ABSTRACT
Objective To compare the effect of different enteral nutritional support methods in elderly patients with severe pneumonia.Methods Elderly patients (average age over 65 years) with severe pneumonia admitted to our hospital from June 2015 to June 2018 were selected as the study subjects,and 86 patients finally completed the study.The patients were randomly divided into the control group and observation group with 43 patients in each group,and nasojejunal tubes were placed for patients in both groups.Patients in the observation group were fed with enteral nutrition emulsion through continuously-heated nutritional pump,while patients in the control group was meal served with enteral nutrition emulsion.Changes in blood biochemical parameters,immune indexes,inflammation indexes,oxygenation indexes,the GIDF and SOFA scores as well as curative effect (mechanical ventilation time and effective rate of treatment) were monitored and compared before and after 10 days of nutritional support treatment.SPSS 20.0 statistical software package was used for data analysis,and self paired t-test was used for comparison before and after intervention in the same group,x2 test was used in comparison between different groups,and the counting data was expressed as the rate (n,％).Results There was no significant difference in baseline data between patients in the two groups (P＞0.05).After ten days of intervention,compared with the control group,the levels of serum albumin and prealbumin in the observation group were higher [(31.22±2.36) g/L and (0.29±0.24) g/L,P=0.015 and P=0.023],the immune indexes were higher [IgG (13.24±0.70) g/L,P=0.020;IgM (1.43±0.19) g/L,P=0.011;CD4+/CD8+ 1.55±0.49,P=0.043],the inflammation indexes were lower [IL-6 (312.54±42.53) pg/mL,P=0.031;PCT (1.56±0.81) ng/mL,P=0.017],the oxygenation indexes were better [PaO2/FiO2 (315.58±20.37) mmHg,P=0.019],and the GIDF and SOFA scores were significantly lower[(10.6±l.2) and (8.5±1.7),P=0.041 and P=0.038].The clinical outcome showed that the mechanical ventilation time in the observation group was significantly shorter [(6.01±1.48) d vs (8.12 ± 1.17)d,P=0.039],and the total effective rate of treatment was better than the control group (67.44％ vs 41.86％,P=0.027).Conclusions Enteral nutrition support through continuously-heated nutritional pump can improve the nutritional status of elderly patients with severe pneumonia,reduce the incidence of gastrointestinal dysfunction,maintain stable organ fuction,thus resulting in better prognosis in elderly patients with severe pneumonia.
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Objective To analyze the changes in nutritional status changes of pediatric acute lymphoblastic leukemia (ALL) patients before and after chemotherapy and to evaluate the effects of enteral nutritional support on the states of nutrition and complication of chemotherapy.Methods Sixty-two newly diagnosed ALL patients from Novem-ber 2012 to December 2013 in Center of Hematology,Beijing Children's Hospital Affiliated to Capital Medical University were enrolled in this study.Patients were randomly assigned into an intervention group and a control group.During the induction and the early consolidation chemotherapy,the control group was given routine low fat diet routinely,and the intervention group was given Nestle peptamen [20 mL/(kg · d)] as the enteral nutritional support,meanwhile the routine low fat diet was also given.Changes in the nutritional status before and after chemotherapy and effectiveness of nutritional complementary therapy for preventing the chemotherapy complications were analyzed.Results (1) Basic information:there was no significant difference in age,gender,risk group,anthropometry,albumin and pre-albumin level between 2 groups before chemotherapy.(2)Nutritional status:the rate of malnutrition was 11.3 ％,and skinniness cases under 5 years of age occupied 10.0％.In the control group,the Z scores of W/H (weight-for-length/height,t =3.160,P =0.040),the Z scores of BMI (body mass index,t =3.490,P =0.010) and the albumin level(t =-1.805,P ＜0.001) decreased after chemotherapy,and the difference was statistically significant.On the other hand,the Z scores of W/H and BMI kept stable after chemotherapy in the intervention group,the albumin level raised from (40.53 ±3.96) g/L to (44.36 ± 3.31) g/L (t =-4.500,P ＜ 0.001) and the pre-albumin level raised from (126.55 ± 39.28) g/L to (189.55 ± 51.81) g/L(t =2.710,P =0.010),which was of statistical difference.The albumin level(t =5.020,P ＜ 0.001),pre-albumin level (t =3.036,P =0.040) and the Z scores of W/H (t =2.790,P =0.010),BMI (t =3.370,P ＜ 0.001),weight for age (W/A,t =2.830,P =0.010) were all higher in the intervention group,and the differences in statistical significance were found.(3)Side effects of chemotherapy:patients in the intervention group had higher hemoglobin (t =2.070,P =0.043) and platelet (Z =-2.19,P =0.033) level during the chemotherapy which induce less platelet [(0.50 ± 1.00) U vs (2.00 ± 2.00) U ; Z =-3.53,P =0.003] and red blood cells [(3.87 ± 2.01) U vs (5.25 ± 1.87) U ;t =-2.810,P =0.007] transfusion.Period of neutrophil deficiency [(15.67 ± 8.85)d vs (25.94 ±8.72) d;t =-4.601,P ＜0.001]was also shorter than that in the control group.Other complications had no difference between two groups exclude mild liver function abnormality was found more in the controls(x2 =6.680,P =0.010).(4)Safety:the complete remission rate 15 days after chemotherapy was 83.3％ in the intervention group and 81.2％ in the control group (x2 =0.046,P =0.830).All patients got complete remission on day 33.There was no significant difference.No pancreatitis happened in both groups during the chemotherapy.Conclusions Malnutrition rate is high among newly diagnosed ALL pediatric patients,and the nutritional status will deteriorate during the chemotherapy.Enteral nutritional support contributes to maintaining the stability of nutritional status.Enteral nutritional support improves the tolerance of hematopoietic system to chemotherapy.The effect for other complications remains to be confirmed by more extensive study in future.Nestle peptamenas enteral nutritional support productions are safe for ALL patients undergoing chemotherapy.
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Objective:To observe the role of enteral nutritional support in treating superior mesenteric artery syndrome. Methods: Enteral nutritional support was used in two patients with superior mesenteric syndrome after percutanous endoscopic jejunostomy.Enteral nutrition was used for 69 days and 180 days.The symptoms were observed.Body weight and index of nutrition were measured.Results: After enteral nutritional support,symptoms of two patients disappeared.Body weight and fibronectin and prealnumin increased.Conclution: Enteral nutritional support is one of effective methods of treating superior mesenteric artery syndrome.
ABSTRACT
Patients with SAP have a hypermetabolic and hypercatabolic state.Nutritional support for patients with SAP is needed.EN by the jejunal route does not stimulate pancreatic secretions and is safe.At present,the beneficeal effects of EN towards improving the nutritional condition,protecting gut barrier function,reducing translocation of bacteria and endotoxins,modulating the inflammatory response,and decreasing the cost have been observed.Therefore,the EN rather than PN should be used by the jejunal route to provide nutritional support for patients with SAP.