Development and application of an early and timely postoperative feeding strategybased on enhanced recovery after surgery concept in old knee replacement patients / 中国实用护理杂志

Objective:The purpose of this paper is based on the concept of enhanced recovery after surgery, to discuss the timing of taking food and water in knee arthroplasty patients, as well as its feasibility and safety, so as to improve the quality of quality nursing services.Methods:The 226 knee arthroplasty patients in Luoyang Orthopedic-Traumatological Hospital (Henan Provincial Orthopedic Hospital) from September 2020 to November 2021 were selected and divided into a control group and a experimental group using the random number table method, with 113 cases in each group. The control group adopted a conventional postoperative feeding management method; the experimental group adopted the early and timely feeding management method after comprehensive assessment. The data were compared between the two groups, including the incidence and severity of postoperative nausea and vomiting within 6 h and from 6 to 24 h after surgery , the incidence of thirst and hunger at 2 h, 4 h and 6 h postoperatively, and the comfort level.Results:The incidence of postoperative nausea and vomiting was lower in the experimental group [19.5%(22/113), 13.3%(15/113)] than in the control group [32.7%(37/113), 23.9%(27/113)] within 6 h and from 6 to 24 h after surgery, and the severity (21 cases of gradeⅠ, 10 cases of gradeⅡand 6 cases of grade Ⅲ) was also lower than in the control group (17 cases of gradeⅠ, 29 cases of gradeⅡand 18 cases of grade Ⅲ), and the differences were all statistically significant ( χ2 = 5.16,4.21, Z = -2.72, P<0.05). The incidence of thirst were lower in the experimental group [14.2%(16/113), 8.0%(9/113), 2.7%(3/113)] than in the control group [26.5%(30/113), 29.2%(33/113), 40.0%(35/113) at 2 h, 4 h and 6 h postoperatively, and the incidence of hunger at 4 h and 6 h postoperatively [11.5%(13/113), 8.0%(9/113)] were lower than in the control group [32.7%(37/113), 34.5%(39/113)], with statistically significant differences ( χ2 values were 5.35 to 32.39, all P<0.05). The postoperative comfort scale scores of physiological (31.04 ± 1.00) and psychological (33.50 ± 1.45) were higher in the experimental group than in the control group (27.46 ± 1.78) and (31.37 ± 1.29), and the differences were statistically significant ( t values were -102.36 to -66.26, all P<0.05). Conclusions:Early postoperative feeding management at the right time reduces the incidence and severity of postoperative nausea and vomiting inknee arthroplasty patients. In addition, it can also reduce the incidence of thirst and hunger, and improve patients′ postoperative physiological and psychological comfort, which has a facilitating effect on achieving rapid recovery of patients.

Observation of the therapeutic effect of different time intake on patients with acute oral organophosphorus pesticide poisoning / 中国实用护理杂志

Objective@#To study the best time of early feeding in patients with acute oral organophosphorus pesticide poisoning.@*Methods@#A prospective study was conducted on 123 patients with acute oral organophosphorus poisoning admitted from January 2018 to May 2019 in Department of Emergency, the Affiliated Hospital of Binzhou Medical University. The patients were divided into four groups, A(<6 h), B(≥6 h-<12 h), C(≥12 h-<24 h) and D(≥24 h), according to the time of poisoning at the time of admission. All the patients in the four groups were fed immediately upon admission with the same method. The cholinesterase activity at 24, 48, 72, 120 h after poisoning, the incidence of rebound after poisoning, the disappearance time of clinical poisoning symptoms were compared among the four groups.@*Results@#Compared with the other three groups, group A had a statistically significant difference in the cholinesterase activity at 24, 48, 72, 120 h after poisoning (H value was 9.466-24.933, P<0.05 or 0.01). There was no significant difference between the two groups in B, C, D group (P>0.05). The incidence of rebound after poisoning in A, B, C, D group was 3.448%(1/30), 7.407%(2/29), 6.452%(2/33), 6.897%(2/31), respectively, with no statistically significant difference (χ2 value was 0.431, P>0.05). Compared with the four groups, the disappearance time of clinical poisoning symptoms in group A was shorter than that in the other three groups, and the difference was statistically significant (H value was18.199, P<0.05).@*Conclusions@#The earlier the patients ate, the faster the recovery of cholinesterase activity, the earlier the improvement of poisoning symptoms, and the incidence of gastrointestinal reaction and rebound after poisoning is not increased.The best time for early feeding is less than 6 h after poisoning.

