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Objective To investigate the therapeutic value of enteral nutrition in disease activity, nutritional status and complications of patients with Crohn's disease (CD).Methods From January 2015 to February 2017,64 CD patients with malnutrition in the First Affiliated Hospital of Soochow University were selected and received basic treatment with enteral nutrition.Before enteral nutrition and three months after therapy,white blood cell (WBC),red blood cell (RBC),hemoglobin,platelet,total protein,albumin,erythrocyte sedimentation rate (ESR)and C-reaction protein (CRP)were examined;Crohn's disease activity index (CDAI)was calculated;abdominal and perianorectal lesions of patients were observed by small intestinal computed tomography (CT ), abdominal ultrasound and anus magnetic resonance imaging (MRI).Paired t test and McNemar test were performed for statistical analysis.Results Compared with those before enteral nutrition treatment,who received enteral nutrition for three months, the levels of WBC,platelet,ESR,CRP and CDAI scores of CD patients were lowered ((7.83±3.61)× 109/L vs.(4.82±2.26)×109/L,(272.52±191.79)×109/L vs.(166.17±67.18)×109/L,33.5 mm/1 h vs.5.5 mm/1 h,21.70 mg/L vs.1.97 mg/L,220.75±119.71 vs.33.48 ±20.22),and the differences were statistically significant (t＝13.14 and 10.02;Z＝501.50 and 57.80;t＝25.44,all P＜0.01).The levels of RBC,hemoglobin,total protein,albumin increased ((4.17 ±0.97)×1012/L vs. (4.97±0.98)×1012/L,(115.33±40.38)g/L vs.(133.88±43.87)g/L,(57.82±19.46)g/L vs. (69.68±16.53)g/L,(34.32 ±16.85)g/L vs.(43.29 ±17.57)g/L),and the differences were statistically significant (t＝-10.45,-7.12,-11.44 and -6.87,all P＜0.01).The CDAI scores of patients with remission of abdominal pelvic diseases and intestinal stenosis were both lower than those of patients without remission (214.3±113.54 vs.296.77±60.24,219.31±104.74 vs.221.04±121.47), and the differences were statistically significant (both t＝28.91,both P＜0.05).Three months after enteral nutrition treatment,the remission patients of perianal lesions,abdominal pelvic diseases and intestinal stenosis were 28,14 and 18 cases,respectively.Conclusion CD patients can achieve clinical remission with enteral nutrition treatment,which also prevent and treat CD related malnutrition and may prove to be a safe and first-line therapeutic approach.
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ObjectiveTo explore the influence of early enteral nutrition (EEN) on the immune function and outcome in patients with severe traumatic brain injury.MethodsTotally 131 patients with severe traumatic brain injury who were admitted to the Intensive Care Unit of our hospital between March 2010 and March 2011 were enrolled in this study.Among them,69 were in EEN group and 62 were in control group.On day 7,humoral immune function was measured using automatic biochemistry analyzer,and the peripheral blood lymphocyte subset proportions were measured using flow cytometry.The complications were recorded in the initial 7 days after trauma.ResultsCompared with the control group,the EEN group had significantly lower incidences of complications including glucose metabolism disorder,diarrhea/stomach intestine distend,infection,multiple organ dysfunction syndrome,and stress ulcer on day 7 ( P =0.000,0.002,0.001,0.004,and 0.002).Hospital mortality in the EEN group was also significantly lower than that in control group ( P =0.028).The serum levels of IgM and IgG in EEN group were significantly higher than in control group ( both P =0.000),whereas the serum levels of C3 and C4 in the EEN group were significantly lower ( both P =0.000).IgA showed no significant difference between these two groups (P =0.144).The serum levels of CD3 + CD4 + T lymphocytes,CD4 +/CD8 + T lymphocytes,and CD19 + lymphocytes in the EEN group were significantly higher than in control group (all P =0.000),while CD3 + CD8 + T lymphocytes showed no significant difference ( P =0.070 ),The serum level of CD16+ CD56+ T lymphocytes in the EEN group was significantly lower than that in control group (P =0.026).ConclusionPatients with severe traumatic brain injury have good tolerance of EEN,which may enhance the immune function and improve the outcome of the patients.
