Chronic intestinal pseudo-obstruction(CIPO)is a type of intestinal dysfunction presenting as symptoms of intestinal obstruction but without actual mechanical obstruction.An extremely low incidence,non-specific clinica...Chronic intestinal pseudo-obstruction(CIPO)is a type of intestinal dysfunction presenting as symptoms of intestinal obstruction but without actual mechanical obstruction.An extremely low incidence,non-specific clinical symptoms,strong heterogeneity,and no definitive cause in some patients make CIPO very difficult to diagnose correctly.Imaging and gastrointestinal manometry are commonly used.Most patients have progressive worsening of their symptoms and require intervention,and nutritional assessment and treatment are very important to determine the prognosis.With improvements in surgical techniques,small bowel transplantation is a feasible treatment option for patients with advanced CIPO;however,the long-term prognosis for CIPO patients remains unsatisfactory.Generally,the disease is rare and difficult to diagnose,which leads to clinicians’lack of understanding of the disease and results in a high rate of misdiagnosis.This review describes the characteristics of CIPO and the latest developments in diagnosis and treatment,in detail.The goal of our review is to improve clinicians'understanding of CIPO so that the disease is identified quickly and accurately,and treated as early as possible to improve patients’quality of life.展开更多
Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction ...Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction were divided into control group (n=63) and observation group (n=63) from May 2015 to May 2017 in Zhongnan Hospital of Wuhan University and Gezhouba Dam group central hospital, the control group only received parenteral nutrition, while the observation group was treated with parenteral nutrition plus alanine glutamine treatment. The expression levels of nutritional indicators, inflammatory factors, immunity and antioxidant were compared between the two groups.Results:Before and 1 d after treatment, there was no significant difference between the two groups of prealbumin (PA), albumin (ALB), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), interferon-γ (IFN-γ) and immunoglobulin (IgA, IgG, IgM), superoxide dismutase (SOD) and malondialdehyde (MDA). 1 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly lower than before the treatment, and TNF- , CRP and MDA were significantly higher than before the treatment. On the 7 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly increased compared with the 1 d after treatment, while TNF-α, CRP and MDA were significantly lower than the 1 d after the treatment, the PA, ALB, IFN-γ, IgA, IgG, IgM and SOD levels in the observation group were significantly higher than those in the control group, while TNF-α, CRP and MDA were significantly lower than those of the control group, there was no significant difference in IgA, IgG and IgM levels between the observation group and that before treatment. There was no significant difference in MDA and SOD levels between the control group and that before tre atment.Conclusions: Parenteral nutrition support in patients with colon cancer with intestinal obstruction, alamyl glutamine, can significantly improve the nutritional level, reduce the inflammatory response, enhance the immune and antioxidant functions.展开更多
AIM:To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis(EPSBO-OP).METHODS:This prospective randomized study included 70 patients dia...AIM:To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis(EPSBO-OP).METHODS:This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June2002 to January 2009.Patients were randomized into two groups:a control group received total parenteral nutrition and nasogastric(NG)tube feeding;and an intervention group received,in addition,somatostatin and dexamethasone treatment.The primary endpoints were time to resolution of bowel obstruction and length of hospital stay,and the secondary endpoints were daily NG output and NG feeding duration,treatment-related complications,postoperative obstruction relapse,and patient satisfaction.RESULTS:Thirty-six patients were allocated to the intervention group and 34 to the control group.No patient needed to undergo surgery.Patients in the intervention group had an earlier resolution of bowel obstruction(22.4±9.1 vs 29.9±10.1 d,P=0.002).Lower daily NG output(583±208 vs 922±399 mL/d,P<0.001),shorter duration of NG tube use(16.7±8.8vs 27.7±9.9 d,P<0.001),and shorter length of hospital stay(25.8 vs 34.9 d,P=0.001)were observed in the intervention group.The rate of treatment-related complications(P=0.770)and relapse of obstruction(P=0.357)were comparable between the two groups.There were no significant differences in postoperative satisfaction at 1,2 and 3 years between the two groups.CONCLUSION:Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay,and are safe for symptom control without increasing obstruction relapse.展开更多
目的探讨丙氨酰-谷氨酰胺强化营养支持对肠梗阻患者辅助性T细胞1(help T cell 1,Th1)/辅助性T细胞2(help T cell 2,Th2)值及体内微炎症状态的影响。方法选取肠梗阻患者91例,用简单随机数字表法分为研究组(n=46)与对照组(n=45)。对照组...目的探讨丙氨酰-谷氨酰胺强化营养支持对肠梗阻患者辅助性T细胞1(help T cell 1,Th1)/辅助性T细胞2(help T cell 2,Th2)值及体内微炎症状态的影响。方法选取肠梗阻患者91例,用简单随机数字表法分为研究组(n=46)与对照组(n=45)。对照组采取肠外营养支持,研究组在对照组治疗的基础上加用丙氨酰-谷氨酰胺。统计2组治疗前、后营养状态指标[转铁蛋白(transferrin,TF)、前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)]的水平、微炎症指标[白细胞介素-6(interleukin-6,IL-6)、高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]的水平、肠道屏障生化指标(二胺氧化酶、D-乳酸)水平和Th1/Th2值。结果研究组禁食及禁水时间、排气及排便时间、腹胀及腹痛缓解时间均短于对照组(P<0.05)。治疗3、7 d后,2组患者血清TF、ALB和PA的水平均增高,且研究组高于对照组(P<0.05);IL-6、hs-CRP和TNF-α的水平均降低,且研究组低于对照组(P<0.05);血清二胺氧化酶、D-乳酸的水平降低,且研究组低于对照组(P<0.05);Th1/Th2值增高,且研究组高于对照组(P<0.05)。结论采取丙氨酰-谷氨酰胺强化营养支持可改善肠梗阻患者的免疫状态和营养状态,减轻体内微炎症反应,恢复肠道屏障功能,缩短功能康复时间。展开更多
基金Supported by the Initial Scientific Research Fund of Young of Beijing Tsinghua Changgung Hospital,No.12020C1003.
