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1.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1368446

ABSTRACT

A doença crítica promove um estado hipercatabólico associado a uma resposta inflamatória intensa. Admite-se que essas alterações contribuem para o aumento do gasto de energia e para a elevação do catabolismo proteico. Objetivo: analisar a adequação calórico-proteica da terapia de nutrição enteral e o seu impacto no desfecho clínico de pacientes críticos. Método: Trata-se de um estudo longitudinal prospectivo realizado com 36 pacientes internados em unidades de terapia intensiva. A adequação da oferta calórico-proteica foi obtida pela relação percentual a partir do quarto dia de implementação da terapia nutricional. Realizou-se o teste de Shapiro Wilk para averiguar a normalidade dos dados e a partir disso, foi aplicado o teste de Mann-Whitney ou de t-Student não pareado. Foi realizada a análise de regressão logística com estimativa de seu coeficiente. Para a regressão estimou-se o intervalo de confiança de 95% e nível de significância de 5%. Foi utilizado o software STATA® versão 14.0 nesta análise. Resultados: Ao avaliar 36 pacientes verificou-se que a sobrevida foi menor entre os indivíduos que apresentaram o menor percentual de adequação calórica (p=0,010) e proteica (p=<0,001). Observou-se que oferta proteica impactou mais expressivamente os desfechos clínicos, ao aumento de 1% na média de adequação proteica as chances de óbito diminuíram 21%. Conclusão: O menor percentual de adequação calórico-proteica foi associado a menor sobrevida de pacientes críticos. Ainda, observou-se que o percentual de adequação proteica se associou mais expressivamente aos desfechos clínicos nessa amostra


The critical illness promotes a hypercatabolic state associated with an intense inflammatory response. It is recognized that those changes contribute to the rise of consumption of energy expenditure and to protein metabolism rise. Objective: to analyze the adequacy caloric-protein of enteral nutrition therapy and its impact on the clinical outcome of critical patients. Method: This is a prospective longitudinal study conducted with 36 hospitalized patients in intensive care units. The caloric-protein adequacy was acquired by percent ratio from the fourth day of nutritional therapy implementation. The Shapiro Wilk test was performed to check the data normality and based on that the Mann-Whitney test or unpaired Student t test was applied. The logistic regression analysis was performed with an estimate of its coefficient. For regression, it was estimated the confidence interval of 95% and significance level of 5%. In this analysis was utilized the STATA® software version 14.0. Results: In the evaluation of 36 patients, it was found that survival was lower among the individuals who had the lower percentage of caloric adequacy (p=0,010) and protein (p=<0,001). It was observed that the protein supply impacted expressively the clinical outcome with an increase of 1% in the average protein adequacy, the chances of death decreased by 21%. Conclusion: The lower percentage of caloric-protein adequacy was associated with lower mortality of critical patients. In addition, in this sampling, it was observed that the protein adequacy percentual joined expressively in the clinical outcome


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Enteral Nutrition , Protein-Energy Malnutrition/therapy , Critical Care , Nutrition Therapy , Longitudinal Studies , Sepsis/therapy , COVID-19/therapy , Inpatients
2.
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1368708

ABSTRACT

Investigar o uso de drogas vasoativas e a sua relação com a intolerância dietoterápica em pacientes críticos. Métodos: Trata-se de um estudo longitudinal retrospectivo realizado em unidades de terapia intensiva (UTIs) de um hospital público de Goiânia, no período de setembro de 2020 a junho de 2021. Realizou-se o levantamento de dados em prontuários eletrônicos do início da terapia nutricional enteral (TNE) correlato ao uso de droga vasoativa (DVA) até o 3° dia de internação. Resultados: A análise incluiu 40 pacientes, observou-se a prevalência do sexo masculino (72,50%) e a média de idade observada foi de 53,67 ± 19,86 anos. Nesse estudo o uso de uma DVA (77,50%) foi mais prevalente do que o uso de duas ou mais DVAs. Verificou-se uma relação significativa entre desfecho clínico e uso de DVA, de modo que, o óbito foi mais frequente naqueles que usavam duas ou mais DVAs (p=0,016). Também foi observada a associação entre a hipoglicemia e o uso de DVA. Essa intercorrência foi frequente naqueles com uso de duas ou mais DVAs (p=0,030). O uso de DVA não se associou a intolerância dietoterápica, porém observamos que a obstipação foi a intercorrência mais prevalente (42,50%). Conclusão: O uso de DVA não se associou a intolerância dietoterápica nessa amostra. Porém observamos uma relação significativa entre o uso de DVA e o óbito. Ainda, verificou-se que a hipoglicemia também se relacionou ao uso de DVA


To investigate the use of vasoactive drugs and its relationship with dietary intolerance in critically ill patients. Methods: This is a retrospective longitudinal study carried out in intensive care units (ICUs) of a public hospital in Goiânia, from September 2020 to June 2021. Data were collected from electronic medical records from the beginning of the enteral nutritional therapy (ENT) correlated with the use of vasoactive drugs (VAD) until the 3rd day of hospitalization. Results: The analysis included 40 patients, there was a prevalence of males (72.50%) and the mean age observed was 53.67 ± 19.86 years. In this study, the use of one VAD (77.50%) was more prevalent than the use of two or more VADs. There was a significant relationship between clinical outcome and use of VAD, so that death was more frequent in those who used two or more VADs (p=0.016). An association between hypoglycemia and the use of VAD was also observed. This complication was more frequent in those using two or more VADs (p=0.030). The use of VAD was not associated with gastrointestinal intolerance (GI), but we observed that constipation was the most prevalent complication (42.50%). Conclusion: The use of VAD was not associated with GA in this sample. However, we observed a significant relationship between the use of VAD and death. Furthermore, it was found that hypoglycemia was also related to the use of VAD


