Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enter...Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.展开更多
BACKGROUND Congenital short bowel syndrome(CSBS)is a rare disorder characterized by a congenital shortage in the length of the small intestines,resulting in compromised intestinal functionality,frequently accompanied ...BACKGROUND Congenital short bowel syndrome(CSBS)is a rare disorder characterized by a congenital shortage in the length of the small intestines,resulting in compromised intestinal functionality,frequently accompanied by congenital intestinal malrotation.This study summarizes the experience of enteral and parenteral nutrition(PN)schemes for two cases of CSBS accompanied by intestinal malrotation to provide a reference for this condition.CASE SUMMARY Case 1 underwent surgical intervention 23 days after birth,but experienced postoperative intolerance to oral feeding.Consequently,the patient was transitioned to nasal feeding for 6 months while concurrently receiving round-the-clock PN.Despite ongoing adjustments to the caloric intake of enteral and PN throughout the treatment,cholestatic liver injury persisted.Furthermore,this child developed malnutrition by the age of 1 year.Case 2 received surgical intervention on 2 days after birth,demonstrating favorable tolerance for enteral feeding and intermittent PN.The child exhibited satisfactory growth and development without any associated complications.CONCLUSION CSBS is rarely encountered in clinical practice and is often accompanied by congenital intestinal malrotation.It can be improved with early diagnosis and active surgical intervention.Thus,we recommend early initiation of total PN,which is a highly effective measure in promoting early growth and development.展开更多
BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nu...BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.展开更多
BACKGROUND Colorectal cancer is a prevalent malignancy with suboptimal postoperative recovery outcomes.Enhancing recovery and prolonging disease-free survival remains a critical challenge.This study investigates facto...BACKGROUND Colorectal cancer is a prevalent malignancy with suboptimal postoperative recovery outcomes.Enhancing recovery and prolonging disease-free survival remains a critical challenge.This study investigates factors influencing the efficacy of probiotics combined with enteral nutrition in postoperative patients with colorectal cancer.AIM To identify predictors of therapeutic efficacy for probiotics combined with enteral nutrition in postoperative patients with colorectal cancer.METHODS A retrospective study was conducted with 511 patients with colorectal cancer who underwent surgery and received probiotics and enteral nutrition from January 2022 to March 2025.Patients were categorized into the“good efficacy group”(n=279)and“poor efficacy group”(n=232)based on outcomes observed 3 months post-surgery.Variables assessed included gut microbiota composition,nutritional intake,immune and inflammatory markers,and demographic characteristics.RESULTS Patients with favorable outcomes were typically younger,had higher caloric,protein,and fiber intake,and displayed enhanced intestinal mucosal barrier function with elevated levels of Bifidobacterium and Lactobacillus.Immune markers such as immunoglobulin A,immunoglobulin M,immunoglobulin G,and CD4+/CD8+T-cell ratios were significantly higher in the good efficacy group.High numbers of Fusobacterium nucleatum and Bacteroides fragilis and levels of tumor necrosis factor-alpha and interleukin-6 were associated with poor efficacy.Multivariate analysis identified age,tumor node metastasis stage,protein intake,and gut microbiota composition as significant predictors of therapeutic success.CONCLUSION The efficacy of combining probiotics with enteral nutrition in postoperative patients with colorectal cancer was influenced by age,nutritional intake,microbiota balance,immune status,and inflammatory markers.展开更多
Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support....Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support.Given its clinical significance,establishing effective,evidence-based,and standardized manage-ment strategies is essential for bettering patient outcomes and mitigating compli-cations.This review systematically synthesized the diagnostic criteria,assessment methods,influencing factors,management procedures,and intervention strategies for gastric retention in EN patients.Although no universal consensus exists re-garding gastric residual volume(GRV)thresholds,evidence indicates that EN can continue at high GRV levels in the absence of gastrointestinal symptoms.Bedside ultrasound emerged as a non-invasive,and precise method GRV assessment,offering potential to standardize clinical practice.Key risk factors for gastric retention include neurological disorders and EN infusion rates exceeding 100 mL/h.Effective management strategies encompass non-pharmacological inter-ventions,pharmacological agents,and traditional Chinese medicine(TCM)the-rapies.This review underscored the need for integrated,multi-modal manage-ment strategies and recommended the adoption of bedside ultrasound and stan-dardized protocols to optimize EN delivery and improve patient outcomes.Large-scale,multicenter clinical trials should be a priority for future investigation to verify the effectiveness of TCM therapies and develop personalized intervention plans for high-risk patients.展开更多
Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospita...Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospital from January 2022 to January 2024 were selected and divided into groups according to the random number table method.The control group(n=30)received routine nursing after surgery,while the observation group(n=30)received early enteral nutrition nursing after surgery.The perioperative indexes,nutritional indexes before and after nursing,humoral and cellular immune indexes before and after nursing,gastrointestinal hormone levels before and after nursing,and the incidence of postoperative complications were compared between the two groups.Results:The perioperative indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the nutritional indexes between the two groups(P>0.05).After nursing,the nutritional indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the humoral and cellular immune indexes between the two groups(P>0.05).After nursing,the humoral and cellular immune indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the gastrointestinal hormone levels between the two groups(P>0.05).After nursing,the gastrointestinal hormone levels of the observation group were better than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:For elderly patients with gastric cancer,early enteral nutrition nursing after surgery can improve their nutritional indexes and gastrointestinal hormone levels,enhance their immune ability,and prevent the incidence of postoperative complications,with good effects.展开更多
BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk ass...BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk assessment on nutritional function in patients with gastrointestinal tumors.METHODS One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method,56 each.Both groups received treatment for four consecutive weeks.The control group received routine enteral nutrition support,while the observation group received enteral nutrition support based on the NRS2002 risk assessment.Nutritional function,intestinal mucosal barrier function,quality of life,and complication rate were compared between the two groups.Statistical analysis was completed using SPSS26.0 and Excel.RESULTS After nutritional intervention,transferrin,albumin,hemoglobin,and diamine oxidase levels in the observation group were higher than those in the control group,while C-reactive protein,tumor necrosis factorα,and quality of life scores were lower,with significant differences(P<0.05).There was no significant difference in complications between groups(P>0.05),but the complication rate was lower in the observation group.CONCLUSION Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery.Patients’quality of life improved,and the incidence of adverse reactions decreased,indicating clinical promotion and application value.展开更多
BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in prev...BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.展开更多
BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due ...BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due to trauma,infection,and posto-perative stress.In the Enhanced Recovery After Surgery(ERAS)protocol,early enteral nutrition is a key strategy for promoting postoperative recovery.Com-pared with parenteral nutrition,enteral nutrition more effectively meets the physiological needs of the GI system,promotes the recovery of gut function,and reduces the risk of GI infections.AIM To evaluate the clinical efficacy of early enteral nutrition support in patients undergoing GP repair within the ERAS protocol.METHODS This retrospective study analyzed 66 patients who underwent GP repair.Patients were divided into a control group(n=32),managed with a traditional nutritional regimen,primarily consisting of total parenteral nutrition;and an observation group(n=34),which included those who received early enteral nutrition support as part of the ERAS protocol.This study examined the time to first postoperative flatus and bowel movement,changes in nutritional and immune function,inflam-matory markers on postoperative days 1 and 5,and adverse reactions.RESULTS The observation group had significantly shorter times to the first postoperative flatus and bowel movement than the control group(P<0.05).On postoperative day 5,the observation group demonstrated higher nutritional and immune function levels than the control group(P<0.05),while C-reactive protein levels were significantly lower(P<0.05).The overall incidence of adverse reactions in the observation group was 8.82%(3/34),which was lower than the 28.13%(9/32)observed in the control group(P<0.05).CONCLUSION Early enteral nutritional support facilitates GI recovery after GP repair.It improves nutritional status,enhances immune function,and attenuates inflammatory responses while also demonstrating a favorable safety profile.展开更多
