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@#Objective To systematically evaluate the efficacy and safety of jejunostomy tube versus nasojejunal tube for enteral nutrition after radical resection of esophageal cancer. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched to collect the clinical effects of jejunostomy tube versus nasojejunal nutrition tube after radical resection of esophageal cancer from inception to October 2021. Meta-analysis was performed using RevMan 5.4 software. Results Twenty-six articles were included, including 17 randomized controlled studies and 9 cohort studies, with a total of 35 808 patients. Meta-analysis results showed that: in the jejunostomy tube group, the postoperative exhaust time (MD=–4.27, 95%CI –5.87 to –2.66, P=0.001), the incidence of pulmonary infection (OR=1.39, 95%CI 1.06 to 1.82, P=0.02), incidence of tube removal (OR=0.11, 95%CI 0.04 to 0.30, P=0.001), incidence of tube blockage (OR=0.47, 95%CI 0.23 to 0.97, P=0.04), incidence of nasopharyngeal discomfort (OR=0.04, 95%CI 0.01 to 0.13, P=0.001), the incidence of nasopharyngeal mucosal damage (OR=0.13, 95%CI 0.04 to 0.42, P=0.008), the incidence of nausea and vomiting (OR=0.20, 95%CI 0.08 to 0.47, P=0.003) were significantly shorter or lower than those of the nasojejunal tube group. The postoperative serum albumin level (MD=5.75, 95%CI 5.34 to 6.16, P=0.001) was significantly better than that of the nasojejunal tube group. However, the intraoperative operation time of the jejunostomy tube group (MD=13.65, 95%CI 2.32 to 24.98, P=0.02) and the indent time of the postoperative nutrition tube (MD=17.81, 95%CI 12.71 to 22.91, P=0.001) were longer than those of the nasojejunal nutrition tube. At the same time, the incidence of postoperative intestinal obstruction (OR=6.08, 95%CI 2.55 to 14.50, P=0.001) was significantly higher than that of the nasojejunal tube group. There were no statistical differences in the length of postoperative hospital stay or the occurrence of anastomotic fistula between the two groups (P>0.05). Conclusion In the process of enteral nutrition after radical resection of esophageal cancer, jejunostomy tube has better clinical treatment effect and is more comfortable during catheterization, but the incidence of intestinal obstruction is higher than that of traditional nasojejunal tube.
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Objective:To compare the efficacy and safety of providing nasogastric (NG), nasojejunal (NJ), and parenteral nutrition (PN) support to pancreatitis patients who were intolerant to oral feeding.Methods:One hundred pancreatitis patients who were intolerant to oral feeding treated at the Xuanwu Hospital of the Capital Medical University from October 2018 to September 2020 were retrospectively studied. They were divided into three groups based on the nutritional support given to them: the NG group, NJ group, and PN group. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), nutritional risk screening 2002 (NRS2002), hemoglobin, albumin, pre-albumin and other clinical data were recorded and compared among the three groups.Results:After nutrition support treatments, the hemoglobin, albumin and pre-albumin levels were significantly better than before giving nutrition support, and the APACHE Ⅱ scores were significantly improved in all the groups. The NRS2002 scores were significantly better in the NJ group ( Z=2.28, P=0.023) and the NG group ( Z=1.99, P=0.046). With compared to the PN group, the albumin and pre-albumin levels were significantly higher in the NG and NJ groups, and the NRS2002 score after giving nutrition support treatment was significantly lower ( P<0.05). Compared with the PN group, the APACHE Ⅱ score ( t=2.18) and the hemoglobin levels ( t=2.04) were significantly better in the NJ group ( P<0.05). The overall incidence of complications in the NJ group was 41.2% (14/34), which was significantly lower than the NG group [78.8%(26/33), χ 2=5.41, P=0.020] and the PN group [66.7% (22/33), χ 2=4.35, P=0.037]. Conclusion:Enteral nutrition support through NG and NJ are better than PN in acute pancreatitis patients who were intolerant to oral feeding.
