ABSTRACT
Objective To explore the clinical effects of arginine-rich enteral nutritional support therapy in patients undergoing gastrectomy.Methods The clinical data of 84 patients with gastric carcinoma who were admitted to the Wuhan Central Hospital from January 2013 to December 2014 were retrospectively analyzed.Mter gastrectomy,42 patients undergoing arginine-rich enteral nutritional support therapy were allocated to the argininerich enteral nutrition (AEN) group and 42 patients undergoing standardized enteral nutritional support therapy were allocated to the enteral nutrition (EN) group.The indexes of nutrition [BMI of patients were calculated and serum total protein (TP),albumin (Alb) and prealbumin (PAB) were detected] and immunology [T-lymphocyte subsets,total number of lymphocyte,white blood cell (WBC) and CD4 +/CD8 + were detected by flow cytometry],postoperative complications and indexes of prognosis were analyzed.The measurment data with normal distributionwere presented as (x) ± s.The comparision between groups were evaluated with the t test and repeated measures ANOVA.The count data were analyzed using the chi-square test.Results The value of TP from preoperation to postoperative day 7 was from (64 ± 16)g/L to (55 ± 13)g/L in the AEN group and from (65 ± 21)g/L to (52 ±11) g/L in the EN group,with no significant difference between the 2 groups (F =29.653,P ＞ 0.05).The values of Alb and PAB from pre-operation to postoperative day 7 were from (33 ± 17) g/L to (32 ± 3) g/L and from (0.20 ± 0.01) g/L to (0.26 ± 0.06) g/L in the AEN group and from (32 ± 19) g/L to (27 ± 5) g/L and from (0.20 ±0.03)g/L to (0.22 ±0.03) g/L in the EN group,respectively,with significant differences in the Alb and PAB between the 2 groups (F =21.784,10.653,P ＜ 0.05).The number of WBC,number of lymphocyte and percentage of CD8 + T-cell in the AEN group were (5.3 ± 0.7) × 109/L,(1.39 ± 0.06) × 109/L and 17.3 ％ ±3.5％ before operation and (5.9 ±0.7) × 109/L,(1.33 ± 0.03) × 109/L and 18.4％ ± 3.8％ after operation.The number of WBC,number of lymphocyte and percentage of CD8 + T-cell in the EN group (5.1 ± 0.5) × 109/L,(1.40±0.04) × 109/L and 16.4％±2.8％ before operation and (5.4±0.5) ×109/L,(1.23±0.04) ×109/L and 17.3％ ± 3.1％ after operation.There was no significant difference in the above indexes between the 2 groups (F =17.429,20.461,38.820,P ＞ 0.05).The percentages of CD4 + T-cell and CD4 +/CD8 + before operation and at postoperative day 10 were 34.7％ ± 5.4％,39.5％ ± 3.9％ and 1.80 ± 0.29,2.23 ± 0.32 in the AEN group,and 33.2％±4.6％,34.6％±2.4％ and 1.73 ±0.26,1.82 ±0.42 in the EN group,respectively,with no significant difference in the above indexes between the 2 groups (F =14.398,7.473,P ＜ 0.05).The incidences of postoperative complication in the AEN group and in the EN group were 9.5％ (4/42) and 31.0％ (13/42),showing a significant difference between the 2 groups (x2=4.459,P ＜ 0.05).The duration of postoperative systemic inflammatory response syndrome (SIRS) were (1.3 ± 0.6)days in the AEN group and (2.4 ± 1.0) days in the EN group,with a significant difference between the 2 groups (t =6.360,P ＜ 0.05).The time to anal exsufflation and time of bowel movements were (2.6 ± 0.3) days and (3.6 ± 0.5) days in the AEN group and (2.5 ± 0.3) days and (3.5 ± 0.5) days in the EN group,respectively,with no significant difference between the 2 groups (t =1.570,0.897,P ＞ 0.05) . There was no perioperative death.The hospital expenses were (17 000 ±4 000) yuan in the AEN group and (22 000 ±5 000) yuan in the EN group,with a significant difference between the 2 groups (t =3.860,P ＜ 0.05).Conclusion Arginine-rich enteral nutritional support therapy is superior to standardized enteral nutrition in effectively improving postoperative nutrition status,immune function and prognosis of patients undergoing gastrectomy.