Systematic review of the effect of early feeding after cesarean section on gastrointestinal function recovery / 中国实用护理杂志

Objective To investigate the correlation between early postoperative diet and gastrointestinal function recovery after cesarean section. Methods A computerized search was performed through The Cochrane Library, PubMed, Embase, Web of Science, CBM, CNKI, Wanfang and VIP database for randomized controlled trails (RCTs) which studied the effects of early feeding after cesarean section on gastrointestinal function recovery. The analysis was performed after searching databases, assessing quality of included studies and extracting data using RevMan5.3. Results Totally 8 RCTs involving 1474 patients were included. It showed that early eating could shorten the recovery time of bowel sounds, the time of passage of flatus, the time of first defecation (P < 0.05), but there was no significant difference in the incidence of nausea and vomiting and abdominal distention (P > 0.05). Conclusion Early eating after cesarean section can shorten the recovery time of gastrointestinal function, but it does not show advantages in improving the incidence of nausea and vomiting and abdominal distention. It is necessary to carry out in-depth study to verify.

Burn Institute of Southwest Hospital and I / 中华烧伤杂志

Dr. Wang has engaged in surgery and burn medicine for 61 years. He is one of the first generation of burn doctor in China, who treated burn patients more than ten thousands and went to dozens of cities and areas to rescue the wounded near hundred batches. He made contribution to the establishment of Chinese special scheme for treating burn patients. He established the institute lab of metabolism and nutrition in 1985, and treated burn patients and carried out research of burn metabolism and nutrition simultaneously. He developed new theory that other routes like internal organs especially intestine besides burn wound can induce hypermetabolism i. e." enterogenous hypermetabolism" . If gut works, early feeding (EF) and enteral nutrition (EN) are better than delayed feeding and parenteral nutrition, and EN or EF can promote gastrointestinal resuscitation, reduce intestine injury, modulate hypothalamus and pituitary function, and decrease hypermetabolism. At the end of the 1980s, by measuring the resting energy expenditure of 105 adult burn patients and normal adults, they worked out the first formula for calories supply in Chinese burn adults. He published 340 papers, while 50 papers were exchanged in international meeting, and published 53 monographs (as editor or associate editor in chief for 9 books). Metabolism and Nutrition in Burns is the 1st burn metabolism and nutrition book in China. We got 24 awards of nation, army, and provincial and ministerial level in science, technology, medicine, and education, and there were two awards of " National 2nd Science and Technology Award" (respectively the 1st and 2nd author). He was the chairman of Burn Institute of Southwest Hospital during 1988-1999, and the institute was appraised as " Model Unit of Grass-roots in General Logistics Department" and awarded the 1st and the 2nd collective merits during that time. He was the vice president of Chinese Burn Association and chief editor of Chinese Journal of Burns.

Effects of early enteral nutrition on patients after emergency and elective gastrointestinal surgery

Background: After gastrointestinal surgery like anastomosis, patients are usually not allowed to take feed orally for five days. This is to prevent post operative nausea and vomiting and also to protect the anastomotic site allowing it to heal. Aim: This randomized control study sought to compare the outcome of early Enteral feeding versus delayed feeding after gastrointestinal surgery. Materials and methods: 60 patients were randomly selected and classified into two groups, early feeding group and late feeding group and following were noted; anastomotic leak, infection (wound, intra-abdominal abscess, pulmonary complication, sepsis), length of hospital stay. Results: The mean length of hospital stay was 9.3 vs 10.90. The difference was 1.6 days (P value: 0.129). Wound infection was 20% vs 26.7%. 6.7% had intra-abdominal abscess in the early feeding group which was statistically insignificant. There were two patients (6.7%) with sepsis in late feeding group (p= 0.150). There were no anastomotic leak and no deaths in the both the groups. Conclusion: The present study indicated that there was no significant difference between the two groups. Late feeding doesn’t confer any significant advantage. There was no advantage of dietary restriction. Hence we recommend that early post-operative feeding is safer