Objective:To explore the effectiveness of early enteral nutrition therapy in ICU patients with respiratory failure.Methods:A total of 76 ICU patients with respiratory failure,admitted from May 2024 to May 2025,were in...Objective:To explore the effectiveness of early enteral nutrition therapy in ICU patients with respiratory failure.Methods:A total of 76 ICU patients with respiratory failure,admitted from May 2024 to May 2025,were included in the study.They were divided into an observation group and a control group using a random number table method,and relevant treatment indicators were compared.Results:The total effective rate in the observation group was higher than that in the control group(p<0.05).After treatment,the observation group showed superior lung function,organ function,health status,nutritional status,body mass index,and blood gas analysis indicators compared to the control group(p<0.05).Conclusion:Early enteral nutrition therapy is effective in treating ICU patients with respiratory failure and is beneficial for improving their lung function,nutritional status,and blood gas parameters,making it worthy of promotion.展开更多
Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to...Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.展开更多
Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe t...Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.展开更多
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 combin...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.展开更多
BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis.However,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in se...BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis.However,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis.Moreover,no consensus on goal enteral caloric intake has been reached in sepsis.AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODS Patients were randomly assigned to receive 30%(defined as group A),60%(group B),or 100%(group C)of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial.The acute gastrointestinal injury(AGI)grades,incidence of feeding intolerance(FI),daily caloric intake,nutritional and inflammatory markers,and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding.The clinical severity and outcome variables were also recorded.RESULTS A total of 54 septic patients were enrolled.The days to goal calorie of group C(2.55±0.82)were significantly longer than those of group A(3.50±1.51;P=0.046)or B(4.85±1.68;P<0.001).The FI incidence of group C(16.5%)was higher than that of group A(5.0%)or B(8.7%)(P=0.009).No difference in the incidence of FI symptoms was found between groups A and B.The serum levels of barrier function biomarkers of group B were significantly lower than those of group A(P<0.05)on the 7th day of feeding.The prealbumin and IL-6 levels of group A were lower than those of group B(P<0.05)on the 7th day of feeding.No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSION Early moderate enteral underfeeding(60%of goal requirements)could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis.However,further large-scale prospective clinical trials and animal studies are required to test our findings.Moreover,the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.展开更多
INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal org...INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal organ dysfunction and rapid recovery ,while severe disease is associated with multiple organ system failure and local complications such as necrosis , abscess , fistulas and pseudocyst formation [4-6].展开更多
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 ...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 biochemical parameters, 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.展开更多
Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were stud...Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were studied.EN was given through jejunostomy tube (or Beng-mark tube) after a period of PN maintenance. ENstarted when serum and urine amylase activity re-turned to normal with regular peristaltic sound, defe-cation or break wind. The sequence of preparationwas as follows: saline glucose→chemically defined di-et→polymeric diet→normal diet.Results: In all the patients, none died. The rate of latecomplications was lower, and the levels of serum albu-min and transferritin significantly increased in thepost-EN period as compared with the pre-EN period,although the count of lymphocytes was less changed.Conclusions: Nutritional support should be trans-formed from PN to EN as early as possible during thetreatment of patients with severe acute pancreatitis. ENcould not only continue sufficient nutritional support,but also avoid the unfavorable effects of long-timePN, thus reducing complications as well as mortality.展开更多
AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed ...AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.展开更多
AIM： To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS： Fifteen dogs were randomly divided into parenteral nutrition （n = 7） and early...AIM： To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS： Fifteen dogs were randomly divided into parenteral nutrition （n = 7） and early intrajejunal nutrition groups （n = 8）. An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy tube after the model was established for 24 h. On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10^6 Bq L-3H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS： The 3H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean number and area of zymogen granules did not show any significant statistical difference in both groups on d i or on d 7 （P 〉 0.05）. CONCLUSION： Early intrajejunal nutrition might be effective in dogs with acute pancreatitis.展开更多
Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrec...Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.展开更多
文摘Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.
