肠鸣音出现时鼻饲能全力。治疗后28 d观察两组急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及并发症发生情况,抽取空腹静脉血检测血生化指标包括血清总蛋白、白蛋白、Hb及总淋巴细胞计数、空腹血糖、氮平衡。结果观察组APACHEⅡ评分及并发症发生率均显著低于对照组,TP、Alb、Hb、氮平衡等血生化指标均优于对照组（P均〈0.05）。结论对重型颅脑损伤患者行早期胃肠内营养支持可通过改善全身营养及免疫状况等改善预后、降低并发症发生率,且具有操作简单、安全、方便、费用相对低廉等优点。     

不同肠内营养对呼吸机相关性肺炎的作用分析

目的探讨鼻胃管和鼻肠管两种肠内营养对呼吸机相关性肺炎的作用分析,从而选择副作用较少的一种进行推广,以提高患者的预后及生活质量。方法选取ICU病房患者38例,并随机分为鼻胃管组与鼻肠管组,均为19例患者。两组均进行肠内营养插管,并给予相同的营养剂,观察患者在治疗前后的肠内营养变化、呼吸机相关性肺炎的发生率,两种肠内营养方式的不良反应比较,以及入住ICU病房时间和机械通气时间。结果进行两种肠内营养方式治疗后,患者肠内营养指数均有明显改善;呼吸机相关性肺炎发生率,鼻胃管组为63.16%,鼻肠管组为21.05%,差异有统计学意义(P<0.05);鼻胃管组不良反应产生较多,鼻肠管组不良反应产生较少,差异均有统计学意义(P<0.05);鼻胃管组ICU入住时间(12.1±1.8)d,机械通气时间(9.1±1.9)d,鼻肠管组ICU入住时间(7.8±1.2)d,机械通气时间和(5.3±1)d,差异有统计学意义(P<0.05)。结论行鼻肠管进行肠内营养对呼吸机相关性肺炎的发生率较鼻胃管低,相应的不良反应及入住ICU病房和机械通气的时间也较少,所以在机械通气时行鼻肠管进行肠内营养对呼吸机相关性肺炎的防治作用要优于鼻胃管进行肠内营养。