ObjectiveTo evaluate the value of omega-3 fish oil fat emulsion in parenteral nutrition support after radical resection of gastric cancer patients.MethodsThe clinical data of 80 patients in Tongling Peopl’s Hospital undergoing radical resection of gastric cancer from March 2018 to September 2019 were enrolled by retrospective method. Of them, 40 patients were treated with routine parenteral nutrition (control group) and 40 patients were treated with extra 100 mL omega-3 fish oil fat emulsion after operation (observation group). Nutritional and stress indicators included blood total albumin (TP), albumin (ALB), c-reactive protein (CRP), and procalcitonin (PCT) on one day before operation, and 1st, 3rd, and 7th day after operation were collected. The collected indexes of liver function included blood cholesterol (CHO), triglyceride (TG), total bilirubin (TBIL), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma glutamyl transpeptidase (γ-GT) on one day before operation, and 3rd and 7th days after operation.Results① Nutritional indicator. There was no significant differences in TP and ALB levels between the two groups on one day before operation, and on the 1st, 3rd, and 7th day after operation (P>0.05). In the same group compared with one day before operation, the average TP level of the control group and the observation group decreased on the 1st, 3rd, and 7th day after operation (P<0.05), and in the control group and the observation group, the ALB level decreased on the 1st day after operation (P<0.05), and increased on the 7th day after operation (P<0.05). ② Stress index. There was no significant difference in CRP and PCT levels between the two groups on one day before and one day after operation (P>0.05), and the CRP and PCT levels in the observation group were lower than those in the control group on the 3rd day and 7th day after operation (P<0.05). Compared with the CRP and PCT levels on the one day before operation, the average CRP and PCT levels in the observation group and the control group increased on the 1st, 3rd, and 7th day after operation (P<0.05). ③ Liver function index. There was no significant differences in CHO, TG, and γ-GT levels between the two groups on one day before operation and the 3rd day after operation (P>0.05), but the above indexes of observation group were lower on the 7th day after operation than those of the control group (P<0.05). There was no significant differences on TBIL, ALT, and ALP levels between the postoperative observation group and the control group (P>0.05). Compared with one day before operation in the same group, there was no significant difference on CHO and ALP levels on 3rd and 7th day after operation in both the observation group and control group (P>0.05). There was no significant differences in TG and TBIL levels in the observation group on 3rd and 7th day after operation (P>0.05), but the TG and TBIL levels in the control group were increased on 7th after operation (P<0.05), and the ALT and γ-GT levels in the observation group and the control group on 7th day after operation were increased in the same group compared with one day before operation (P<0.05).ConclusionParenteral nutrition with omega-3 fish oil fat emulsion do not improve the recent postoperative nutritional status, but reduce the inflammatory stress response and protecte liver function in patients with gastric cancer after operation.
Objective To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy. Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed. Results There were no significant differences between two groups (Pgt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004). Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.
Thirty two surgical patients with liver disease (hepatocelluar carcinoma 16, liver cirrhosis 8, obstructive jaundice 8) were studied. All of them were randomly divided into three groups for administration of different kinds of TPN during the postoperative period [group Ⅰ (TPN without fat emulsion), group Ⅱ (TPN with fat emulsion, 1g/kg body weight/day of fat), group Ⅲ (TPN with fat emulsion 2g/kg body weight/day of fat )]. Their liver function test, glucose, lipid metabolism were examined and compared during the period of TPN. Result: ①TB, ALT and AST decreased in group Ⅱ and group Ⅲ (Plt;0.05), but increased in group Ⅰ (Plt;0.05). ②The blood glucose and insulin levels were normal in group Ⅱ and groupⅢ, but showed hyperglycemia and hyperinsulinemia in group Ⅰ (Plt;0.05). ③The serum lipid, lipoprotein, apoliprotein level and LCAT activity returned to normal 6 days after operation in group Ⅱ (Plt;0.05), but not in group Ⅰ and groupⅢ (Plt;0.05). Conclusion: ①TPN with fat emulsion for surgical patients with liver disease can make more improvement on hepatic functions than TPN without fat emulsion. ②1g/kg body weight/day of fat dosage may be suitable for the patients during the period of postoperative TPN.
【Abstract】ObjectiveTo explore the mechanisms of anabolism intensified by recombination human growth hormone (GH) on the basis of total parenteral nutrition (TPN) during postoperative in gastrointestinal carcinoma patients. MethodsNinety-four gastrointestinal carcinoma patients undergone operation were randomly divided into TPN group and TPN+GH group. The levels of TNF-α, IL-1, IL-6 and CRP were detected in the first, third, seventh postoperative day. ResultsThe levels of TNF-α, IL-1, IL-6 and CRP were significantly lower in TPN+GH group than those in the TPN group at the first, third, seventh postoperative day （P＜0.01）. The levels of TNF-α, IL-1, IL-6 and CRP were significantly higher at the indicated time of postoperative days than the pre-operative days in the two groups (P＜0.01）. ConclusionBy inhibiting TNF-α, IL-1, IL-6 and CRP production in gastrointestinal carcinoma patients undergone operation and blocking high catabolism induced by inflammatory cytokines, GH promotes the synthesis of anabolism.
ObjectiveTo explore influence of different nutritional approaches on liver function in patients after esophagectomy. MethodsA total of 160 patients with esophageal cancer who underwent surgical treatment were divided into a enteral nutrition (EN) group and a total parenteral nutrition (TPN) group according to different medical staff. There were 80 patients in each group. Two and 7 days postoperatively, albumin (ALB), prealbumin (PA), alanine aminotransferase (ALT) and total bilirubin (TB) of the 2 groups were examined to evaluate liver function. ResultsAbnormities in liver function (ALB, PA, ALT, TB) was common phenomenon in esophageal cancer patients, but there was no statistical difference in ALB, PA, ALT, TB on the 2nd postoperative day between the EN group and the TPN group (P > 0.05). On the 7th postoperative day, liver functions were improved than those on the 2nd postoperative day in the two groups. And frequencies of liver function abnormity in the EN group were significantly lower than those in the TNP group (P < 0.05). ConclusionCompared with TPN, EN has advantages in facilitating hepatic protein synthesis and recovery of liver function after esophagectomy.
