Objective:To study the effect of glutamine nutrition support on the intestinal mucosal barrier function and inflammatory response in patients with severe acute pancreatitis.Methods:Patients with severe acute pancreati...Objective:To study the effect of glutamine nutrition support on the intestinal mucosal barrier function and inflammatory response in patients with severe acute pancreatitis.Methods:Patients with severe acute pancreatitis who were treated in Pengzhou People's Hospital between May 2014 and November 2016 were selected as the research subjects and randomly divided into two groups, control group received conventional symptomatic treatment and conventional enteral nutrition intervention, and Gln group received conventional symptomatic treatment and glutamine enteral nutrition intervention. The contents of intestinal mucosal barrier damage markers and inflammatory mediators in serum as well as the expression of inflammatory signaling molecules in peripheral blood were detected before and after treatment;the number of intestinal flora was detected after treatment.Results:After treatment, LPS, DAO, HBD2, TNF-α, sTREM-1, IL-1β and IL-6 levels in serum as well as TLR4, NF-kB, MyD88 and p38MAPK mRNA expression in peripheral blood mononuclear cells of both groups of patients were significantly lower than those before treatment, LPS, DAO, HBD2, TNF-α, sTREM-1, IL-1β and IL-6 levels in serum as well as TLR4, NF-kB, MyD88 and p38MAPK mRNA expression in peripheral blood mononuclear cells of Gln group after treatment were significantly lower than those of control group, and the number of lactobacillus, bifidobacterium and bacteroides were significantly higher than those of control group while the number of escherichia coli and enterococcus were significantly lower than those of control group.Conclusion: Glutamine nutrition support for severe acute pancreatitis can reduce the intestinal mucosal barrier function injury and inhibit the inflammatory response activation.展开更多
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 wer...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.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
BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate ...BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate therole of individually staged nutritional support (ISNS) in thetreatment of SAP.METHODS: One hundred patients with SAP admitted toour hospital from January 1997 to October 2002 were ran-domly divided into total parenteral nutrition group (TPNgroup, 50 patients) and individually staged nutrition group(individualized group, 50 patients), between which thetherapeutic outcome and the incidence of complicationswere carefully analyzed.RESULTS: Compared with the TPN group, the individuali-zed group had less complications (62 vs 94 patients) inclu-ding incubation related complications (2% vs 16%), super-infections (8% vs 30%), hepatic functional insufficiency(4% vs 24%) and intra-peritoneal infections (4% vs 12%),in addition to a sooner restoring of oral nutrition (18.5 vs24.8 days, P<0.05), a shorter hospital stay (24.5 vs 30.2days) and a lower hospital cost (4.1 vs 5.8 10 000 yuan, P<0.05).CONCLUSION: ISNS, which provides SAP patients withsufficient energy and nutrients according to their truepathological status, is an ideal nutrition planning with low-ered incidence of complications, shortened hospital stayand lightened financial burden.展开更多
Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clea...Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.展开更多
文摘Objective:To study the effect of glutamine nutrition support on the intestinal mucosal barrier function and inflammatory response in patients with severe acute pancreatitis.Methods:Patients with severe acute pancreatitis who were treated in Pengzhou People's Hospital between May 2014 and November 2016 were selected as the research subjects and randomly divided into two groups, control group received conventional symptomatic treatment and conventional enteral nutrition intervention, and Gln group received conventional symptomatic treatment and glutamine enteral nutrition intervention. The contents of intestinal mucosal barrier damage markers and inflammatory mediators in serum as well as the expression of inflammatory signaling molecules in peripheral blood were detected before and after treatment;the number of intestinal flora was detected after treatment.Results:After treatment, LPS, DAO, HBD2, TNF-α, sTREM-1, IL-1β and IL-6 levels in serum as well as TLR4, NF-kB, MyD88 and p38MAPK mRNA expression in peripheral blood mononuclear cells of both groups of patients were significantly lower than those before treatment, LPS, DAO, HBD2, TNF-α, sTREM-1, IL-1β and IL-6 levels in serum as well as TLR4, NF-kB, MyD88 and p38MAPK mRNA expression in peripheral blood mononuclear cells of Gln group after treatment were significantly lower than those of control group, and the number of lactobacillus, bifidobacterium and bacteroides were significantly higher than those of control group while the number of escherichia coli and enterococcus were significantly lower than those of control group.Conclusion: Glutamine nutrition support for severe acute pancreatitis can reduce the intestinal mucosal barrier function injury and inhibit the inflammatory response activation.
文摘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.
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.
文摘BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate therole of individually staged nutritional support (ISNS) in thetreatment of SAP.METHODS: One hundred patients with SAP admitted toour hospital from January 1997 to October 2002 were ran-domly divided into total parenteral nutrition group (TPNgroup, 50 patients) and individually staged nutrition group(individualized group, 50 patients), between which thetherapeutic outcome and the incidence of complicationswere carefully analyzed.RESULTS: Compared with the TPN group, the individuali-zed group had less complications (62 vs 94 patients) inclu-ding incubation related complications (2% vs 16%), super-infections (8% vs 30%), hepatic functional insufficiency(4% vs 24%) and intra-peritoneal infections (4% vs 12%),in addition to a sooner restoring of oral nutrition (18.5 vs24.8 days, P<0.05), a shorter hospital stay (24.5 vs 30.2days) and a lower hospital cost (4.1 vs 5.8 10 000 yuan, P<0.05).CONCLUSION: ISNS, which provides SAP patients withsufficient energy and nutrients according to their truepathological status, is an ideal nutrition planning with low-ered incidence of complications, shortened hospital stayand lightened financial burden.
文摘Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.