文摘BACKGROUND Congenital short bowel syndrome(CSBS)is a rare disorder characterized by a congenital shortage in the length of the small intestines,resulting in compromised intestinal functionality,frequently accompanied by congenital intestinal malrotation.This study summarizes the experience of enteral and parenteral nutrition(PN)schemes for two cases of CSBS accompanied by intestinal malrotation to provide a reference for this condition.CASE SUMMARY Case 1 underwent surgical intervention 23 days after birth,but experienced postoperative intolerance to oral feeding.Consequently,the patient was transitioned to nasal feeding for 6 months while concurrently receiving round-the-clock PN.Despite ongoing adjustments to the caloric intake of enteral and PN throughout the treatment,cholestatic liver injury persisted.Furthermore,this child developed malnutrition by the age of 1 year.Case 2 received surgical intervention on 2 days after birth,demonstrating favorable tolerance for enteral feeding and intermittent PN.The child exhibited satisfactory growth and development without any associated complications.CONCLUSION CSBS is rarely encountered in clinical practice and is often accompanied by congenital intestinal malrotation.It can be improved with early diagnosis and active surgical intervention.Thus,we recommend early initiation of total PN,which is a highly effective measure in promoting early growth and development.
文摘BACKGROUND: This study aimed to explore the risk factors associated with intensive care unitacquired weakness(ICU-AW) in critically ill patients at risk of malnutrition and to evaluate the efficacy of early enteral nutrition(EEN) and the role of biomarkers in managing ICU-AW.METHODS: This retrospective, observational cohort study included 180 patients at risk of malnutrition admitted to the emergency intensive care unit of the First Affiliated Hospital of Xiamen University Hospital from January 2022 to December 2023. Patients were divided into ICU-AW group and non-ICU-AW group according to whether they developed ICU-AW, or categorized into EEN and parenteral nutrition(PN) groups according to nutritional support. ICU-AW was diagnosed using the Medical Research Council score. The primary outcome was the occurrence of ICU-AW.RESULTS: The significant factors associated with ICU-AW included age, sex, type of nutritional therapy, mechanical ventilation(MV), body mass index(BMI), blood urea nitrogen(BUN), and creatinine(Cr) levels(P<0.05). The PN group developed ICU-AW earlier than did the EEN group, with a significant difference observed(log-rank P<0.001). Among biomarkers for ICU-AW, the mean prealbumin(PAB)/C-reactive protein(CRP) ratio had the highest diagnostic accuracy(area under the curve [AUC] 0.928, 95% confidence interval [95% CI] 0.892–0.946), surpassing the mean Cr/BUN ratio(AUC 0.740, 95% CI 0.663–0.819) and mean transferrin levels(AUC 0.653, 95% CI 0.574–0.733).CONCLUSION: Independent risk factors for ICU-AW include female sex, advanced age, PN, MV, lower BMI, and elevated BUN and Cr levels. EEN may potentially delay ICU-AW onset, and the PAB/CRP ratio may be an effective diagnostic marker for this condition.
基金Supported by Zunyi Science and Technology Plan Project,No.Zunshi Kehe HZ Zi(2023)No.49.
文摘BACKGROUND Colorectal cancer is a prevalent malignancy with suboptimal postoperative recovery outcomes.Enhancing recovery and prolonging disease-free survival remains a critical challenge.This study investigates factors influencing the efficacy of probiotics combined with enteral nutrition in postoperative patients with colorectal cancer.AIM To identify predictors of therapeutic efficacy for probiotics combined with enteral nutrition in postoperative patients with colorectal cancer.METHODS A retrospective study was conducted with 511 patients with colorectal cancer who underwent surgery and received probiotics and enteral nutrition from January 2022 to March 2025.Patients were categorized into the“good efficacy group”(n=279)and“poor efficacy group”(n=232)based on outcomes observed 3 months post-surgery.Variables assessed included gut microbiota composition,nutritional intake,immune and inflammatory markers,and demographic characteristics.RESULTS Patients with favorable outcomes were typically younger,had higher caloric,protein,and fiber intake,and displayed enhanced intestinal mucosal barrier function with elevated levels of Bifidobacterium and Lactobacillus.Immune markers such as immunoglobulin A,immunoglobulin M,immunoglobulin G,and CD4+/CD8+T-cell ratios were significantly higher in the good efficacy group.High numbers of Fusobacterium nucleatum and Bacteroides fragilis and levels of tumor necrosis factor-alpha and interleukin-6 were associated with poor efficacy.Multivariate analysis identified age,tumor node metastasis stage,protein intake,and gut microbiota composition as significant predictors of therapeutic success.CONCLUSION The efficacy of combining probiotics with enteral nutrition in postoperative patients with colorectal cancer was influenced by age,nutritional intake,microbiota balance,immune status,and inflammatory markers.