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cardiovascular Agents/therapeutic use , Enteral Nutrition , Nutrition Therapy , Food Intolerance , Longitudinal Studies , Constipation , Hematoma, Subdural, Acute , Brain Injuries, Traumatic , Noncommunicable Diseases , Hypoglycemia , Aneurysm
3.
Rev. Nutr. (Online) ; 35: e210054, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365432

ABSTRACT

ABSTRACT Objective To assess factors related to the achievement of the caloric estimates of enteral nutritional therapy and the survival of patients with advanced cancer in exclusively palliative care. Methods Retrospective study, where patients using enteral nutrition admitted from March 2019 to February 2020 were divided into two groups: Group 1 included patients who reached 75% of the estimated caloric goals, and Group 2 included those who did not. The data were extracted from the patients' electronic medical records. Logistic regression analyzes were performed to assess associations between the studied sociodemographic, clinical, and nutritional variables, and the Kaplan-Meier curve and Cox regression were used to assess the survival of the groups. Results A total of 158 patients participated in the study, with a median age of 63 (IIQ: 55-70) years. 57% reached the caloric goal (Group 1). In the logistic regression, the functional capacity (OR: 5.82; CI: 2.28-14.84; p<0.001) and symptoms of nausea or vomiting (OR: 0.050; CI: 0.005-0.455; p=0.008) were independent variables for achieving the caloric goal. Cox regression showed Karnofsky Performance Status as an independent predictor for survival (HR: 1.85; CI: 1.13-3.04). Conclusion Patients with better functionality have longer survival and are potential candidates for reaching the caloric goals proposed by national and international guidelines for cancer patients.


RESUMO Objetivo Avaliar os fatores relacionados ao alcance das estimativas calóricas da terapia nutricional enteral e a sobrevida dos pacientes com câncer avançado em cuidados paliativos exclusivos. Métodos Estudo retrospectivo no qual pacientes em uso de nutrição enteral internados no período de março de 2019 a fevereiro de 2020 foram divididos em dois grupos: Grupo 1, composto por pacientes que atingiram 75% das metas calóricas estimadas, e Grupo 2, composto por aqueles que não atingiram. Os dados foram extraídos do prontuário eletrônico dos pacientes. Análises de regressão logística foram realizadas para avaliar associações entre as variáveis sociodemográficas, clínicas e nutricionais estudadas, e a curva de Kaplan-Meier e regressão de Cox foram usadas para avaliar a sobrevida dos grupos. Resultados Participaram do estudo 158 pacientes, com mediana de idade de 63 (IIQ:55-70) anos. Cinquenta e sete por cento dos pacientes atingiram a meta calórica (Grupo 1). Na regressão logística, a capacidade funcional (OR:5,82; IC: 2,28-14,84; p<0,001) e os sintomas náuseas ou vômitos (OR:0,050; IC:0,005-0,455; p=0,008) se mostraram variáveis independentes para o alcance da meta calórica. A regressão de Cox mostrou o Karnofsky Performance Status como preditor independente para sobrevida (HR: 1,85; IC: 1,13-3,04) Conclusão Pacientes com melhor funcionalidade possuem sobrevida maior e são potenciais candidatos ao alcance das metas calóricas propostas por diretrizes nacionais e internacionais para pacientes com câncer em terapia nutricional enteral.

4.
Arq. gastroenterol ; 58(3): 402-404, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345303

ABSTRACT

ABSTRACT BACKGROUND: There is controversy about the initiation of gastric or oral feeding in patients with severe acute pancreatitis (SAP) because they could increase pancreatic stimulation and exacerbate symptoms and complications. OBJECTIVE: To describe the clinical characteristics and results of patients with SAP who underwent gastric tube or oral feeding versus parenteral or jejunal feeding. METHODS: A retrospective study was carried out on patients over 18 years old with SAP diagnostic, who had been treated in critical care units. We excluded patients coming from other hospitals and those with incomplete medical records. RESULTS: Thirty patients with SAP were included, fifty three percent of them tolerated the gastric tube or oral feeding, and most of them were females and older than patients who received parenteral or jejunal feeding. Other clinical characteristics and outcomes were similar in both groups. Conclusion: Gastric tube or oral feeding is no absolute contraindication for SAP.


RESUMO CONTEXTO Há controvérsias sobre o início da alimentação gástrica ou oral em pacientes com pancreatite aguda grave (PAG), pois elas podem aumentar a estimulação pancreática e exacerbar os sintomas e complicações. OBJETIVO Descrever as características clínicas e os resultados de pacientes com PAG submetidos à alimentação por sonda gástrica ou via oral versus alimentação parenteral ou jejunal. MÉTODOS Foi realizado um estudo retrospectivo em pacientes maiores de 18 anos com diagnóstico de PAG, atendidos em unidades de terapia intensiva. Excluímos pacientes procedentes de outros hospitais e aqueles com prontuário incompleto. RESULTADOS Trinta pacientes com PAG foram incluídos, 53% deles toleravam a sonda gástrica ou alimentação via oral, e a maioria era do sexo feminino e tinha mais idade do que os pacientes que receberam alimentação parenteral ou jejunal. Outras características clínicas e resultados foram semelhantes em ambos os grupos. CONCLUSÃO A sonda gástrica ou alimentação oral não é contra-indicação absoluta para PAG.


