Effect of Early Enteral Nutrition Combined with Probiotics on the Nutritional Status of Patients with Severe Craniocerebral Injury

Objective:To observe the effect of early enteral nutrition combined with probiotics on the nutritional status of patients with severe craniocerebral injury.Methods:Thirty-five patients with severe craniocerebral injury were divided into the study group(17 patients)and the control group(18 patients)according to the method of a randomized numerical table;both groups of patients started enteral nutrition via nasogastric tube within 24–48 hours after admission to the hospital,and probiotics were given in addition to the study group.Hemoglobin,total plasma protein,albumin,prealbumin,cholinesterase,fasting blood glucose,and other indexes were monitored before and early morning after enteral nutrition support,and upper arm circumference(AC),triceps skinfold thickness(TSF),and upper arm muscle circumference(AMC)were measured,and gastrointestinal response and time to first defecation of the patients were observed and compared with GCS score.Results:The hemoglobin,serum albumin,prealbumin,cholinesterase,and total plasma protein levels in the study group were significantly higher and fasting blood glucose levels were significantly lower than those in the control group after treatment(P<0.05).The incidence of reflux and constipation in the study group was lower than that in the control group,and the time to first defecation was shorter than that in the control group(P<0.05).After treatment,AC,TSF,and AMC were higher in the study group than in the control group(P<0.05).GCS scores were significantly higher in both groups after treatment,but the trend was more pronounced in the study group(P<0.05).Conclusion:Compared with simple enteral nutrition,enteral nutrition combined with probiotics can better correct metabolic disorders after heavy craniocerebral injury and improve the nutritional status of patients.

Effect of Sequential Early Enteral Nutrition on Postoperative Rehabilitation and Complications in Gastric Cancer Patients

Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.

Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

BACKGROUND Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases,and it is associated with a large trauma:Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery,thus affecting the efficacy of surgical treatment.Therefore,early postoperative nutritional support can provide essential nutritional supply,restore the intestinal barrier and reduce complication occurrence.However,different studies have shown different conclusions.AIM To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.METHODS Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed,EMBASE,Springer Link,Ovid,China National Knowledge Infrastructure,China Biology Medicine databases.Notably,only randomized controlled trial articles were retrieved from the databases(from establishment date to October 2022).The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0.The outcome indicators,such as albumin,prealbumin,and total protein,after statistical intervention were combined.RESULTS Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery(1138 patients(53.1%)receiving early postoperative nutritional support and 1007 patients(46.9%)receiving traditional nutritional support or delayed nutritional support)were included in this study.Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding.Furthermore,six literatures had"some risk of bias,"and eight literatures had"low risk".The overall quality of the included studies was good.Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels,than patients receiving delayed nutritional support[MD(mean difference)=3.51,95%CI:-0.05 to 7.07,Z=1.93,P=0.05].Also,patients receiving early nutritional support had shorter hospital stay(MD=-2.29,95%CI:-2.89 to-1.69),Z=-7.46,P<0.0001)shorter first defecation time(MD=-1.00,95%CI:-1.37 to-0.64),Z=-5.42,P<0.0001),and fewer complications(Odd ratio=0.61,95%CI:0.50 to 0.76,Z=-4.52,P<0.0001)than patients receiving delayed nutritional support.CONCLUSION Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay,reduce complication incidence,and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Effects of early enteral nutrition on immune function of severe acute pancreatitis patients

AIM:To investigate the effects of early enteral nutrition (EEN) on the immune function and clinical outcome of patients with severe acute pancreatitis (SAP).METHODS:Patients were randomly allocated to receive EEN or delayed enteral nutrition (DEN).Enteral nutrition was started within 48 h after admission in EEN group,whereas from the 8 th day in DEN group.All the immunologic parameters and C-reactive protein (CRP) levels were collected on days 1,3,7 and 14 after admission.The clinical outcome variables were also recorded.RESULTS:Sixty SAP patients were enrolled to this study.The CD4+ T-lymphocyte percentage,CD4+/CD8+ ratio,and the CRP levels in EEN group became significantly lower than in DEN group from the 7 th day after admission.In contrast,the immunoglobulin G(IgG) levels and human leukocyte antigen-DR expression in EEN group became significantly higher than in DEN group from the 7 th day after admission.No difference of CD8+ T-lymphocyte percentage,IgM and IgA levels was found between the two groups.The incidences of multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection as well as the duration of intensive care unit stay were significantly lower in EEN group than in DEN group.However,there was no difference of hospital mortality between the two groups.CONCLUSION:EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent immunosuppression.EEN can improve the clinical outcome,but not decrease the hospital mortality of SAP patients.

Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients

BACKGROUND The imbalance of Th17/Treg cells and the IL-23/IL-17 axis have been confirmed to be associated with sepsis and various inflammatory diseases. Early enteral nutrition (EEN) can modulate the inflammatory response, improve immune dysfunction, and prevent enterogenic infection in critically ill patients;however, the precise mechanisms remain unclear. Considering the important roles of Th17 and Treg lymphocytes in the development of inflammatory and infectious diseases, we hypothesized that EEN could improve the immune dysfunction in sepsis by maintaining a balanced Th17/Treg cell ratio and by regulating the IL- 23/IL-17 axis. AIM To investigate the effects of EEN on the Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients. METHODS In this prospective clinical trial, patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. Enteral feeding was started within 48 h in the EEN group, whereas enteral feeding was started on the 4th day in the DEN group. The Th17 and Treg cell percentages and the interleukin levels were tested on days 1, 3, and 7 after admission. The clinical severity and outcome variables were also recorded. RESULTS Fifty-three patients were enrolled in this trial from October 2017 to June 2018. The Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission (P < 0.05). The duration of mechanical ventilation and of the intensive care unit stay of the EEN group were shorter than those of the DEN group (P <0.05). However, no difference in the 28-d mortality was found between the two groups (P = 0.728). CONCLUSION EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL- 23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity of sepsis but did not reduce the 28-d mortality of septic patients.

Early intrajejunal nutrition: bacterial translocation and gut barrier function of severe acute pancreatitis in dogs

Objective: To evaluate the effect of early intrajejunalnutrition in attenuating bacterial and/or endotoxintranslocation and improving gut barrier function ofsevere acute pancreatitis (SAP) in dogs.Methods: 15 dogs were divided into parenteral nutrition(PN) group(7 dogs)and early intrajejunal nutrition(EIN) group(8). EIN was delivered nutrients via a nee-dle jejunostomy catheter feeding at 48h after operation.SAP model was induced by injecting 1 ml/kg of com-bined solution of 5% sodium taurocholate and 8000-10000 BAEE units trypsin/ml into the pancreas via thepancreatic duct. Systemic blood samples were ob-tained before and 1, 3, 5, 7 d following SAP, and culturedby aerobic as well as anaerobic bacterial growth. Systemicplasma and portal vein endotoxin levels were quantifiedby the chromogenic limulus amebocyte lysate (LAL)technique. Portal vein blood and specimens of tissuefrom the mesenteriolum and mesocolon lymph nodes,lung, pulmonary portal lymph nodes, pancreatitis tissueand periopancreas tissue were adopted before the experi-ment was finished. Aliquots of the homogenata were cul-tured as blood mentioned above to determine the magnitudeof the bacteria DNA, protein and the villi, the thickness ofmucosa, and the whole bowel wall of the ileum and trans-verse colon were measured.Results: The study showed that the levels of systemicplasma endotoxin and the magnitude of bacterialtranslocation to the portal and systemic blood and dis-tant organ were reduced significantly in the EINgroup as compared with the TPN group. The contentsof protein and DNA, the height of villi, the thicknessof mucosa and whole bowel wall of the ileum andtransverse colon in the EIN group were higher thanthose in the PN group.Conclusion: Our results suggested that EIN is safe andeffective to be adopted by intrajejunal delivery of nu-trients in SAP, decreases the occurrence of gut bacterialtranslocation, and improves the gut barrier function.

Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice

BACKGROUND Most cholangiocarcinoma patients with malignant obstructive jaundice(MOJ)have varying degrees of malnutrition and immunodeficiency preoperatively.Therefore,perioperative nutritional support has important clinical significance in the treatment of cholangiocarcinoma.AIM To investigate the effects of postoperative early enteral nutrition(EEN)on immunity function and clinical outcomes of cholangiocarcinoma patients with MOJ.METHODS This prospective clinical study included 60 cholangiocarcinoma patients with MOJ who underwent surgery.The patients were randomly divided into an experimental group and a control group according to the nutrition support modes.The control group received postoperative total parenteral nutrition(TPN),whereas the experimental group received postoperative EEN and parenteral nutrition(PN;EEN+PN).The clinical outcomes,postoperative immune function,incidences of surgical site infection and bile leakage,intestinal function recovery time,average hospitalization days,and hospitalization expenses of the two groups were assessed on postoperative days(PODs)1,3,and 7.RESULTS The CD3+T,CD4+T,CD8+T,and CD4+T/CD8+T cell count and the immunoglobulin(Ig)G,IgM,and IgA levels in the EEN+PN group were significantly higher than those in the TPN group on PODs 3 and 7(P<0.05),whereas no significant differences in the CD3+T,CD4+T,CD8+T,and CD4+T/CD8+T cell counts and IgG,IgM,and IgA levels before operation and on POD 1 were found between the two groups(P>0.05).The intestinal function recovery time and postoperative hospital stay were shorter(P<0.001 for both)in the EEN+PN group than in the TPN group.The hospitalization expenses of the EEN+PN group were lower than those of the TPN group(P<0.001).However,the incidence of abdominal distension was higher than in the EEN+PN group than in the TPN group(P<0.05).The incidence rates of biliary leakage and surgical site infection were not significantly different between the two groups(P>0.05).CONCLUSION A postoperative EEN program could reduce the incidence of postoperative complications and improve the clinical outcomes and immune functions of cholangiocarcinoma patients with MOJ and is thus beneficial to patient recovery.