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Objective:To investigate the effectiveness and safety of nasojejunal tube placement in children by gastroscopic drafting method.Methods:We retrospectively analyzed the clinical data of children with nasojejunal tube placement from January 2016 to December 2021 in our hospital, and compared the operation time, successful rate and complications of nasojejunal tube placement in the gastroscopic wire drawing method retraction group(observation group)and the gastroscopic foreign body clamp placement method placement group(control group).Results:All of the 167 cases, 65 cases were in observation group and 102 cases in control group.There were no significant differences in sex and age between two groups( P>0.05). The operation time was(6.7±0.8)min in observation group and(8.2±1.3)min in control group, and the difference was statistically significant( t=8.312, P<0.001). The successful rate was 100% in observation group and 96% in control group.One child in control group complicated with the mucosal erosion and bleeding in the duodenal bulb, while the observation group with no erosion, bleeding, perforation, and other complications. Conclusion:The gastroscopic wire drawing method of nasojejunal tube placement has a shorter operation time, higher successful rates, and lower complication rates, which is significantly superior to the gastroscopic foreign body clamp placement method.
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Resumen El manejo de la nutrición en pancreatitis aguda ha sido cuestión de debate. Durante muchos años el concepto de reposo pancreático fue generalizado y aceptado en el manejo de la pancreatitis aguda. Actualmente se conoce que la nutrición temprana permite mantener la integridad de la barrera intestinal, que previene la aparición de complicaciones infeccionas y se asocia con una menor estancia hospitalaria, menos complicaciones y un mejor pronóstico. En esta revisión se discuten las principales ventajas de la nutrición temprana en pancreatitis aguda, la seguridad de la misma y la vía de administración.
Abstract Nutrition management in acute pancreatitis has been a matter of debate worldwide. For many years, the concept of pancreatic rest was widespread and accepted to treat acute pancreatitis. However, current knowledge of early nutrition allows maintaining the intestinal barrier's integrity, preventing the occurrence of infectious complications, which is associated with a shorter hospital stay, fewer complications, and better prognosis. This review presents the main advantages of early nutrition in acute pancreatitis, its safety, and the route of administration.
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Humans , Pancreatitis , Nutritional Sciences , RestABSTRACT
Objective To explore the clinical efficacy of enteral nutrition combined with traditional Chinese medicine (TCM) acupuncture and moxibustion for treatment of craniocerebral trauma complicated by gastric paralysis.Methods A prospective study was conducted.One hundred and sixty-seven patients with craniocerebral trauma complicated by gastric paralysis admitted to the Department of Neurological Critical Care Medicine in Affiliated Hospital of the Logistics University Chinese People's Armed Police Force from January 2013 to October 2015 were divided into single group (83 cases) and combined group (84 cases) according to the random number table method.The basic treatment program was the same in the two groups.On the basis of gastrointestinal decompression,a nasojejunal tube was indwelled in the digestive canal of the patients in single group,and the nutrient food could be given by dripping slowly and continuously through the tube into the body,while in the combined group,they were additionally treated by acupuncture and moxibustion at auricular point,zusanli and neiguan acupoints,1 time a day,each time 30 minutes.Both groups were treated consecutively for 30 days,and then the clinical efficacies were evaluated.Before and after treatment in both groups,the changes of total serum protein (TP),pre-albumin (PA),hemoglobin (Hb) were observed;the incidences of reflux,vomiting,abdominal distension,diarrhea,pulmonary infection and intestine derived infection were also evaluated.Results After treatment the levels of TP,PA,Hb were significantly higher in combined group than those in the single group [TP (g/L):36.97 ± 2.17 vs.33.14± 2.13,PA (mg/L):215.19 ± 7.91 vs.203.15 ± 6.12,Hb (g/L):126.73 ± 11.17 vs.117.61 ± 11.24,all P ＜ 0.01].The numbers of patients with reflux,vomiting,abdominal distension,diarrhea were significantly lower in combined group than those in the single group,respectively (the number of patients had reflux being 15 cases vs.31 cases,vomiting 13 cases vs.28 cases,abdominal distension 17 cases vs.29 cases,diarrhea 17 cases vs.31 cases) and pulmonary infection (17 cases vs.29 cases),intestine derived infection (4 cases vs.12 cases),all the above comparisons showing statistically (all P ＜0.05).Conclusions Enteral nutrition combined with acupuncture and moxibustion treatment can effectively enhance the patients' nutritional status,reduce gastrointestinal dysfunction and the incidence of complications,thus the prognosis of patients with craniocerebral trauma complicated by gastric paralysis is obviously improved.