Subject(s)
Humans , Female , Adolescent , Pancreatitis/complications , Acute Disease , Retrospective Studies , Enteral Nutrition , Parenteral Nutrition
5.
Revista Pesquisa em Fisioterapia ; 11(4): 631-639, 20210802. ilus, tab
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1348943

ABSTRACT

INTRODUÇÃO: A desnutrição proteico-energética é definida como resultado da deficiência calórica e/ou proteica, podendo causar alterações na composição corporal como a sarcopenia, no estado mental, na funcionalidade e consequentemente prejudicar o desfecho clínico. OBJETIVO: Avaliar oferta energética e proteica de pacientes críticos, submetidos à fisioterapia convencional associada ao cicloergômetro ativo (ou unicamente a fisioterapia convencional) e correlacionar com os dados antropométricos, e a escala MRC e Perme Escore. MATERIAL E MÉTODOS: estudo piloto com pacientes críticos internados na UTI, divididos entre grupo controle (GC) e experimental (GE). Todos foram avaliados pela escala MRC e PERME escore e submetidos a medidas antropométricas. Após 8 dias de intervenção fisioterapêutica convencional (GC), ou clicoergômetro ativo associado a abordagem convencional (GE), eles foram reavaliados. O aporte proteico e calórico de todos foram avaliados todos os dias. RESULTADOS: Houve redução significativa de medidas de circunferência de panturrilha no GC e perda não significativa de medidas no GE (p=0,001). O nível de adequação calórico e proteico foi de 73,9% e 69,5% respectivamente. Não houve diferença significativa entre os grupos. CONCLUSÃO: A mobilização com o cicloergômetro parece exercer efeito positivo na preservação da massa muscular em membros inferiores de pacientes críticos. No entanto, estudos que avaliam a medida de massa muscular em membros inferiores de modo mais controlado são necessários para comprovar essa hipótese.


INTRODUCTION: Protein-energy malnutrition is defined by caloric and/or protein deficiency, which can cause changes in body composition such as sarcopenia, mental status, functionality and consequently impair the clinical outcome. OBJECTIVE: To assess the energy and protein supply of critically ill patients undergoing conventional physical therapy associated with an active cycle ergometer (or only conventional physical therapy) and correlate with anthropometric data and the MRC scale and PERME score. MATERIALS AND METHODS: A pilot study with critically ill patients admitted to the ICU, divided into a control (CG) and experimental (EG) group. All were evaluated by the MRC scale and PERME score and submitted to anthropometric measurements. After eight days of conventional physical therapy intervention (CG) or active ergometer associated with the conventional approach (GE), they were reassessed. The protein and caloric intake of all were evaluated every day. RESULTS: There was a significant reduction in calf circumference measurements in the CG and a non-significant loss of measurements in the EG (p=0.001). The caloric and protein adequacy level was 73.9% and 69.5%, respectively. There was no significant difference between the groups. CONCLUSION: Mobilization with a cycle ergometer seems to positively affect the preservation of muscle mass in lower limbs in critically ill patients.

6.
Infectio ; 25(2): 84-88, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1250072

ABSTRACT

Resumen Introducción: Klebsiella pneumoniae produce enzimas como Betalactamasas de Espectro Extendido (BLEE) y Carbapenemasas. Estas enzimas tienen implicancia en las Unidades de Cuidados Intensivos (UCI), porque posibilitan la supervivencia de especies bacterianas a condiciones desfavorables y por ende, facilitan su permanencia en ambiente intrahospitalario. Existe evidencia de presencia de Klebsiella pneumoniae en UCI, en muestras procedentes de: pacientes, personal de salud, habitación, lavamanos y fórmulas nutricionales. Objetivo: Evaluar el perfil de resistencia de los aislamientos de Klebsiella pneumoniae en una UCI de Paraguay. Material y métodos: Estudio descriptivo observacional, transversal. Se recolectaron 200 muestras (124 fórmulas enterales, 40 ambiente y 36 pacientes). Variables analizadas: origen de muestra, presencia del germen, producción de enzimas y perfil de resistencia. Resultados: Se aisló Klebsiella pneumoniae en 14% de las muestras. Se identificó al germen en: 25% pacientes, 12,9% fórmulas enterales y 7,5% ambiente. Se observó producción de BLEE en 85,7% de las cepas, con perfiles de resistencia idénticos, y producción de carbapenemasas en 14,3% de las cepas, con perfiles de resistencia diferentes. Conclusión: la presencia y los perfiles de resistencia de Klebsiella pneumoniae en las tres clases de muestras estudiadas, sugieren transferencia de genes de resistencia y diseminación del germen en UCI.