Application of Early Enteral Nutrition in Critically Ill Children

Objective: The objective is to investigate the incidence of moderate and severe malnutrition in children in intensive care units, and to analyze the safety and clinical efficacy of early enteral nutrition therapy in critically ill children. Methods: A total of 80 children hospitalized in the pediatric care unit meeting the inclusion criteria were selected and general data were collected, including 48 in the early enteral nutrition (EEN) group and 32 in the late EN group. The two groups were compared in the incidence of moderate to severe malnutrition, feeding tolerance, length of stay in ICU, total length of stay, changes in blood routine and biochemical indicators. Results: After 1 week in ICU, the feeding tolerance of the treatment group was better than that of the control group (P < 0.05). The average length of stay in ICU and total length of stay in the treatment group were shorter than those in the control group (P < 0.05). After 1 week of comprehensive treatment (anti-infection and EEN), the total number of WBC, absolute value of neutrophil and C-reactive protein in peripheral blood of the treatment group were decreased (P < 0.01), which was significantly lower than that of the control group with bacterial infection (P < 0.01). After 1 week of treatment in ICU, serum prealbumin in treatment group was significantly higher than that in control group (P < 0.05), but serum albumin was not significantly higher (P > 0.05). The rate of moderate to severe malnutrition at discharge was lower in the treatment group than at admission to the ICU (17 cases vs. 20 cases, 35.4% vs. 41.7%), but higher in the control group (19 cases vs. 16 cases, 59.4% vs. 50.0%). Conclusion: Malnutrition is prevalent in children treated in pediatric intensive care units. Early enteral nutrition therapy for critically ill children is safe and effective, that can significantly improve the nutritional status of critically ill children, reduce inflammatory response, and shorten the hospital stay.

Effect of Aggressive Early High-Dose Intravenous Amino Acid Infusion and Early Trophic Enteral Nutrition on Very Low Birth Weight Infants

Objective: Very-low-birth-weight (VLBW) preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study Design: The effect of a high-dose 3 g amino acid (HAA)/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA) supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003) and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047). In addition, shorter parenteral nutrition time was achieved by HAA administration (p Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m2. Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days;P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%;P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m2 might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.

Effect of postoperative early enteral nutrition support on anti-tumor immune response and inflammatory response process in the elderly patients with esophageal cancer

Objective: To explore the effect of postoperative early enteral nutrition support on anti-tumor immune response and inflammatory response process in the elderly patients with esophageal cancer. Methods: A total of 110 cases of elderly patients with esophageal cancer who underwent radical operation in this hospital between January 2015 and December 2017 were divided into the parenteral nutrition group (n=57) who received parenteral nutrition support and the enteral nutrition group (n=53) who received enteral nutrition support according to the postoperative nutrition intervention methods. The differences in anti-tumor immune response and inflammatory response degree were compared between the two groups of patients immediately after the patients returned to the ward (T0), 48h after nutritional support (T1) and 72h after nutritional support (T2). Results: At T0, there was no statistically significant difference in the contents of Th1/Th2 immune response and Th17/Treg immune response indexes as well as inflammatory mediators in serum between the two groups of patients. At T1 and T2, serum Th1 cytokines IFN-γ and IL-12 contents of enteral nutrition group were higher than those of parenteral nutrition group whereas Th2 cytokines IL-4 and IL-13 contents were lower than those of parenteral nutrition group;serum contents of Th17 cytokines IL-6 and IL-17 as well as Treg cytokines TGF-β and IL-10 were lower than those of parenteral nutrition group;serum inflammatory mediators hs-CRP, PGE and HMGB1 contents were lower than those of parenteral nutrition group. Conclusion: Postoperative early enteral nutrition support can effectively regulate the Th1/Th2 and Th17/Treg immune response balance and inhibit the systemic inflammatory response in elderly patients with esophageal cancer.