Objective To evaluate the effectiveness and safety of total enteral nutrition (TEN) versus total parenteral nutrition (TPN) in patients with severe acute pancreatitis (SAP). Methods The databases such as Pubmed (1996 to June 2011), EMbase (1984 to June 2011), Cochrane Central Register of Controlled Trials of The Cochrane Library (Issue 6, 2011) and CBM (1978 to June 2011) were electronically searched, and the relevant references of the included papers were also manually searched. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. Meta-analyses were performed using the Cochrane Collaboration’s RevMan 5.1 software. Results Seven randomized controlled trials (RCTs) involving 379 patients with SAP were included. The results of meta-analyses showed that compared with TPN, TEN could significantly reduce the risk of mortality (RR=0.33, 95%CI 0.20 to 0.55, Plt;0.000 1), pancreatitis-related infections (RR=0.35, 95%CI 0.25 to 0.50, Plt;0.000 01), required rate of surgical intervention (RR=0.43, 95%CI 0.23 to 0.82, P=0.01), and incidence of multiple organ failure (MOF) (RR=0.28, 95%CI 0.17 to 0.46, Plt;0.000 01). There was no significant difference in the nutrition strategies associated complications between TPN and TEN (RR=1.16, 95%CI 0.42 to 3.22, P=0.78). Conclusion Meta-analyses show that compared with TPN, TEN can reduce the risk of mortality, pancreatitis-related infections, required rate of surgical intervention, and incidence of MOF; and it will not increase the nutrition strategies associated complications. Consequently, TEN should be considered a better choice for SAP patients as early as possible.
Objective To study glutamine (GLN) and cholecystokinin (CCK) effects on prevention of cholestasis in total parenteral nutrition (TPN). Methods White rabbits were choosed as TPN models, which were divided into four groups, group 1, TPN only (n＝10); Group 2, TPN plus GLN administration (n＝10); Group 3, TPN plus CCK (n＝10); Group 4, TPN plus GLN and CCK administration. Bile components were assayed and the structural change in gallbladder and liver were observed under light and election microspes at the forth and eighth week. Results Increasing of bilirubin and cholesterol was observed in the 1st and 2nd groups at the forth week, but increasing in the 3rd group was observed at the eighth week. The 4th group was normal. Changes of gallbladder and liver structure in 1st and 3rd group occured at the forth week. Changes of 2nd group occured at the eighth week. No structural change was found in the 4th group. Conclusion The test prove that cholestasis would occure during TPN and become serious with time prolonging. Integrity and function of gallbladder-wall tissue cell could be defended and sustained by applying GLN, but there is no direct preventing action. There is apparent cholecy stokinetic and cholagogic fundations by applying CCK. But CCK would lose its function if gallbladderwall was damaged. The test prove that TPN+GLN+CCK is the best way to prevent cholestasis during TPN.
Objective To compare the clinical efficacy between total enteral nutrition and enteral nutrition combined with parenteral nutrition after pancreaticoduodenectomy. Methods A total of 70 patients who underwent pancreaticoduodenectomy in our hospital from July 2012 to July 2015 were collected prospectively, and all patients were divided into 2 groups randomly: enteral nutrition group and combined nutrition group. Patients in enteral nutrition group received total enteral nutrition, and patients in combined nutrition group received enteral nutrition combined with parenteral nutrition. Compared the nutritional indicators, other related indexes, and morbidity between the 2 groups. Results ① The nutritional indexes. Compared with before treatment, the body mass index (BMI), white blood cell count, serum albumin level, serum albumin level, and total lymphocyte count at 1 week and 2 weeks after treatment improved (P<0.05). At the same time point (before treatment, 1 week after treatment, and 2 weeks after treatment), there was no significant in the BMI, white blood cell count, serum albumin level, serum albumin level, and total lymphocyte count between the 2 groups (P>0.05). ② Other related indexes. The anal exhaust time, defecation time, and hospital stay of the patients in the combined nutrition group were shorter than those of enteral nutrition group, and the cost of treatment in combined nutrition group was less than that of the enteral nutrition group (P<0.05). ③ Morbidity. There was no significant difference in the total morbidity between the combined nutrition group〔11.4% (4/35)〕 and enteral nutrition group 〔20.0% (7/35)〕,P>0.05. Conclusion Total enteral nutrition and enteral nutrition combined with parenteral nutrition after pancreaticoduodenectomy both can obtain well curative effect, but enteral nutrition combined with parenteral nutrition can make the patients recover faster with lower cost, which is suitable for promotion.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
Objective To promote the clinical application of parenteral and enteral nutrition preparations in hospitalized patients. Methods Domestic and foreign articles about parenteral and enteral nutrition support were enrolled to make a review. Results Nowadays, parenteral and enteral nutrition played an important role in the medical treatment of perioperative and critically ill patients. Rational nutrition support could improve the condition of patients with nutritional risk and result in better clinical outcomes. Different enteral nutrition formulations should be used according to the diseases. Supplementally parenteral nutrition may also be useful in combination with enteral nutrition to reach the required intake targets. We should pay attention to the application of glucose, lipid emulsion, amino acids, vitamins, and so on, when performed parenteral nutrition support. Conclusion It is necessary to standardize parenteral and enteral nutrition support in the work of clinical practice, including the application of nutrition support and selection of nutrition preparations.