ABSTRACT
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
ABSTRACT
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/ effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
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Objective:To investigate the application and feasibility of the night-vision puncture technique in performing peripherally inserted central catheter(PICC).Methods:Seventy patients were randomly divided into ultrasound guided puncture group or modified blind puncture group,35 cases in each group.The puncture success rate,the achievement ratio of catheterization,the puncture site,arm circumference,catheterization time and complications were recorded in two groups.Results:Two groups had no significant difference in the puncture success rate,the achievement ratio of catheterization,the puncture site,arm circumference,phlebitis incidence,subcutaneous congestion (bleeding) (P ＞ 0.05).The catheterization time in modified blind puncture group was shorter than the ultrasound guided puncture group (P ＜ 0.001).In modified blind puncture group,a negative correlation (correlation coefficient:-0.475,P =0.004)between arm circumference and the puncture success rate was found.Conclusion:The puncture success rate of the modified blind puncture technique in performing peripherally inserted central catheter (PICC) is high and close to the puncture success rate of the PICC under ultrasound.Additionally,the modified blind puncture technique does not increase the incidence of complications and delay the catheter time.
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Objective To explore the change of complications and inflammatory mediators in patients at nutritional risk after intervention with fish oil after major abdominal surgery.Methods Totally 60 patients who had received extrahepatic bile duct exploration ± left lobectomy and radical surgeries for their gastrointestinal tumors in our department from September 2010 to March 2011 were enrolled in this study.Their Nutritional Risk Screening 2002 scores were ≥3 points the day after surgery.These 60 cases patients were randomly divided into fish oil group (n =30) and the control group (n =30).Both groups were treated with total parenteral nutrition isocaloric and isonitrogenous energy emulsion intralipid of 3 Ls' bags after surgery.Aslo,they were treated with electrolyte,vitamins and trace elements equally,which were adjusted according to laboratory tests.The application of parenteral nutrition was no less than 5 days,and the other treatment was provided routinely.Surgeries were performed under general anesthesia in all patients.Urinary catheter was uniformly placed preoperative,and was removed within 24 hours after surgery.The degree of surgical trauma was scored on the operative day.Fasting venous blood samples were collected for measuring the fasting interleukin (IL)-6 and tumour necrosis factor-α (TNF-α) one day before surgery and one and six days after surgery.The relevant complications were recorded.Two patients in the fish oil group withdrew from the study on the third post-operative day.Results TheIL-6 levels were (10.65 ± 4.24),(29.45 ± 9.39),and (13.37 ± 6.99) ng/Land the TNF-α levels were (2.47 ± 1.16),(23.05 ± 11.43),and (6.05 ± 2.97) ng/L in the fish oil group one day before surgery and one and six days after surgery.In the control group,in contrast,the IL-6 levels were (11.17 ± 4.67),(25.10 ± 10.13),and (17.38 ± 7.13) ng/L and the TNF-α levels were (2.70 ± 1.63),(22.11 ± 12.54),and (8.93 ± 3.61) ng/L at the corresponding time points.Comparisons of the IL-6 and TNF-α between the fish oil group and control group showed no significant difference one day before surgery and one day after surgery (P =0.787,P =0.206,P =0.983,P =0.852).Comparison of the IL-6 between the one day and six days after surgery also had no statistical significance (P =0.101).However,the decrease of IL-6 was significantly larger in the fish oil group than in the control group from day 1 to day 6 after surgery (P =0.036).The post-operative levels of TNF-α were significantly different between these two groups (P =0.024).Complications were noted in 3 cases (2 cases of infectious complications) in the fish oil group and in 6 cases in the control group (5 cases of infectious complications) (P =0.002),in which the inffectious complications were also statistically significant (P =0.001).Conclusions Patients at nutritional risks after major abdominal surgeries have higher TNF-α and IL-6 levels.Fish oil can notably reduce the TNF-α level in these patients.In addition,fish oil decreases the surgical complications,in particular the infectious complications.
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Objective To probe the changes of plasma albumin concentration and its correlation with that of blood inflammatory factors at the postoperative early stage in patients undergoing intraabdominal surgery. Methods From August 2008 to March 2009, 45 patients undergoing abdominal surgery were divided into three groups according to different types of operation with 15 cases in each group, cholecystectomy group( A), chole cystectomy plus common bile duct exploration group(B) and radical resection of alimentary duct maliguance group (C). Before the surgery and 12,24,48,72 h after operation, plasma albumin contentserum IL-6 and TNF-α concentration were measured. Results Postoperatively the content of plasma albumin did not change significantly in group A ( P ＞ 0.05 ), while that decreased after operation in group B and group C(P ＜0.01 ). The postoperative concentration of serum IL-6 and TNF-α increased in group A at 12, 24 h and 48 h after operation(P ＜0.01 ). In group B and group C IL-6 and TNF-α increased at all tested time point after operation ( P ＜ 0.01 ). The postoperative alterations of IL-6 and TNF-α were statistically different between the three groups at all time points(P ＜0.01 ). The content of plasma albumin was in a negative correlation with the concentration of IL-6 and TNF-α; ( r = - 0.376, P = 0.000; r =-0.772,P = 0.000). Conclusions The content of plasma albumin decreased at the early stage after major and moderate abdominal surgery. The content of plasma albumin was in a negative correlation with the concentration of inflammatory factors at the early stage after abdominal surgery.
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Objective: To investigate the effects of trentment with hydroxythy starch(130/0.4) on the serum albumin and immunologic function in postoperative patients with obstructive jaundice.Methods: 24 patients with obstructive jaundice were randomly divided into the control group(n=12) and hydroxythy starch(130/0.4) (HS) group(n=12). The serum ALB was detected 1d, 3d, 5d, 7d after the operation,and the immunologic index were detected 1d and 7d after the operation.Results: The ALB content of control group and HS group were not significantly different in the postoperative 1d and 7 d(P>0.05) and had significant differences in the postoperative 3 d, 5 d (P0.05).Conclusion: The ALB content of patients with obstructive jaundice may decrease postoperatively. Treatment with hydroxylthy starch(130/0.4) can alleviate the drop of the ALB content. But it has no effects on immunologic function.