ABSTRACT
Objective To investigate the effect of early adequate enteral nutrition (EN) on diaphragmatic thickness and prognosis of mechanical ventilation (MV) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by ultrasound. Methods Sixty-two MV patients with AECOPD and feasible to receive early EN were admitted to the Department of Intensive Care Unit (ICU) of Wenling Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from April 2017 to March 2018, and they were divided into an observation group and a control group according to random number table, 31 cases in each group. Besides conventional treatment, both groups started EN (EN) within 2 days, in the observation group, the EN was adequately treated, and the target calories were gradually reached within 3 days; in the control group, nourishing feeding was given, and the target calories were gradually reached after 7 days. Ultrasound was used to measure the diaphragmatic end-expiratory muscle thickness (DTee) and end-inspiratory muscle thickness (DTei) before and after treatment for 3 days, 7 days, and the diaphragmatic thickening fraction (DTF) were calculated; in addition, the MV time, ICU time of stay, 14-day success rate of off-line and incidence of ventilator associated pneumonia (VAP) were compared between the two groups. Results There were no statistical significant differences in the comparisons of age, arterial blood gas analysis and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score etc general status, and the parameters of DTee, DTei and DTF between the two groups before treatment (all P > 0.05). No statistical significant differences in DTee were found after treatment for 3 days, 7 days and after off-line in the comparisons between the two groups (mm: 3 days was 2.69±0.12 vs. 2.68±0.15, 7 days was 2.70±0.14 vs. 2.70±0.13, off-line was 2.71±0.15 vs. 2.70±0.10, all P > 0.05); while the DTei of the two groups were decreased after treatment for 3 days of treatment, the difference between the two groups being not statistically significant (mm: 3.27±0.13 vs. 3.26±0.12, P > 0.05), but the levels of DTei in the two groups were significantly increased after treatment for 7 days and after off-line, the differences between the two groups being statistically significant (7 days: 27.26±5.25 vs. 28.74±6.39, off-line: 34.19±4.78 vs. 30.10±2.90, both P < 0.01). There was no significant difference in MV time and ICU time of stay between the two groups [MV time (days): 7.8±1.0 vs. 8.5±1.2, ICU time of stay (days): 11.4±2.6 vs. 12.1±2.8, both P > 0.05], the 14-day success rate of off-line and incidence of VAP were similar in the two groups, and the difference were not statistically significant [14-day success rate off-line: 77.42% (24/31) vs. 70.98% (22/31), incidence of VAP: 6.45% (2/31) vs. 9.68% (3/31), both P > 0.05]. Conclusion The early adequate EN therapy can improve diaphragmatic function and prognosis in MV patients with AECOPD.
ABSTRACT
Objective To investigate the effects of same calorie intake of different enteral nutrition (EN) on blood glucose in patients with mechanical ventilation.Methods A total of 60 critically ill patients who were admitted to the Department of Intensive Care Unit (ICU) of Taizhou Combined Traditional Chinese and Western Medicine Hospital and received mechanical ventilation from January 2015 to January 2017 were selected. According to the random number table method, the patients were divided into a control group and a study group, 30cases in each group. The patients in the control group were given EN suspension (nutrison fibre), patients in the study group received EN emulsion (fresubin diabetes), on the first day, 1/3 standard calorie was supplied, if the patient had no any discomfort, on the second day 1/2 standard heat was given, from the third day to the tenth day they took the full amount and achieved complete EN (TEN).The fasting blood glucose (FBG), 2 hours postprandial blood glucose (2 h PBG) and glycated hemoglobin (HbA1) level before and after the EN for 10 days were observed, the gastrointestinal tolerance, dosage of insulin, inflammation related indexes, the incidence of ventilator associated pneumonia (VAP) and fatality were analyzed in the two groups.Results Compared with those before EN support, the FBG and 2 h PBG were decreased after the support for 10 days in both groups, the dosage of insulin used was decreased, and the degrees of decrease were more marked in the study group than those in the control group [FBG (mmol/L): 8.03±1.69 vs. 8.87±1.75, 2 h PBG (mmol/L): 8.25±1.98 vs. 10.43±2.34, dosage of insulin (U/d): 38.02±3.24 vs. 40.87±3.48, allP < 0.05], but there was no statistical significant difference in HbA1 level between the two groups [(7.36±1.53)% vs. (7.37±1.29)%,P > 0.05]. The incidence of gastrointestinal intolerance was lower in study group than that in control group [6.67% (2/30) vs. 10.0% (3/30)], but there was no statistical significant difference between the two groups (P > 0.05). Compared with those before EN support, the levels of γ-interferon (IFN-γ) were significantly increased (P < 0.05), while the tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-8) levels were significantly decreased after 10 days of EN support, but no statistical significant differences were found (allP > 0.05) between the two groups. During the treatment in the two groups, the incidence of VAP and mortality were relatively low, and there were no statistical significant differences were seen between the two groups (bothP > 0.05).Conclusions The blood glucose control of fresubin diabetes in patients with mechanical ventilation is superior to that of nutrison fibre, fresubin diabetes can reduce the dosage of insulin, decrease the levels of inflammatory factors and conducive to the prognosis of the patients.
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Objective To investigate the effect of perioperative regional intra peritoneal chemotherapy on postoperative recurrence of advanced gastric cancer.Methods Eighty-six patients with advanced gastric cancer were divided into observation group (44 patients) and control group (42 patients) according to the aspiration of patients.All patients received 2-4 cycles of chemotherapy of PCF regimen before and after surgical treatment.Observation group was combined with perioperative regional intraperitoneal chemotherapy,and control group only received surgical treatment.The treatment effectiveness and the status of postoperative recurrence were compared between two groups.Results The response rate of control group and observation group were 76.2％ (34/42) and 93.2％ (41/44),respectively.There was significant difference (P ＜ 0.05).The adverse effect of the two groups were gastrointestinal adverse reaction and myelosuppression.There was no significant difference between two groups (P＞ 0.05).After followed up for 3-36 months,6 patients in observation group occurred recurrence,and 14 patients in control group occurred recurrence.The long-term recurrence rate (＞ 24 months) between two groups had significant difference (P ＜ 0.05).Conclusion Perioperative regional intraperitoneal chemotherapy has better effectiveness on inhibiting the postoperative recurrence of advanced gastric cancer.