Influnece of early postoperative feeding in formation of gastrointestinal anastomotic fistula and healing time in rabbits / 吉林大学学报(医学版)

Objective To observe the influence of early postoperative feeding in the healing of intestinal anastomosis in rabbits,and to clarify preliminarily the relationships between early postoperative feeding after gastrointestinal surgery and gastrointestinal anastomotic fistula formation and healing time in rabbits.Methods 48 rabbits were randomly divided into experimental group and control group, then they were treated with gastrointestinal anastomosis.The rabbits in experimental group were fed with liquid diet 24 h after operation,and the rabbits in control group were fed nothing after operation and supplied by total parenteral nutrition.Two rabbits of each group were selected for exploratory laparotomy on the 3rd,5th,7th,10th and 15th day after operation,and the healing rate of anastomosis,the anastomotic bursting pressure,the anastomotic breaking strength,and the hychoxyproline level of anastomosis were observed.Results The healing rate of anastomosis in control group was 91.6%(22/24), and the healing rate of anastomosis in experimental group was 95.8%(23/24),there was no significant difference between two groups(P>0.05).The anastomotic bursting pressures of the rabbits in two groups were decreased remarkably at the 72nd hour after operation,which was the lowest point,and they were increased remarkably on the 5th day after operation,but the anastomic bursting pressure in experimental group was a little lower than that in control group,and it reached the peak on the 7th day after operation in control group. On the 10th day after operation,the anastomic bursting pressure in control group was a little lower than that on the 7th day after operation,but the anastomic bursting pressure in experimental group reached the peak.There were no significant differences of anastomic bursting pressure at different time points between two groups(P>0.05).The anastomotic breaking strength had no significant difference between two groups at the 72nd hour after operation,both of them reached the lowest points,however the anastomtic breaking strengths in two groups were increased remarkably on the 10th day after operation,and reached the peaks.but there were no significant differences of anastomic breaking strength at different time points between two groups (P>0.05 ). The hychoxyproline level of anastomosis:in experimental group was a little lower than that in control group at the 72tnd hour after operation,and both of them reached the peaks on the 7th day after operation;but there were no significant differences of hychoxyproline levels of anastomosis at different time points between two groups(P>0.05).Conclusion Early postoperative feeding can not cause the increase of anasmotic healing time and the incidence rate of gastrointestinal anastomotic fistula.

Early Postoperative 24-Hour Continuous Jejunostomy Feeding in Esophagectomy Patients

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.

The dietary therapy and use of probiotics in the treatment of pediatric acute diarrhea

In the process of medical care of acute diarrhea in children, two pathophysiologic aspects should be considered: dehydration associated with electrolyte imbalance, and nutritional disorder. It is important to continue to provide foods easy to digest with appropriate recipes from the early stage after a remedy of dehydration using oral rehydration solution or intravenous fluid therapy according to patients' condition. Nil per os or diluted diet can slow the recovery of an intestinal function and lengthen the diarrheal period. Although the damage on the intestinal mucosa occurs from various causes, the gastrointestinal mucosa maximizes absorbing capacity by expanding the area of a surface. Early oral-feeding contributes to restoring mucosa favorably and thus facilitates a rapid improvement of symptoms. Breast-feeding should continue to be performed in the midst of rehydration, and lactose-containing regular cow's milk formula is recommended for cow's milk-fed patients after rehydration. In mild or severe acute diarrhea, administering probiotics in conjunction with feeding is expected to shorten the diarrheal period.