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Objective To investigate the influence of enteral nutrition (EN) via feeding pump-based continuous infusion (FPBCI) on nutrition support-associated complications in stroke patients. Methods Totally 53 patients were randomized into BPBCI group (n = 28) and control group (bolus feeding) (n = 25 ). The nutrition support-associated complications including bloating, diarrhea, hyperglycemia, and regurgitation-associated low respiratory tract infection were compared between these two groups. Results The incidences of nutrition support-associated complications were significantly lower in BPBCI group than in control group (bloating: 14.3%vs. 64.0%, P=0.0002; diarrhea: 25.0% vs. 52.0%, P=0.0429; hyperglycemia: 17.9% vs. 44.0%, P=0. 0385 ). There was no significant difference in regurgitation-associated lower respiratory tract infection between these two groups (32. 1% vs. 40.0% , P = 0. 5516). Conclusion Compared with conventional bolus feeding,BPBCI may greatly decrease tube-feeding related complications.
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Objective To evaluate the influence of early entemal nutrition and parenteral nutrition support on gastric juice pH in patients with severe brain injury. Methods Totally 168 patients with severe brain injury ( Glasgow Coma Scale ≤ 8 ) admitted to our hospital from January 2007 to May 2009 were equally and randomly divided into early enternal nutrition (EEN) group and parenteral nutrition (PN) group. Gastric juice pH and upper gastrointestinal hemorrhage were monitored on admission and on the 3rd, 5th, and 7th day after admission. Results The gastric juice pH was significantly decreased in patients with severe brain injury. In addition, it was significantly higher in EEN group than in PN group on the 3rd, 5th, and 7th day after admission ( P ＜ 0. 001 ). The alimentary tract hemorrhage incidence showed no difference on admission between two groups but was significantly lower in the EEN group on the 3rd, 5th, and 7th day ( P ＜ 0. 05 ). Conclusions Hypersecretion of gastric acid may occur in patients with severe brain injury. EEN can neutralize gastric acid and increase gastric juice pH,which may lead to the decrease of upper gastriontestiual hemorrhage. Monitoring of the gastric juice pH also can provide a warning message of stress ulcer bleeding.
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Objective To investigate the effect of rice water on prevention of diarrhea in patients with traumatic head injury undergoing enternal nutrition. Methods 110 patients with traumatic head injury in neurosurgery department were selected and randomly divided into the observation group and the control group.The observation group was fed with rice water in the early two days of entemal nutrition and then begun with nutrient solution on the third day, as to the control group,patients were fed with nutrient solution at the beginning of enternal nutrition. Incidence of diarrhea in these two groups were viewed and underwent χ2 test. Results The number of samples with diarrhea in the observation group(3 cases) was significantly less than that of the control group (12 cases). Conclusions Feeding with rice water can clean the intestine, regulate the function of gastrointestinal tract and reduce the incidence of diarrhea obviously in patients with traumatic head injury during the early period of enternal nutrition.
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Objectives:To discuss clinical significance of enternal nutrition of Nutrison fibre in neurosurgical coma patients. Methods:The study group(20 cases,GCS≤5) was fed gastrically with Nutrison fibre by a nasal feeding tube, and the control group(20 cases,GCS≤5) was supported with common fluid diet.In all cases,triceps skin fold,blood sugar,albumin,total lymphocyte count,complications and nitrogen balance were observed. Results:There were not significant differences between the study group and the control group in nutritional status,but the rate of complication in study group was obviously lower than that in control group. Conclutions:Enteral nutrition with Nutrison fibre can decrease the complications in nurosurgical coma patients and improve the quality of life.