Abstract Introduction: Klebsiella pneumoniae produces enzymes such as Extended Spectrum Betalactamases (ESBL) and Carbapenemases. These enzymes have implica tions in Intensive Care Units (ICU), because they enable the survival of bacterial species under unfavorable conditions and, therefore, facilitate their permanence in the hospital environment. There is evidence of the presence of Klebsiella pneumoniae in the ICU, in samples from: patients, health staff, room, sink, and nutri tional formulas. Objective: To evaluate the resistance profile of Klebsiella pneumoniae isolates in an ICU in Paraguay. Material and methods: descriptive, observational, cross-sectional study. 200 samples were collected (124 enteral formulas, 40 ambient and 36 patients). Variables analyzed: sample origin, presence of the germ, enzyme production and resistance profile. Results: Klebsiella pneumoniae was isolated in 14% of the samples. The germ was identified in: 25% patients, 12.9% enteral formulas and 7.5% environment. Pro duction of ESBL was observed in 85.7% of the strains, with identical resistance profiles, and production of carbapenemases in 14.3% of the strains, with different resistance profiles. Conclusion: the presence and resistance profiles of Klebsiella pneumoniae in the three classes of samples studied, suggest transfer of resistance genes and disse mination of the germ in ICU.


Subject(s)
Humans , Male , Female , beta-Lactamases , Intensive Care Units , Klebsiella pneumoniae , Paraguay , Drug Resistance, Microbial , Bacteremia
7.
Rev. bioét. (Impr.) ; 29(2): 427-436, abr.-jun. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1340959

ABSTRACT

Resumo O número de idosos e, consequentemente, a incidência de doenças crônicas não transmissíveis, entre elas a demência, têm aumentado exponencialmente. A demência leva a perda progressiva de funcionalidade, incluindo complicações relacionadas com alimentação. Este artigo traz resultados de revisão integrativa sobre as evidências científicas atuais da terapia nutricional enteral em pacientes com demência em cuidados paliativos. Foram incluídos artigos publicados entre 2009 e 2019. Os dados foram coletados em novembro de 2019, em cinco indexadores, a partir de busca pelos descritores "nutrição enteral", "cuidados paliativos" e "demência". Depois de aplicados os critérios de inclusão, 11 artigos compuseram a amostra. Os principais achados dessas publicações foram divididos em três categorias: "cuidados paliativos e plano de cuidados", "cuidados paliativos e nutrição enteral" e "nutrição enteral em idosos com demência". Os resultados chamam atenção para a necessidade de que a tomada de decisão se baseie em evidências científicas.


Abstract The number of older adults and, consequently, the incidence of chronic non-communicable diseases, including dementia, have increased exponentially. Dementia leads to progressive loss of functionality, including food-related complications. This article presents results of an integrative review on the current scientific evidence of enteral nutritional therapy in patients with dementia in palliative care. Articles published between 2009 and 2019 were included. Data were collected in November 2019 in five databases, based on the following search words: "enteral nutrition", "palliative care" and "dementia". After applying the inclusion criteria, 11 articles remained in the sample. The main findings of these publications were divided into three categories: "palliative care and care plan", "palliative care and enteral nutrition" and "enteral nutrition in older adults with dementia". The results call attention to the need for decision making to be based on scientific evidence.


Resumen El número de ancianos y, en consecuencia, la incidencia de enfermedades crónicas no transmisibles, entre ellas la demencia, han aumentado exponencialmente. La demencia lleva a una pérdida progresiva de funcionalidad, incluidas complicaciones relacionadas con la alimentación. Este artículo presenta resultados de una revisión integrativa de las evidencias científicas actuales de la terapia nutricional enteral en pacientes con demencia en cuidados paliativos. Para ello, se incluyeron artículos publicados entre el 2009 y el 2019. Los datos se recopilaron en noviembre del 2019, en cinco indexadores, con base en los descriptores "nutrición enteral", "cuidados paliativos" y "demencia". Después de aplicados los criterios de inclusión, la muestra final consistió en 11 artículos. Los principales hallazgos de estas publicaciones se dividieron en tres categorías: "cuidados paliativos y plan de cuidados", "cuidados paliativos y nutrición enteral" y "nutrición enteral en ancianos con demencia". Los resultados llaman la atención sobre la necesidad de tomar decisiones basadas en evidencias científicas.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Palliative Care , Health of the Elderly , Enteral Nutrition , Dementia
8.
Rev. Nutr. (Online) ; 34: e200283, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250805

ABSTRACT

ABSTRACT Objective The present study assessed the differences in nutritional markers (albumin, transferrin, total body fat, and body mass index) and clinical complications (diarrhea, vomiting, and diet interruptions) associated with enteral nutrition. Methods This is an open-label, randomized, two-arm parallel-group controlled clinical trial. Out of 105 patients assessed for eligibility, 35 adult patients were randomly divided into two groups and followed for 28 days. The sample comprised a heterogeneous group of severely ill individuals initially treated in the intensive care units. Neurological conditions (i.e., strokes and brain tumours) were the most common reasons for hospitalization. Patients had one singularity: the clinical need for exclusive enteral nutrition therapy. One group received the diet via gastric tube and the other via a post-pyloric tube. Results The groups presented increases in the calories prescribed and administered, as well as reduced diet discontinuation. Although similar values were observed up to day 21, the post-pyloric group showed increased albumin levels compared to the gastric group on Day 28. Transferrin levels increased over time in both groups. Conclusion There were no differences in the complications recorded between groups, albeit serum albumin significantly increased in the post-pyloric group.


