加速康复外科(enhanced recovery after surgery,ERAS)在胃肠外科领域开展已有20余年,尤其在结直肠外科中应用较为广泛。胃肠外科领域已有多部ERAS指南发表,近年来国内外对胃肠外科ERAS指南又作了多次修订与更新,有助于进一步规范围手...加速康复外科(enhanced recovery after surgery,ERAS)在胃肠外科领域开展已有20余年,尤其在结直肠外科中应用较为广泛。胃肠外科领域已有多部ERAS指南发表,近年来国内外对胃肠外科ERAS指南又作了多次修订与更新,有助于进一步规范围手术期胃肠外科管理。临床营养是ERAS中必不可少的重要组成部分,包括术前营养评估、口服营养补充预康复、术后早期肠内营养等内容,在指南更新中得到越来越多的关注与重视,本文就国内外最新更新的ERAS指南中的临床营养部分进行重点解读。展开更多
Background This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula （Diason low energy： 313.8 k J/100 ml）, compared with a standard formula, on insulin s...Background This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula （Diason low energy： 313.8 k J/100 ml）, compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid （FFA） in type 2 diabetics. Methods In total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples （0.5, 1, 2, 3 hours） were collected at day -7 after a 75 g oral glucose tolerance test （OGTT）, day 1 after a standard test meal （1673.6 k J） and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose, serum insulin, C peptide and lipids were.measured. Results After the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour （P 〈0.05） and 1 hour （P 〈0.01）; significantly lower peak height of plasma glucose （P=0.05）; significantly lower plasma insulin concentrations at 0.5 hour （P〈0.01）, 1 hour （P〈0.01） and 2 hours （P 〈0.01）; and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal （P 〈0.05）. The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well tolerated. Conclusions In summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this, the insulin sensitivity （HOMA-IS） was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be used by diabetic and hyperglycemic patients in need of nutritional support.展开更多
文摘加速康复外科(enhanced recovery after surgery,ERAS)在胃肠外科领域开展已有20余年,尤其在结直肠外科中应用较为广泛。胃肠外科领域已有多部ERAS指南发表,近年来国内外对胃肠外科ERAS指南又作了多次修订与更新,有助于进一步规范围手术期胃肠外科管理。临床营养是ERAS中必不可少的重要组成部分,包括术前营养评估、口服营养补充预康复、术后早期肠内营养等内容,在指南更新中得到越来越多的关注与重视,本文就国内外最新更新的ERAS指南中的临床营养部分进行重点解读。
文摘Background This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula （Diason low energy： 313.8 k J/100 ml）, compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid （FFA） in type 2 diabetics. Methods In total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples （0.5, 1, 2, 3 hours） were collected at day -7 after a 75 g oral glucose tolerance test （OGTT）, day 1 after a standard test meal （1673.6 k J） and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose, serum insulin, C peptide and lipids were.measured. Results After the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour （P 〈0.05） and 1 hour （P 〈0.01）; significantly lower peak height of plasma glucose （P=0.05）; significantly lower plasma insulin concentrations at 0.5 hour （P〈0.01）, 1 hour （P〈0.01） and 2 hours （P 〈0.01）; and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal （P 〈0.05）. The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well tolerated. Conclusions In summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this, the insulin sensitivity （HOMA-IS） was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be used by diabetic and hyperglycemic patients in need of nutritional support.