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Objective To assess the effect of Chinese Rhubarb in assisting the treatment of severe acute pancreatitis (SAP) by nasojejunal tube (NJ) and nasogastric tube (NG).Methods Cochrane Library, PubMed, Embase, Science Citation Index Expanded-SCIE, EBSCO-CINAHL Complete, SinoMed, VIP network and Wan Fang net were retrieved systematically and randomized controlled trails (RCT) that involved in Chinese rhubarb assisting the treatment of SAP by NJ and NG were searched.According to eligibility and extraction standards, 2 researchers independently selected relevant literature and extracted the relevant data.The quality of literature was evaluated using criteria published by Australian Evidence-Based Health Care Center (2008).RevMan5.3 software was employed for Meta analysis.Results Eleven RCTs were enrolled and the quality of all the 11 papers was B grade.Compared with NG, NJ had lower score of APACHE-Ⅱ, shorter time of decreased CRP, amylase activity, IL-6 and IL-1, and shorter recovery time of bowel function and abdominal pain, and the differences were statistically significant (P<0.01).However, there were no significant differences between two groups on complication rate, mortality, the rate of bowel function failure, the rate of surgical operation and recovery rate.Conclusions Chinese Rhubarb by NJ irrigation in assisting the treatment of SAP can rapidly alleviate abdominal pain, promote bowel function recovery and reduce inflammatory reaction, which had better efficacy than NG.
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Objective To compare the clinical efficacy and safety of Qingyi Decoction (a preparation of Chinese herbal medicine) between two different routes of the administration by using nasogastric tube or nasojejunal tube for treatmnent of severe acute pancreatitis (SAP).Methods A total of 79 SAP patients enrolled were randomly divided into nasogastric tube group (n =41) and nasojejunal tube group (n =38) according to the random number table method.In addition to the conventional therapy,they were treated with Qingyi Decoction administered by using nasogastric tube or nasojejunal tube.Results After treatment for 14 days,the levels of C-reactive protein (CRP),procalcitonin (PCT) and white blood cell count (WBC),urinary bladder pressure,and APACHE Ⅱ score in nasojejunal tube group were significantly lower than those in nasogastric tube group (P ＜ 0.05).The time required for the recovery of bowel sounds,length of abnormal serum amylase persistence,the duration of abdominal pain,the time necessary for mechanical respiratory support in nasojejunal tube group was significantly shorter than those in nasogastric tube group.The blood fungus infection rate and pulmonary fungus infection rate in nasojejunal tube group were significantly lower than those in nasogastric tube group,and 28-day survival rate in nasojejunal tube group was significantly higher than that in nasogastric tube group (P ＜ 0.05).Conclusion The nasojejunal tube route for the administration of Qingyi Decoction for the treatment of SAP can effectively alleviate the severity of patient's condition,shorten the time required for improving clinical symptoms,reduce the incidence of morbidity and mortality,and it is worthy of further popularization in clinical practice.
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Objective To investigate the complications of different enteral nutrition in patients after surgery for massive cerebellar infarction,so as to guide rational application of enteral nutrition in patients.Methods Forty-nine patients with massive cerebellar infarction were divided into three groups randomly:conventional nasogastric tube feeding group (group A,n =12),nasogastric tube feeding plus gastric motor drug group (group B,n =18),and nasojejunal tube feeding group (group C,n =19).The incidences of diarrhea,reflux,aspiration,upper gastrointestinal bleeding and aspiration pneumonia within 3 weeks after initiation of enteral nutrition were observed and compared among the groups.Results The incidence of diarrhea showed no statistically significant difference among the 3 groups (x2 =0.092,P =0.955).Compared with group A,the incidences of reflux,aspiration and aspirafion pneumonia were significantly lower in group B and group C (P ＜ 0.05),and lower in group C compared with group B (P ＜ 0.05).Compared with group C,the incidence of upper gastrointestinal bleeding was significantly lower in group C than in group A and group B (x22 =4.748,P2 =0.029;x23 =4.284,P3 =0.038),but the difference between group A and group B was not significant (x21 =0.000,P1 =1.000).Conclusions Because of the unique pathophysiological features in patients after surgery for massive cerebellar infarction,early enteral nutrition by conventional nasogastric tube feeding may be inappropriate.Nasogastric tube feeding plus gastric motor drug may be applied in mild case with short course of disease.Nasojejunal tube feeding may be the approach of choice for enteral nutrition in critical patients with massive cerebellar infarction for its association with lower incidence of complications.