RESUMO Objetivo Avaliar diferenças tanto nos marcadores nutricionais (albumina, transferrina, gordura corporal e índice de massa corporal) quanto nas complicações clínicas (diarreia, vômitos e interrupções na dieta) associadas à nutrição enteral administrada através de duas vias tradicionais. Métodos Este é um ensaio clínico de tratamento, paralelo de dois braços, aberto e randomizado controlado. Dos 105 participantes avaliados para elegibilidade, 35 pacientes adultos foram divididos aleatoriamente em dois grupos e seguidos por 28 dias. A amostra foi formada por um grupo heterogêneo e gravemente enfermo, tratados inicialmente em unidades de terapia intensiva. Condições neurológicas, como acidente vascular e tumores cerebrais foram as razões principais para hospitalização. Os pacientes tinham em comum um aspecto, a saber, a necessidade clínica exclusiva de receber nutrição enteral. Um grupo recebeu a dieta via sonda gástrica e o outro através de sonda pós-pilórica. Resultados Os grupos apresentaram aumento de calorias prescritas e administradas, bem como redução da descontinuação da dieta. Embora valores semelhantes tenham sido observados até o 21° dia, o grupo pós-pilórico apresentou aumento dos níveis de albumina em relação ao grupo gástrico no dia 28. Os níveis de transferrina aumentaram ao longo do tempo em ambos os grupos. Conclusão Não houve diferenças nas complicações registradas entre os grupos, embora níveis séricos de albumina aumentaram significativamente no grupo pós-pilórico.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Serum Albumin/analysis , Transferrin/analysis , Body Mass Index , Enteral Nutrition/methods , Intubation, Gastrointestinal/methods , Biomarkers/blood , Enteral Nutrition/adverse effects
9.
Article in Chinese | WPRIM | ID: wpr-912179

ABSTRACT

Objective:To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.Methods:Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.Results:There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively. Conclusion:For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.

10.
Article in Chinese | WPRIM | ID: wpr-911940

ABSTRACT

Objective:To investigate the incidence of hypothyroxinemia in very low birth weight infant (VLBWI) and its effect on early postnatal feeding and weight gain.Methods:This retrospective study analyzed 164 cases of VLBWIs admitted to the Neonatal Intensive Care Unit of Peking University First Hospital from January 2017 to December 2018. According to the gestational age, these VLBWIs were divided into <30 weeks group ( n=85) or ≥30 weeks group ( n=79), and the basic data and thyroid function were compared. According to the levels of serum tetraiodothyronine and free tetraiodothyronine at the first thyroid function test, the subjects were further assigned into normal thyroxine group and hypothyroxinemia group. The risk factors of hypothyroxinemia identified at the first detection were analyzed by single and multiple-facter analysis. The results of the second detection of thyroxine were also analyzed. On the basis of the first detection and receiving treatment or not, the <30 weeks and ≥30 weeks groups were divided into normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups, and differences in the tolerance of early feeding and weight gain were compared between different groups. Two independent samples/paired t-test, rank sum test, Chi-square test and logistic regression were used for statistical analysis. Results:Out of the 164 VLBWIs with the gestational age of (29.7±2.0) weeks and birth weight of (1 210±210) g, 27 cases (16.5%) were extremely low birth weight infants. The age at their first detection was (10.7±3.1) d and the incidence of hypothyroxinemia was 45.1% (74/164), including 71 mild and three severe cases, with a higher incidence in the ≥30 weeks group comparing to the <30 weeks group [55.7%(44/79) vs 35.5%(30/85), χ 2= 6.883, P=0.009]. All the three severe cases were in the ≥30 weeks group. The gestational age ( OR=1.413, 95% CI:1.044-1.912, P=0.025) and male infant ( OR=2.082, 95% CI: 1.047-4.143, P=0.037) were the risk factors of hypothyroxinemia. At the second detection, the incidence of hypothyroxinemia in VLBWIs with normal thyroid function at their first test was 47.6% (39/82), which is higher in the ≥30 weeks group than in the <30 weeks group [64.5%(20/31) vs 37.3%(19/51), χ 2= 5.745, P=0.017]. Among the infants with hypothyroxinemia at the first detection, those untreated had a significantly higher incidence of hypothyroxinemia at the second detection than those treated [81.3%(26/32) vs 38.7%(12/31), χ 2= 11.905, P=0.001]. The incidence of abdominal distension within 21 days, feeding volume on day 7, 14, and 21, and neonatal weight gain within 7, 14, and 21 days were similar between normal thyroxine, hypothyroxinemia treated and hypothyroxinemia untreated subgroups within the ≥30 weeks or the <30 weeks groups (all P>0.05). Conclusions:VLBWI is at high risk of hypothyroxinemia. Two times of postnatal thyroid function tests can help to detect the delayed hypothyroxinemia. Thyroxine level and receiving treatment or not may have no significant effect on the early postnatal feeding and weight gain.

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Chinese Journal of Geriatrics ; (12): 1291-1294, 2021.
Article in Chinese | WPRIM | ID: wpr-911005