基金Supported by Zhejiang Province Medical and Health Technology Planning Project,No.2019332856.
文摘Gastric retention is a common complication in individuals receiving enteral nutrition(EN)via a nasogastric tube,increasing the risk of aspiration pneumonia and causing unnecessary interruptions in nutritional support.Given its clinical significance,establishing effective,evidence-based,and standardized manage-ment strategies is essential for bettering patient outcomes and mitigating compli-cations.This review systematically synthesized the diagnostic criteria,assessment methods,influencing factors,management procedures,and intervention strategies for gastric retention in EN patients.Although no universal consensus exists re-garding gastric residual volume(GRV)thresholds,evidence indicates that EN can continue at high GRV levels in the absence of gastrointestinal symptoms.Bedside ultrasound emerged as a non-invasive,and precise method GRV assessment,offering potential to standardize clinical practice.Key risk factors for gastric retention include neurological disorders and EN infusion rates exceeding 100 mL/h.Effective management strategies encompass non-pharmacological inter-ventions,pharmacological agents,and traditional Chinese medicine(TCM)the-rapies.This review underscored the need for integrated,multi-modal manage-ment strategies and recommended the adoption of bedside ultrasound and stan-dardized protocols to optimize EN delivery and improve patient outcomes.Large-scale,multicenter clinical trials should be a priority for future investigation to verify the effectiveness of TCM therapies and develop personalized intervention plans for high-risk patients.
文摘Objective:To study the application effect of early postoperative enteral nutrition in the nursing care of elderly patients with gastric cancer.Methods:Sixty elderly patients with gastric cancer admitted to the hospital from January 2022 to January 2024 were selected and divided into groups according to the random number table method.The control group(n=30)received routine nursing after surgery,while the observation group(n=30)received early enteral nutrition nursing after surgery.The perioperative indexes,nutritional indexes before and after nursing,humoral and cellular immune indexes before and after nursing,gastrointestinal hormone levels before and after nursing,and the incidence of postoperative complications were compared between the two groups.Results:The perioperative indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the nutritional indexes between the two groups(P>0.05).After nursing,the nutritional indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the humoral and cellular immune indexes between the two groups(P>0.05).After nursing,the humoral and cellular immune indexes of the observation group were better than those of the control group(P<0.05).Before nursing,there was no significant difference in the gastrointestinal hormone levels between the two groups(P>0.05).After nursing,the gastrointestinal hormone levels of the observation group were better than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:For elderly patients with gastric cancer,early enteral nutrition nursing after surgery can improve their nutritional indexes and gastrointestinal hormone levels,enhance their immune ability,and prevent the incidence of postoperative complications,with good effects.
文摘BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk assessment on nutritional function in patients with gastrointestinal tumors.METHODS One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method,56 each.Both groups received treatment for four consecutive weeks.The control group received routine enteral nutrition support,while the observation group received enteral nutrition support based on the NRS2002 risk assessment.Nutritional function,intestinal mucosal barrier function,quality of life,and complication rate were compared between the two groups.Statistical analysis was completed using SPSS26.0 and Excel.RESULTS After nutritional intervention,transferrin,albumin,hemoglobin,and diamine oxidase levels in the observation group were higher than those in the control group,while C-reactive protein,tumor necrosis factorα,and quality of life scores were lower,with significant differences(P<0.05).There was no significant difference in complications between groups(P>0.05),but the complication rate was lower in the observation group.CONCLUSION Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery.Patients’quality of life improved,and the incidence of adverse reactions decreased,indicating clinical promotion and application value.