A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery

OBJECTIVE: This prospective randomized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations. METHODS: A total of 199 patients underwent colorectal surgery and were randomly assigned to early feeding (n = 99) or a regular diet (n = 100). Patients’ characteristics, diagnoses, surgical procedures, comorbidity, bowel movements, defecation, nasogastric tube reinsertion, time of tolerance of solid diet, complications, and length of hospitalization were assessed. RESULTS: The two groups were similar in terms of gender, age, diagnosis, surgical procedures, and comorbidity. In the early feeding group, 85.9 percent of patients tolerated the early feeding schedule. Bowel movements (1.7±0.89 vs. 3.27±1.3), defecation (3.4±0.77 vs. 4.38±1.18) and time of tolerance of solid diet (2.48±0.85 vs. 4.77±1.81) were significantly earlier in the early feeding group. There was no change between the groups in terms of nasogastric tube reinsertion, overall complication or anastomotic leakage. Hospitalization (5.55±2.35 vs. 9.0±6.5) was shorter in the early feeding group. CONCLUSIONS: The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively. Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions.

Early feeding after elective open colorectal surgery / 中华临床营养杂志

e and feasible for postcolectomy patients.

Safety of Early Postoperative Feeding after Elective Colorectal Surgery

Introduction: Several investigators demonstrated that routine nasogastric decompression after abdominal surgery was unnecessary and can be safely eliminated. Some authors suggested that early feeding could be tolerated by the majority of patients after elective colorectal surgery. PURPOSE: The aim of our study was to prospectively assess the safety and tolerability of early oral feeding after colorectal surgery. METHODS: This trial included 69 patients who underwent an colon or rectal operation between April 1997 and August 1998. Patients were randomized after the operative procedure into one of two groups. Group 1: early oral feeding-all patents received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated. Group 2: delayed feeding-all patients were treated in the traditional way with feeding only after the resolution of their postoperative ileus. Both groups had intraoperative nasogastric tubes that were removed at the end of surgery. The patients were monitored for vomiting, nasogastric tube reinsertion, time of regular diet consumption, complication, and length of hospitalization. The nasogastric tube was reinserted if two or more episodes of vomiting of more than 100 ml occurred in the absence of bowel movement. RESULTS: Sixty-nine consecutive patients were studied, 34 patients in group 1 (12 males and 22 females, mean age 58.1+/-12.7), and 35 patients in group 2 (16 males and 19 females, mean age 58.5+/-12.7). Significant differences were not noted in age and type of procedures. No significant differences were seen in rates of vomiting and overall complications. However, early feeding group well tolerated a regular diet (postoperative period to take regular diet of group 1: 5.4+/-4.0 days, group 2 : 8.1+/-4.6 days, p=0.013), and were discharged from hospital significantly earlier than the delayed feeding group(group 1: 14.0+/-5.1 days, group 2: 19.1+/-8.6 days, p=0.004). CONCLUSION: Early feeding after colorectal surgery is successfully tolerated by the majority of patients and led to earlier hospital discharge.

The effect of early enteral feeding on intestinal mucosal energy systhesis in burned rats / 肠外与肠内营养

Objectives:To investigate the effect of early enteral feeding on intestinal mucous energy systhesis in burned rats. Mothods:Wistar rats with 30% total body surface area Ⅲ degree burns were randomly divided into 3 groups:early feeding(EF) group,delayed feeding(DF) group,control group.The ATP,ADP,AMP of intestinal mucosa were detected by HPLC and energy charge were calculated according to formula. Results:The contents of ATP,ADP and energy charge in both experimental groups were all fluctuated at much lower level than those in control group,and the above indices exhibited significant decrease in DF group as compared with EF group at all time points except post burned 6 h.On the contrary,the contents of AMP increased more significantly in DF group than in EF group. Conclusions:Early feeding could increase the energy storage and alleviate the catabolism of energy rich phosphates of intestinal mucosa.