ABSTRACT

Objective:To investigate the effects of enteral nutrition on the incidence of treatment complications, results from nutritional indexes and proportions of immune cell subsets in elderly patients with esophageal carcinoma during concurrent chemoradiotherapy.Methods:From January 1, 2020 to December 31, 2020, 108 elderly patients(≥60 years)undergone concurrent chemoradiotherapy for esophageal carcinoma at Quanzhou First Hospital and eligible for inclusion were enrolled in the case-control study.They were randomly divided into the study group(enteral nutrition group)and the control group(normal diet group), with 54 cases in each group.The incidence of complications, results from nutritional indexes and immune cell subsets of the two groups were analyzed according to data type.Results:The incidence of bone marrow suppression(Grade Ⅰ-Ⅱ)in the study group(37.0%)was significantly lower than that in the control group(63.0%)( χ2=7.259, P<0.01). The incidence of bone marrow suppression(Grade Ⅲ-Ⅳ)in the study group(11.1%)was significantly lower than that in the control group(27.8%)( χ2=4.788, P<0.05). The levels of hemoglobin, total serum protein and albumin were(121.36±11.63)g/L, (73.78±7.79)g/L and(40.95±3.52)g/L in the study group and(106.45±10.85)g/L, (63.12±8.35)g/L and(35.54±4.12)g/L in the control group, respectively, after 4 weeks of radiotherapy and chemotherapy( P<0.05). The proportions of CD3+ and CD4+ were(64.15±5.84)% and(48.64±4.28)% in the study group and(59.25±6.27)% and(45.27±4.52)% in the control group, respectively, after 4 weeks of radiotherapy and chemotherapy( P<0.05). The proportion of CD8+ was(26.93±3.63)% in the study group and(30.35±3.36)% in the control group after 4 weeks of radiotherapy and chemotherapy( P<0.05). Conclusions:During concurrent chemoradiotherapy for elderly patients with esophageal carcinoma, enteral nutrition with adjustment based on patient's food intake can reduce patients' nutritional risk and modulate the proportion of immune cell subsets, thus reducing the occurrence of bone marrow suppression.

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Chinese Journal of Geriatrics ; (12): 712-715, 2021.
Article in Chinese | WPRIM | ID: wpr-910903

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Objective:To compare the clinical effects of two enteral nutritional emulsions, TP-HE and TPF, in elderly patients with severe pneumonia.Methods:This was a randomized study with contemporaneous controls.A total of 56 elderly patients over 65 years old who met the diagnostic criteria for severe pneumonia and were receiving insulin were enrolled.They were randomly divided into the observation group(n=28, enteral TPF-HE at a uniform rate through a nasogastric tube)and the control group(n=28 cases, enteral TPF at a uniform rate through a nasogastric tube). The total daily energy supply was calculates based on the ideal weights of patients.Prealbumin(PA), serum albumin(ALB), body mass index(BMI)and hemoglobin(Hb)were continuously measured at 1, 2, 3, 4, 5, 6 and 7 days after treatment.The effects of the enteral nutritional emulsions in elderly patients with severe pneumonia were analyzed by using repeated measures analysis of variance in a general linear model.Results:There was no significant difference in PA(244.5±55.1)mg/L vs.(237.8±40.4)mg/L, ALB(37.6±5.6)mg/L vs.(38.3±5.5)mg/L, BMI(21.9±0.2)kg/m 2vs.(22.4±0.2)kg/m 2)or Hb(104.4±26.8)mg/L vs.(103.6±25.6)mg/L between the TP-HE group and the TPF group before admission( P>0.05). The energy received from the enteral nutritional emulsions was not significantly different between the TP-HE group and the TPF group(79.8±4.8)kcal/d vs.(79.3±6.6)kcal/d( P>0.05). PA and serum ALB levels had significant differences between the TP-HE group and the TPF group at 1, 2, 3, 4, 5, 6 and 7 days after treatment( P<0.01 or 0.05). Increases in PA and serum ALB levels varied at certain time points between the TP-HE group and the TPF group.Hb levels had no significant difference at 1 and 2 days( P>0.05), but were significantly different at other time points between the two groups( P<0.01). There was no significant difference in BMI between the two groups( F=1.709, P>0.05). Conclusions:Both of the enteral nutrition emulsions can improve PA, ALB and Hb levels, with TP-HE offering more significant effects on PA, ALB and Hb levels.There is no difference in BMI at any time point whether patients receive TP-HE or TPF.

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Journal of Chinese Physician ; (12): 978-981, 2021.
Article in Chinese | WPRIM | ID: wpr-909651

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Objective:To investigate the indwelling time of nasointestinal tube and the safety of delayed use, and to analyze the main influencing factors.Methods:216 patients with indwelling nasointestinal tube were analyzed retrospectively by designing a survey from 2018 to 2020. Receiver operating characteristic curve (ROC) analysis method was used to analyze the threshold of pipe blocking time.Results:Among the 216 patients, the shortest indwelling time was 7 days and the longest was 120 days. The incidence rate of tube blockage, aspiration and accidental extubation was 6.02%(13/216), 2.78%(6/216) and 1.39%(3/216), respectively. Statistical analysis of 13 patients with tube occlusion showed that the incidence of tube occlusion was related to the indwelling time and the speed of pumping (χ 2=46.056, 36.564, P<0.05). In addition, the duration of nasointestinal tube use not only affected the incidence of tube occlusion, but also was related to the incidence of aspiration. With the prolongation of catheter insertion time, the rate of tube occlusion and the incidence of aspiration also increased significantly (χ 2=13.190, P<0.05). ROC curve was used to analyze the correlation between the indwelling time of the feeding tube and the occlusion. The area under the ROC curve was 0.933 (95% CI: 0.886-0.981, P<0.001), the Youden index was 0.829, and the cut-off value of the best indwelling time was 52.5 d. The sensitivity and specificity of the method for determining the occurrence of pipe blockage were 92.3% and 90.6%. Conclusions:It is safe and feasible to extend the indwelling time of nasointestinal tube appropriately, which can reduce the discomfort caused by frequent replacement of nasointestinal tube in patients with long-term enteral nutrition, and reduce the medical cost at the same time. However, when the indwelling time exceeds the threshold, the probability of tube blockage increases significantly, so we should maintain the catheter or replace it in time.