Effects of early enteral nutrition + alanyl-glutamine on intestinal flora, inflammation and oxidative response in patients with SAP

Objective: To investigate the effects of early enteral nutrition + alanyl-glutamine on intestinal flora, inflammation and oxidative response in patients with severe acute pancreatitis (SAP). Methods: A total of 90 patients with SAP who were treated in the hospital between February 2013 and July 2017 were divided into normal EEN group and enhanced EEN group according to different nutritional modes. Normal EEN group received early EEN intervention, and enhanced EEN group received alanyl-glutamine intervention based on early EEN. The differences in the flora distribution in intestinal excreta as well as the contents of inflammatory factors and oxidative stress indexes in serum were compared between the two groups. Results:Before intervention, the differences in the flora distribution in intestinal excreta as well as the contents of inflammatory factors and oxidative stress indexes in serum were not statistically significant between the two groups of patients. After intervention, the bifidobacterium and lactobacillus count in intestinal excreta of enhanced EEN group were higher than those of normal EEN group whereas the enterococcus and escherichia coli count were lower than those of normal EEN group;serum inflammatory cytokines IL-1β, IL-17 and IL-23 contents were lower than those of normal EEN group;serum oxidative stress indexes MPO and XO contents were lower than those of normal EEN group while SOD and CAT contents were higher than those of normal EEN group. Conclusion: EEN combined with alanyl-glutamine therapy can effectively balance the intestinal flora and inhibit the systemic inflammatory response and oxidative stress response in patients with SAP.

Effect of early enteral nutrition intervention on nerve function, systemic oxidative stress and inflammatory response in patients with hypertensive cerebral hemorrhage

Objective: To study the effect of early enteral nutrition intervention on nerve function, systemic oxidative stress and inflammatory response in patients with hypertensive cerebral hemorrhage. Methods: A total of 98 patients with hypertensive cerebral hemorrhage who received hospitalization in the hospital between April 2015 and February 2017 were collected and divided into control group and observation group by random number table method, 49 cases in each group. Control group received routine enteral nutrition intervention and observation group received early enteral nutrition intervention. The differences in serum levels of nerve function-related indexes, oxidative stress indexes and inflammatory mediators were compared between the two groups of patients before and after intervention. Results: Before intervention, the differences in serum levels of nerve function-related indexes, oxidative stress indexes and inflammatory mediators were not statistically significant between the two groups of patients. After 1 week of intervention, serum S100B, NSE, GFAP, MBP, LPO, MDA, PCT, IL-1β, IL-6 and TNF-α levels of both groups of patients were lower than those before intervention while GSH-PX levels were higher than those before intervention, and serum S100B, NSE, GFAP, MBP, LPO, MDA, PCT, IL-1β, IL-6 and TNF-α levels of observation group were lower than those of control group while GSH-PX level was higher than that of control group. Conclusion:Early enteral nutrition intervention can effectively optimize the nerve function and suppress the systemic oxidative stress and inflammatory response in patients with hypertensive cerebral hemorrhage.

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

Early warning systems for enteral feeding intolerance in patients with stroke

Objective:The objective of this study was to construct an early warning system(EWS)to facilitate risk assessment,early identification,and appropriate treatment of enteral nutrition feeding intolerance(FI)in patients with stroke,so as to provide a reference for risk classification standards and interventions toward a complete EWSs for nursing care of stroke.Materials and Methods:Based on evidence and clinical nursing practice,a structured expert consultation method was adopted on nine experts over two rounds of consultation.Statistical analysis was used to determine the early warning index for FI in patients with stroke.Results:The expert authority coefficient was 0.89;the coefficients of variation for the two rounds of consultation were 0.088-0.312 and 0.096-0.214,respectively.There were significant differences in the Kendall’s concordance coefficient(P<0.05).Finally,22 items in five dimensions of patient age,disease,treatment,biochemical,and enteral nutrition-related factors were identified.Conclusion:The early warning index for FI in patients with a history of stroke is valid and practical.It provides a reference for the early clinical identification of FI risk.

