Objective To research the effects of recombinant growth hormone (rhGH) with total parenteral nutrition (TPN) on nitrogen balance and nutritional state of the patients following major abdominal surgery. Methods We randomly selected 45 patients receiving TPN after major abdominal surgery and distributed them to study group (rhGH+TPN, n＝30) and control group (TPN only, n＝15). For 7 days after operation, every one was given rhGH 4u or replaced by hypodermic injection of normal saline (control group). Results TPN+rhGH promoted the rehabilitant of nitrogen balance, heightened the level of plasma albumin and transferrin and increased the weight and creatinin/height index (CHI), but the thickness of triceps skin fold (TSF) had no significant change in patients following major abdominal surgery. Conclusion The rhGH can improve the effects of 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.
In order to investigater the effect of nutritional support on nutrients metabolism after liver resection,we researched into the hepatectomy and total parenteral nutrition model in rats.The features of the model were no fasting before surgery,10% glucose subcutaneous injection prior to operation avoiding of blood loss and shortening of the surgical process.The 7-day mortality was markedly decreased.Anesthetized with phenobarbital(25mg/kg) injection in combination of ether inhalation,the rats recovered quickly from anesthesia and developed almost no infection of the respiratory tract after hepatectomy.The rats were supplied parenterally energy of 573kJ/kg and a marked improvement in survival was achieved after liver resection.By applying dual preventive rotation equipment of protective spring and IN-Stopper,nutrient solution could be safely infused.
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 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.
摘要:目的: 探討早期腸內營養支持在胃腸道惡性腫瘤術后患者中應用的臨床效果。 方法 :54 例胃腸道惡性腫瘤行根治手術的患者,隨機分為對照組和研究組,分別接受腸外營養支持(PN)和腸內營養支持(EN)。比較兩組治療前后的血清白蛋白、前白蛋白和轉鐵蛋白水平,肝腎功能指標,胃腸功能恢復時間以及并發癥的發生率。 結果 :經過術后7 d 的營養支持治療,EN組術后血清前白蛋白、轉鐵蛋白水平升高程度明顯大于PN組,胃腸功能較PN組更快恢復。在術后并發癥的發生率和肝腎功能指標方面兩組沒有顯著性差異。 結論 :早期腸內營養支持能夠安全有效地促進胃腸道腫瘤術后患者的恢復。Abstract: Objective: To investigate the clinical effect of early enteral nutrition (EN) support on postoperative patients with gastrointestinal malignancy. Methods : A total of 54 postoperative patients with gastrointestinal malignancy were randomly divided into EN group and parenteral (PN) group. Both groups received isocaloric and isonitrogen nutrition support. The serum albumin, transferrin, prealbumin and liver and renal function were measured using standard techniques. The gastrointestinal function and postoperative complications were evaluated. Results : After nutrition support, serum albumin was not significantly different between two groups. Compared with PN group, serum transferrin and prealbumin level significantly increased in EN group (P＜005). The gastrointestinal function in EN group resumed earlier than that in PN group. There was also no difference in liver and renal function and postoperative complications between two groups. Conclusion : The application of early enteral nutrition support is beneficial to the recovery of the gastrointestinal cancer patients after surgery.
To study the effects of arginine supplementation in total parenteral nutrition (TPN) on lymphocytic immune function in postoperative patients with gastric cancer. Thirty six patients with gastric cancer receiving TPN were eligible for entry into randomized and prospective clinical trial of the study. T cell subsets, NK cell activity, plasma IL-2 content and peripheral blood CD25 were measured in before and after parenteral nutrition of the patients. Results: usual TPN could not improve lymphocytic immunosuppression of postoperative patients with gastric cancer. The patients receiving arginine supplementation in TPN might enhance lymphocytic immune function by increasing CD4 level, IL-2 production and NK cell activity, but there was no significant effect of arginine on CD25 expression. Conclusion: there are some effects of supplement with arginine on releasing of the cellular immunosuppression and restoring of lymphocytic immune function.
Malnutrition is directly related to the outcomes of critically ill children. Providing ideal nutritional treatment can reduce the high catabolic state caused by the critically ill, reduce oxidative damage and regulate immune response, then improving clinical prognosis. Optimized nutritional supply for critically ill children has been transformed from auxiliary support to one of the important treatment methods. Enteral nutrition is the preferred way to provide nutrition, but parenteral nutrition is the only method of supplement and replacement when the supply of enteral nutrition is insufficient or deficient. This article reviews the timing of parenteral nutrition initiation, protein and amino acids in parenteral nutrition, the mechanism of possible adverse effects in early parenteral nutrition, and issues related to parenteral nutrition in premature infants, in order to help clinicians in pediatric intensive care unit improve the evaluation and management of parenteral nutrition use.
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.