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Journal of Chinese Physician ; (12): 974-977, 2021.
Article in Chinese | WPRIM | ID: wpr-909650

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Objective:To study the short-term effect of early application of intestinal microecological therapy after gastric cancer surgery.Methods:A retrospective analysis was made on 96 patients with early and middle stage gastric cancer who underwent surgical treatment in the department of gastrointestinal surgery of Shulan (Hangzhou) Hospital from June 1, 2020 to May 31, 2021. Among them, 48 patients in the observation group were given enteral nutrition support treatment in the early stage after operation and intestinal microecological preparation, while the control group of 48 patients in the early postoperative were given enteral nutrition support. The serum total protein, albumin, prealbumin and other nutrition related indexes and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before and 7 days after operation. The clinical indexes such as the time of first anal exhaust and the incidence of infectious complications were recorded. Results:There was no significant difference between the two groups in preoperative serum total protein, albumin, prealbumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + ( P>0.05). 7 days after operation, the above indexes in the observation group were significantly higher than those in the control group (all P<0.05). The anal exhaust recovery time of observation group was faster ( P<0.05); There was no significant difference in the incidence of postoperative infectious complications between the two groups ( P>0.05). Conclusions:Early application of intestinal microecological agents in patients with gastric cancer after operation can significantly improve the nutritional status and immune function, promote the recovery of intestinal function, and will not increase the incidence of complications.

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Journal of Chinese Physician ; (12): 970-973, 2021.
Article in Chinese | WPRIM | ID: wpr-909649

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Objective:To investigate the effect of early enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery.Methods:The clinical data of 104 patients with severe traumatic brain injury requiring exploratory abdominal surgery treated in the PLA Army 72th Group Military Hospital from January 2016 to December 2020 were retrospectively analyzed. Among them, 47 patients were given early enteral nutrition (24-48 hr) as the observation group, and 57 patients were given delayed enteral nutrition (>48 hr), as the control group. The levels of hemoglobin, albumin, prealbumin, total bilirubin, alanine transaminase, C-reactive protein, white blood cells, postoperative infectious complications and clinical outcomes were compared between the two groups on the 1st, 7th and 14th days after surgery.Results:On the 14th day after operation, the prealbumin level of the observation group was higher than that of the control group, and the leukocyte level of the observation group was lower than that of the control group, with statistical significance ( P=0.020, P=0.013). The hospital stay and hospitalization costs of the observation group were lower than those of the control group ( P=0.017, P=0.032). The incidence of pulmonary infection in the observation group was 10.6%, which was lower than 29.8% in the control group ( P=0.017). Conclusions:Early postoperative enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery can significantly improve the nutritional status of patients, reduce the incidence of pulmonary infection, the hospital stay and the hospitalization cost.

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Chinese Critical Care Medicine ; (12): 903-918, 2021.
Article in Chinese | WPRIM | ID: wpr-909426

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Enteral nutrition plays an irreplaceable role in the nutritional treatment of critically ill patients. In order to help clinical medical staff to manage the common complications during the implementations of enteral nutrition for critically ill patients, the consensus writing team carried out literature retrieval, literature quality evaluation, evidence synthesis. Several topics such as diarrhea, aspiration, high gastric residual volume, abdominal distension, etc. were assessed by evidence-based methodology and Delphi method. After two rounds of expert investigations, Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China (2021 edition) developed, and provided guidance for clinical medical staff.

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Article in Chinese | WPRIM | ID: wpr-909346

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Objective:To explore the application of home nutrition support in children with intestinal failure.Methods:Children with intestinal failure admitted to Division of Pediatric Gastroenterology and Nutrition and Department of Pediatric Surgery in Xinhua Hospital were retrospectively enrolled since January 2009. The details of home nutrition support, nutritional status and home parenteral nutrition (HPN) associated complications were collected.Results:A total of 10 children received HPN support, 7 of whom were with short bowel syndrome (SBS) and the other 3 with pediatric intestinal pseudo-obstruction. The average length of remnant small bowel in 7 SBS children was (36.7±32.4) cm. The average age at HPN onset was (5.4±4.7) years. The average duration of follow-up was (3.1±2.1) years. The average duration of HPN was (619.5±669.1) days after (391.8±340.1) days of parenteral nutrition support in our hospital. All 10 cases started home enteral nutrition (HEN) with tube feeding (3 cases transited to oral feeding during treatment). The average duration of HEN was (536.1±429.6) days. Daily calorie intake was 104.0%±39.0% of the recommended intake according to the guideline, with 46.5%±21.3% via HPN and 57.5%±29.2% via HEN. During follow-up, 3 cases were found with severe malnutrition, 5 with moderate malnutrition and 2 with mild malnutrition. Four children suffered from catheter-related thrombosis and five children were identified with catheter-related blood stream infection. No intestinal failure associated liver disease was observed.Conclusions:HPN is feasible but needs the support of national medical insurance policy. At present, there are still frequent nutritional deficiencies and complications in HPN. Nutrition support team (NST) should provide guidance for more scientific nutrition screening and nutrition management.