文摘BACKGROUND Compared to standard hospital meals,nutritional intervention using recovery K5(RK5),a concentrated liquid diet,offers a comprehensive immunonutritional profile,suggesting its potential effectiveness in preventing surgical site infections(SSIs)after gastrointestinal surgery.AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery,focusing on postoperative infections and nutritional status.METHODS This single-center,open-label,randomized,parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery,Nippon Medical School Hospital,between February 2023 and August 2024.Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group.The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner(400 kcal per serving)2 days prior to surgery,whereas the control group received only standard meals.Postoperative infection,nutritional status,and bowel habits were assessed.RESULTS No cases of remote infection were observed.SSIs occurred in one of the 17 patients(5.9%)in the intervention group and six of the 18 patients(33.3%)in the control group,with an odds ratio of 0.125(95%confidence interval:0.013-1.181,P=0.0695).Energy intake and percentage of target energy intake were significantly higher in the intervention group.No significant differences were observed betShinji S et al.RK5 in colorectal cancer surgery WJGS https://www.wjgnet.com 2 November 27,2025 Volume 17 Issue 11 ween the two groups regarding nutritional status,bowel movement frequency,or the incidence of diarrhea.CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.
文摘BACKGROUND Gastrointestinal(GI)perforation(GP)repair is a surgical procedure to promptly seal perforations in the GI tract to prevent further leakage.After surgery,patients often experience a high metabolic state due to trauma,infection,and posto-perative stress.In the Enhanced Recovery After Surgery(ERAS)protocol,early enteral nutrition is a key strategy for promoting postoperative recovery.Com-pared with parenteral nutrition,enteral nutrition more effectively meets the physiological needs of the GI system,promotes the recovery of gut function,and reduces the risk of GI infections.AIM To evaluate the clinical efficacy of early enteral nutrition support in patients undergoing GP repair within the ERAS protocol.METHODS This retrospective study analyzed 66 patients who underwent GP repair.Patients were divided into a control group(n=32),managed with a traditional nutritional regimen,primarily consisting of total parenteral nutrition;and an observation group(n=34),which included those who received early enteral nutrition support as part of the ERAS protocol.This study examined the time to first postoperative flatus and bowel movement,changes in nutritional and immune function,inflam-matory markers on postoperative days 1 and 5,and adverse reactions.RESULTS The observation group had significantly shorter times to the first postoperative flatus and bowel movement than the control group(P<0.05).On postoperative day 5,the observation group demonstrated higher nutritional and immune function levels than the control group(P<0.05),while C-reactive protein levels were significantly lower(P<0.05).The overall incidence of adverse reactions in the observation group was 8.82%(3/34),which was lower than the 28.13%(9/32)observed in the control group(P<0.05).CONCLUSION Early enteral nutritional support facilitates GI recovery after GP repair.It improves nutritional status,enhances immune function,and attenuates inflammatory responses while also demonstrating a favorable safety profile.
文摘Objective:To explore the effectiveness of early enteral nutrition therapy in ICU patients with respiratory failure.Methods:A total of 76 ICU patients with respiratory failure,admitted from May 2024 to May 2025,were included in the study.They were divided into an observation group and a control group using a random number table method,and relevant treatment indicators were compared.Results:The total effective rate in the observation group was higher than that in the control group(p<0.05).After treatment,the observation group showed superior lung function,organ function,health status,nutritional status,body mass index,and blood gas analysis indicators compared to the control group(p<0.05).Conclusion:Early enteral nutrition therapy is effective in treating ICU patients with respiratory failure and is beneficial for improving their lung function,nutritional status,and blood gas parameters,making it worthy of promotion.
文摘Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.
基金Supported by the Natural Science Foundation of Shandong province(Y2008C35)Technology Supporting Program of Qingdao(12-1-3-5-(1)-nsh)
文摘Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.