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Objective To explore the application and effect of modified-type nasojejunal tube of early enteral nutrition in severe traumatic brain injury patients. Methods 60 sever brain injury patients were collected in the neurosurgery ward of our hospital. The patients were divided into control group and trial group by random number table. The patients in control group were treated with normal spiral nasojejunal tube, and the patients in trail group were given modified-type nasojejunal tube. The study mainly researched the success rate of intubation, the operation time of two groups, the recovery time of gastropareaia and so on. Results The success rate of intubation of experimental group was 93.3%(28/30) which was significantly higher than 73.3% (22/30) in the control group (χ2=4.320, P0.05). The satisfaction of patient or family of experimental group was 93.3%(28/30) which was significantly higher than 60.0%(18/30) of the control group (χ2=9.317, P<0.05). Conclusions The modified-type nasojejunal tube was conducive to improve the success rate of intubation. The symptoms of gastroparesis were recovered early. The modified-type nasojejunal tube was easy operation, suitable for beginners and young nurses. The satisfaction of patient or family was higher.
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Objective: To evaluate the intestinal trophic effects and adverse reactions of nasojejunal and jejunostomy tube im-plants on patients with total gastrectomy. Methods:A total of 86 patients with advanced gastric cancer were randomly and equally di-vided into two groups. Groups A and B received enteral nutrition therapies through nasojejunal and jejunostomy feeding tube implants, respectively. The therapeutic efficacy of the two methods of enteral nutrition therapy and the corresponding adverse reactions observed in the two groups were compared. Results:Group B patients demonstrated shorter anal evacuation and defecation times than group A patients, the difference is statistically significant (P0.05). Nonetheless, the patients in group B tolerated the treatment well compared with those in group A (P0.05). Conclusion:Patients subjected to total gastrecto-my showed higher tolerance to jejunal tube implants for enteral nutrition than to nasojejunal tube implants, indicating that jejunal tube implants can be used to improve the nutritional status of patients.
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Objective To investigate the effects of electroacupuncture (EA) on the implementation of blind nasojejunal (NJ) tube placement and enteral nutrition (EN) in neurosurgical severe coma patients in intensive care unit (ICU).Methods Seventy-nine neurosurgical severe coma patients admitted to ICU were randomly divided into conventional group (blind NJ tube placement,n =40) and EA group (NJ placement and EA,n =39).EA was performed after NJ tube placement at bilateral acupoints Zusanli (ST36) and Hegu (L14) points using EA treatment instrument.The impelling distance of NJ tube were measured and the success rate of NJ tube placement were calculated.The postoperative complications were observed.Results The difference of NJ tube impelling distances at the 24th,48th,and 72th hours after surgery in EA group were significant longer than that in conventional group (P ＜ 0.05).The success rates of NJ tube placement at the 24th and 72nd hours after surgery in EA group were significantly better than that in conventional group (P ＜ 0.05).Their EN calories qualifiedness rate in 72 hours also increased significantly compared with conventional group and the proportion of patients assisted with parenteral nutrition decreased (P ＜0.05).The postoperative complications including alimentary tract hemorrhage,vomiting,and abdominal distension decreased remarkably in EA group compared with conventional group (P ＜ 0.05).Conclusions EA stimulation at acupoints could promote the gastrointestinal peristalsis of neurosurgical severe coma patients and elevate the success rate of blind NJ tube placement,so it is beneficial for the implementation of early enteral nutrition (EEN).