胸腹腔镜食管癌根治术联合早期肠内营养支持治疗老年食管癌的临床观察

目的:研究胸腹腔镜根治术联合早期肠内营养支持治疗老年食管癌的效果。方法:研究对象选取2018年01月至2021年12月我院收治的96例老年食管癌患者,按照随机数字法分为观察组和对照组,每组各48例。对照组术后采取肠外营养支持治疗,观察组术后采取肠内营养支持治疗,比较两组患者术后住院时间、肛门排气时间、首次排便时间、下床活动时间、恢复饮食时,以及术前及术后7 d的营养相关状况指标白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)和体质量指数(BMI),免疫功能相关指标CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+),观察两组主要并发症的发生情况。结果:观察组住院时间、肛门排气时间、首次排便时间、恢复饮食时间均少于对照组(P<0.05);观察组术后7 d的ALB、TP、PA、BMI均高于对照组(P<0.05);观察组术后7 d的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05);观察组吻合口瘘、肺部并发症及总并发症的发生率(P<0.05),均低于对照组。结论:早期肠内营养支持可以有效改善老年患者在胸腹腔镜联合食管癌根治术后营养状态,增强免疫功能,减少并发症,促进术后恢复,具有较大临床价值。

急性胃肠功能损伤分级指导下脓毒症患者早期肠内营养的效果及对近期预后的影响

目的探讨急性胃肠功能损伤(AGI)分级指导下脓毒症患者早期肠内营养(EN)的效果及对近期预后的影响。方法回顾性选择2014年3至8月浙江省14个成人综合ICU收治的脓毒症患者102例,按照入院后1周内最差的AGI分级分为4组:无AGI组、AGIⅠ级组、AGIⅡ级组、AGIⅢ+Ⅳ级组。比较各组入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、平均动脉压(MAP)等基本资料及住院28 d生存率、无机械通气时间、抗生素使用时间、入院7 d内EN达标比例等指标。采用Kaplan-Meier生存曲线和log-rank检验评估不同AGI分级脓毒症患者生存率的差异,采用Cox回归分析脓毒症患者生存预后的独立影响因素。结果4组患者APACHEⅡ评分、SOFA评分、MAP、乳酸、无机械通气时间及抗生素使用时间比较,差异均有统计学意义(均P<0.05)。存在AGI的患者住院28 d生存率低于无AGI患者,且AGI分级越高,生存率呈下降趋势,差异均有统计学意义(均P<0.05)。入院第3天EN 80%达标、第7天EN达标的患者住院28 d生存率高于未达标组,差异均有统计学意义(均P<0.05)。Cox回归分析发现乳酸(HR=1.180,95%CI:1.045~1.340,P=0.008)、AGI分级(HR=1.304,95%CI:1.041~1.567,P=0.012)、APACHEⅡ评分(HR=1.069,95%CI:1.013~1.129,P=0.015)和SOFA评分(HR=1.183,95%CI:1.040~1.330,P=0.005)是导致脓毒症患者死亡的独立危险因素,而MAP(HR=0.969,95%CI:0.949~0.989,P=0.003)和入院第7天EN达标(HR=0.458,95%CI:0.225~0.930,P=0.031)则是保护性因素。结论基于AGI分级标准来指导脓毒症患者的早期EN具有一定的临床适用性。同时,AGI分级越高预示死亡率越高,而EN早期达标则可降低脓毒症患者的死亡率。

早期肠内营养乳剂支持疗法治疗重症脑出血患者的临床研究

目的研究早期肠内营养支持疗法治疗重症脑出血患者的临床疗效及有效性分析。方法选择2021年10月至2023年2月期间于四川大学华西医院住院的108例重症脑出血患者作为研究对象,以随机数字表法分为对照组和观察组,每组各54例。对照组给予一般鼻饲饮食,观察组给予肠内营养乳剂,比较2组营养状况、急性生理与慢性健康评分(APACHEⅡ)、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、肠黏膜屏障功能、免疫指标、并发症发生情况。结果治疗前,2组营养状况[血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)]、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能[二胺氧化酶(DAO)、D-乳酸(D-LAC)、内毒素(ET)]、免疫指标[免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)]水平比较,差异无统计学意义(P>0.05);治疗2周后,观察组营养状况、APACHEⅡ评分、NIHSS评分、GCS评分、肠黏膜屏障功能、免疫指标水平较对照组更佳,差异有统计学意义(P<0.05);观察组并发症发生率为7.41%,较对照组的29.63%更低,差异有统计学意义(P<0.05)。结论对重症脑出血患者早期给予肠内营养乳剂,能够改善患者的营养状况、肠黏膜屏障功能,增强免疫力,减少并发症,减轻神经功能缺损,促进患者病情恢复,值得推广。