ABSTRACT
Objective To explore the effects of timing of enteral nutrition (EN) in the severe acute pancreatitis (SAP).Methods The rabbit model of SAP was constructed,and 40 experimental rabbits were divided randomly into the experimental group (20 rabbits) and the control group(20 rabbits).(1) The parenteral nutrition (PN) was administered to rabbits in the experimental group,and then EN was administered after bowel sound restoration.(2) EN was administered to the rabbits in the control group at hour 12 after PN.The values of TNF-α,IL-6 and IL-8 on post-modeling day 1,3 and 7 and intra-abdominal pressures at hour 1 before EN and on post-modeling day 1 and 3 were respectively examined.The experimental animals were sacrificed on post-modeling day 7 and 10.The expression of nuclear factor-kappa B (NF-κB) was detected by immunohistochemistry and bacteria from mesenteric lymph nodes were cultured.The measurement data with normal distribution were presented as (x) ± s.The trend comparison between groups and pairwise comparison were analyzed using the repeated measures ANOVA and t test.Results The 40 rabbit models of SAP were constructed successfully.(1) The results of serum test showed that the values of TNF-α,IL-6 and IL-8 in the experimental group on post-modeling day 1,3and 7 were (6.9 ±2.1)ng/L,(5.9 ± 1.8) ng/L,(5.3 ± 1.8) ng/L and (109 ± 17) ng/L,(96 ± 16) ng/L,(83 ± 17)ng/L and (89 ±20)ng/L,(78 ±21)ng/L,(70 ± 19)ng/L,respectively.The values of TNF-α,IL-6 and IL-8 in the control group on post-modeling day 1,3 and 7 were (7.4 ± 1.5) ng/L,(7.1 ± 1.6) ng/L (6.8 ±1.7) ng/L and (101 ± 19) ng/L,(98 ± 18) ng/L,(93 ±20) ng/L and (91 ± 14) ng/L,(91 ± 16) ng/L,(83 ±19)ng/L,respectively.There were significant differences in the changing trends of TNF-α and IL-6 between the 2 groups (F =7.947,19.386,P ＜ 0.05),with no significant difference in the changing trend of IL-8 between the 2 groups (F =2.756,P ＞ 0.05).(2)The intra-abdominal pressures in the experimental group at hour 1 before EEN and on post-modeling day 1 and 3 were (3.5 ± 1.6) cmH2O (1 cmH2O =0.098 kPa),(4.3 ± 1.7) cmH2Oand (3.6 ± 1.8) cmH2O,which were significantly different from (4.9 ± 1.9) cmH2O,(5.7 ± 2.2) cmH2O and (4.5 ± 1.6)cmH2O in the control group (F =7.042,P ＜0.05).(3) The expression of NF-κB in the tissues of pancreas was localized mainly in the cell nucleus.The expression of NF-κB in the experimental group on postmodeling day 7 was 5.0 ± 2.7,which was significantly different from 7.0 ± 2.9 in the control group (t =2.236,P ＜ 0.05).(4) The amount of bacteria culture from mesenteric lymph nodes in the experimental group on postmodeling day 7 and 10 were (4.7 ±0.9) × 103 cfu/g and (4.1 ±0.7) × 103 cfu/g,which were significantly different from (5.5 ± 1.0) × 103 cfu/g and (4.6 ± 0.7) × 103 cfu/g in the control group (t =2.382,2.126,P ＜0.05).Conclusion The selective timing of EN can effectively improve the recovery of rabbits with SAP,and the efficacy of EN administering based on the recovery of bowel function may be better than immediate EN administering.