文摘Chronic intestinal pseudo-obstruction(CIPO)is a type of intestinal dysfunction presenting as symptoms of intestinal obstruction but without actual mechanical obstruction.An extremely low incidence,non-specific clinical symptoms,strong heterogeneity,and no definitive cause in some patients make CIPO very difficult to diagnose correctly.Imaging and gastrointestinal manometry are commonly used.Most patients have progressive worsening of their symptoms and require intervention,and nutritional assessment and treatment are very important to determine the prognosis.With improvements in surgical techniques,small bowel transplantation is a feasible treatment option for patients with advanced CIPO;however,the long-term prognosis for CIPO patients remains unsatisfactory.Generally,the disease is rare and difficult to diagnose,which leads to clinicians’lack of understanding of the disease and results in a high rate of misdiagnosis.This review describes the characteristics of CIPO and the latest developments in diagnosis and treatment,in detail.The goal of our review is to improve clinicians'understanding of CIPO so that the disease is identified quickly and accurately,and treated as early as possible to improve patients’quality of life.
文摘Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction were divided into control group (n=63) and observation group (n=63) from May 2015 to May 2017 in Zhongnan Hospital of Wuhan University and Gezhouba Dam group central hospital, the control group only received parenteral nutrition, while the observation group was treated with parenteral nutrition plus alanine glutamine treatment. The expression levels of nutritional indicators, inflammatory factors, immunity and antioxidant were compared between the two groups.Results:Before and 1 d after treatment, there was no significant difference between the two groups of prealbumin (PA), albumin (ALB), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), interferon-γ (IFN-γ) and immunoglobulin (IgA, IgG, IgM), superoxide dismutase (SOD) and malondialdehyde (MDA). 1 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly lower than before the treatment, and TNF- , CRP and MDA were significantly higher than before the treatment. On the 7 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly increased compared with the 1 d after treatment, while TNF-α, CRP and MDA were significantly lower than the 1 d after the treatment, the PA, ALB, IFN-γ, IgA, IgG, IgM and SOD levels in the observation group were significantly higher than those in the control group, while TNF-α, CRP and MDA were significantly lower than those of the control group, there was no significant difference in IgA, IgG and IgM levels between the observation group and that before treatment. There was no significant difference in MDA and SOD levels between the control group and that before tre atment.Conclusions: Parenteral nutrition support in patients with colon cancer with intestinal obstruction, alamyl glutamine, can significantly improve the nutritional level, reduce the inflammatory response, enhance the immune and antioxidant functions.
文摘AIM:To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis(EPSBO-OP).METHODS:This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June2002 to January 2009.Patients were randomized into two groups:a control group received total parenteral nutrition and nasogastric(NG)tube feeding;and an intervention group received,in addition,somatostatin and dexamethasone treatment.The primary endpoints were time to resolution of bowel obstruction and length of hospital stay,and the secondary endpoints were daily NG output and NG feeding duration,treatment-related complications,postoperative obstruction relapse,and patient satisfaction.RESULTS:Thirty-six patients were allocated to the intervention group and 34 to the control group.No patient needed to undergo surgery.Patients in the intervention group had an earlier resolution of bowel obstruction(22.4±9.1 vs 29.9±10.1 d,P=0.002).Lower daily NG output(583±208 vs 922±399 mL/d,P<0.001),shorter duration of NG tube use(16.7±8.8vs 27.7±9.9 d,P<0.001),and shorter length of hospital stay(25.8 vs 34.9 d,P=0.001)were observed in the intervention group.The rate of treatment-related complications(P=0.770)and relapse of obstruction(P=0.357)were comparable between the two groups.There were no significant differences in postoperative satisfaction at 1,2 and 3 years between the two groups.CONCLUSION:Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay,and are safe for symptom control without increasing obstruction relapse.