基金Supported by Grants from Jiangsu Provincial GovernmentChinaNo.ZX200605
文摘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.
基金Supported by National Natural Science Foundation of China,No.81701881Nanjing Medical Science and Technology Development Foundation,No.YKK17102.
文摘BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis.However,few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis.Moreover,no consensus on goal enteral caloric intake has been reached in sepsis.AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis.METHODS Patients were randomly assigned to receive 30%(defined as group A),60%(group B),or 100%(group C)of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial.The acute gastrointestinal injury(AGI)grades,incidence of feeding intolerance(FI),daily caloric intake,nutritional and inflammatory markers,and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding.The clinical severity and outcome variables were also recorded.RESULTS A total of 54 septic patients were enrolled.The days to goal calorie of group C(2.55±0.82)were significantly longer than those of group A(3.50±1.51;P=0.046)or B(4.85±1.68;P<0.001).The FI incidence of group C(16.5%)was higher than that of group A(5.0%)or B(8.7%)(P=0.009).No difference in the incidence of FI symptoms was found between groups A and B.The serum levels of barrier function biomarkers of group B were significantly lower than those of group A(P<0.05)on the 7th day of feeding.The prealbumin and IL-6 levels of group A were lower than those of group B(P<0.05)on the 7th day of feeding.No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups.CONCLUSION Early moderate enteral underfeeding(60%of goal requirements)could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis.However,further large-scale prospective clinical trials and animal studies are required to test our findings.Moreover,the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.
文摘INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal organ dysfunction and rapid recovery ,while severe disease is associated with multiple organ system failure and local complications such as necrosis , abscess , fistulas and pseudocyst formation [4-6].
基金Supported by the National Natural Science Foundation,No.81372582“New-Star”Young Scientists Program of Shaanxi Province,No.2014kjxx-30the Fundamental Research Funds for the Central Universities
文摘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 biochemical parameters, 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.
文摘Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were studied.EN was given through jejunostomy tube (or Beng-mark tube) after a period of PN maintenance. ENstarted when serum and urine amylase activity re-turned to normal with regular peristaltic sound, defe-cation or break wind. The sequence of preparationwas as follows: saline glucose→chemically defined di-et→polymeric diet→normal diet.Results: In all the patients, none died. The rate of latecomplications was lower, and the levels of serum albu-min and transferritin significantly increased in thepost-EN period as compared with the pre-EN period,although the count of lymphocytes was less changed.Conclusions: Nutritional support should be trans-formed from PN to EN as early as possible during thetreatment of patients with severe acute pancreatitis. ENcould not only continue sufficient nutritional support,but also avoid the unfavorable effects of long-timePN, thus reducing complications as well as mortality.
基金Supported by the Ministry of Education and Research of Estonia(IUT34-24)
文摘AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.
基金Supported by grant from the Morning Star Fund of Shanghai, China, No. 99QB14010
文摘AIM： To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS： Fifteen dogs were randomly divided into parenteral nutrition （n = 7） and early intrajejunal nutrition groups （n = 8）. An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy tube after the model was established for 24 h. On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10^6 Bq L-3H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS： The 3H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean number and area of zymogen granules did not show any significant statistical difference in both groups on d i or on d 7 （P 〉 0.05）. CONCLUSION： Early intrajejunal nutrition might be effective in dogs with acute pancreatitis.
文摘Objective To investigate the effects of enteral nutrition （EN） and parenteral nutrition （PN） on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group （n=20） and PN group （n=21 ）. From the first postoperative day to the seventh day, patients received either EN （EN group） or PN （PN group） with isocalofic （84.9kJ·kg^-1·d^-1） and isonitrogenous （0.11g·kg^-1·d^-1） intake. Serum gastrin （GAS）, plasma mofilin （MTL）, and plasma cholecystokinin （CCK） were measured on preoperative day, the first and seventh postoperative day. Electrogastrography （EGG） was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy （ P 〈 0. 001 ）, but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained （ P 〈 0. 001 ）. On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group （ P 〈 0.05 ）. There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.