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Article in Chinese | WPRIM | ID: wpr-909336

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Objective:To investigate the effects of nutritional intake in the first two weeks of life on bronchopulmonary dysplasia (BPD) in preterm infants with gestational age (GA) ≤ 32 weeks.Methods:A retrospective case-control study was conducted 154 preterm infants with birth weight ≤ 1500 g and GA ≤ 32 weeks were enrolled from neonatal intensive care unit (NICU) of Affiliated Hospital of Qingdao University between January 1, 2016 and December 31, 2017. These infants were divided into BPD group or non-BPD group. All clinical and nutritional data were collected and analyzed to investigate the effects of early-life (within 2 weeks after birth) nutritional intake on BPD.Results:Among a total of 154 eligible neonates, 68 were without BPD and 86 with BPD (55.8%). Mild, moderate and severe BPD accounted for 39.5% (34/86), 58.1%(50/86)and 2.4%(2/86)of all BPD cases respectively. GA and birth-weight of BPD group were significantly lower than that of non-BPD group [(28.35 ± 1.55)weeks vs. (30.12 ± 1.23)weeks; (1050.91 ± 190.6)g vs. (1205.88 ± 195.83)g, both P = 0.000]. The duration of mechanical ventilation in BPD group was longer than that in non-BPD group [(2.65 ± 1.08)days vs. (0.47 ± 0.12)days, P < 0.05]. The incidences of complications in BPD group, including neonatal asphyxia, sepsis and patent ductus arteriosus, were all higher than those in non-BPD group( P < 0.05). The fluids and caloric intake, enteral fluids and caloric intake were significantly lower in BPD group on Day 7 and 14 of life ( P < 0.05). The macronutrient intake in BPD group was also consistently lower, reaching statistical significance for carbohydrate intake on Day 7 and 14 of life, and for protein and lipid intake on Day 14 of life ( P < 0.05). Multivariate logistic regression analysis showed that mechanical ventilation ( OR = 2.257, 95% CI: 1.143~4.456, P = 0.019) and GA ( OR = 0.325, 95% CI: 0.215~0.49, P = 0.000) were high-risk factors for BPD. The decreased odds of developing BPD were associated with higher levels of enteral calories on Day 14 of life ( OR = 0.96, 95% CI: 0.94~0.98, P = 0.000), fluids on Day 7 of life ( OR = 0.927, 95% CI: 0.876~0.981, P = 0.009) and protein intake on Day 14 of life ( OR = 0.044, 95% CI: 0.011~0.177, P = 0.000). Conclusions:GA and mechanical ventilation were independent high-risk factors for BPD. Higher intake of protein and enteral calories were protective factors. Proactive early enteral nutrition support, adequate protein intake and decreasing the duration of mechanical ventilation may reduce the risk of BPD.

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Article in Chinese | WPRIM | ID: wpr-909335

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Objective:To understand the current situation of clinical application and management of food for special medical purpose (FSMP) in China's medical institutions.Methods:A questionnaire was developed based on literature review, consultation with experts and multiple discussions to investigate the application and management of FSMP in hospitals. The survey was conducted in secondary and tertiary general or specialized hospitals in China. The accountable person of Clinical Nutrition Department in each hospital filled in the questionnaire with the guidance from provincial quality control center.Results:A total of 592 hospitals across 30 provinces/municipalities participated in the survey. The majority (40.5%) of prescription for FSMP with approved batch number was given by clinical nutrition departments, nutritional risk screening was conducted before using FSMP as enteral nutrition in 64.0% of the hospitals, consent from patients or their families prior to initial FSMP use was required in 94.8% of the hospitals, follow-up after FSMP use was carried out in 86.5% of the hospitals, 79.2% of the hospitals maintained electronic or paper documentation of the clinical application of enteral nutrition preparations, 41.6% of the hospitals had no organization or institution to supervise the standardized application of FSMP.Conclusion:In the future, we should strengthen the construction of FSMP professional team, establish convenient and efficient nutrition diagnosis and treatment information module, and set up special institutions to implement FSMP standardized management.

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Article in Chinese | WPRIM | ID: wpr-909328

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Objective:To investigate the enteral nutrition (EN) practices in patients with neurological diseases in the tertiary hospitals of northern China in 2020.Methods:A questionnaire survey was conducted among clinicians in 123 tertiary hospitals of northern China, which admitted patients with neurological diseases and implemented EN practices, in June 2020. The selected departments included neurology, neurological intensive care unit (ICU), neurosurgery ICU, and general ICU. The indicators for evaluation included: the equipment and personnel for EN practices, the application of screening, assessment and implementation methods of EN management, the timing of EN support, the route and methods of EN infusion, and the monitoring of nutrition-related indicators.Results:Concerning the EN practices in the 123 tertiary hospitals of northern China, 82.9% were equipped with weight measuring instruments, 85.4% with EN infusion pumps, 74.8% applied nutrition risk screening 2002 (NRS 2002) or nutrition risk in critically ill (NUTRIC) score scale to evaluate the nutritional status of patients, 71.5% applied nutrition assessment scales, 74.8% elevated the head of the bed to ≥ 30 degrees during EN infusion. Only 30.1% were equipped with an indirect calorimetry instruments (metabolic cart), 31.7% had their own standard operating procedures for nutrition management, 46.3% had a percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) devices, 46.3% had a nutrition support team, 48.0% started EN practices within 48 hours, 57.7% started EN infusion based on Water Swallow Test, and 58.5% stopped EN infusion based on Water Swallow Test.Conclusions:The EN equipments in practices for patients with neurological diseases in tertiary hospitals of northern China were basically adequate, the evaluation and monitoring of EN related indicators were basically consummate. However, there were still some deficiencies warranting further improvement.

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