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Objective To study the enteral nutritional (EN) approach to decrease the risk of developing hypo-albuminemia in elderly patients with severe pneumonia. Methods Sixty elderly patients with severe pneumonia admitted to the intensive care unit (ICU) of Hangzhou Geriatric Hospital from January 2016 to January 2017 were enrolled, and they were given EN support with different protein contents but the same non-protein calories (125.52 kJ·kg-1·d-1). Thirty patients given standard EN formula [supplied as nutrition fibre, thermal nitrogen ratio (HRN) = 130:1] were assigned as the standard EN group, another 30 patients fed with high-protein EN formula (supplied as fresubin 750 MCT, HRN = 100:1) were arranged as the high-protein EN group, and the clinical efficacy in the two groups was evaluated after treatment for 14 days. The serum levels of total protein (TP), albumin (Alb), pre albumin (PA), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) of both groups were compared at admission and after treatment. Results The levels of TP, Alb, PA, TC, HDL, LDL in two groups on 7 and 14 days after treatment were lower than those on admission, but the degrees of reduction in high-protein EN group were not as significant as those in standard EN group; the levels of blood glucose (Glu) in the standared EN group after treatment were lower than those on admission, Glu in high-protein EN group were higher than those on admission;after treatment for 14 days, the levels of TP (g/L: 62.1±7.6 vs. 60.1±5.2), Alb (g/L: 33.0±4.8 vs. 32.0±4.2), PA (mg/L: 226.79±79.22 vs. 202.79±71.78), TC (mmol/L: 4.88±1.09 vs. 4.09±0.80), HDL (mmol/L: 1.07±0.2 vs. 0.92±0.20), LDL (mmol/L: 3.16±0.76 vs. 2.50±0.56), Glu (mmol/L: 7.68±2.44 vs. 6.72±1.75) in high-protein EN group were significantly higher than those in standard EN group; after treatment, TG showed a trend of firstly decreasing and then increasing, while TG in high-protein EN group manifested continuously increasing, after 7 days of treatment, TG in the high-protein EN group was significantly higher than that in the standard EN group (mmol/L: 3.56±1.43 vs. 2.78±0.81, P < 0.05). Within 14 days after disease onset, the incidence of hypoalbuminemia in high-protein EN group was significantly lower than that in standard EN group in patients with acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score > 19 score [66.67% (10/15) vs. 100.00% (13/13), P < 0.05]; there was no statistical significant difference in the incidence of hypoalbuminemia between the two groups in patients with APACHE Ⅱ score < 19 score [54.54% (6/11) vs. 44.44% (4/9), P > 0.05]. Compared with standard EN group, the 3-month mortality in high-protein EN group showed a trend of decreasing [14 days: 13.3% (4/30) vs. 26.7% (8/30), 28 days: 20.0% (6/30) vs. 30.0% (9/30), 60 days: 30.0% (9/30) vs. 33.3% (10/30), 90 days: 36.7% (11/30) vs. 40.0% (12/30)], but there was no statistical significant difference between the two groups (all P > 0.05). Conclusion Application of high-protein EN in elderly patients with severe pneumonia can improve protein metabolism, and reduce the incidence of hypoalbuminemia.
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Objective: To study the effect of cytochrome P-450 4F2 (CYP4F2, rs2108622) gene polymorphisms in patients with warfarin for initial doses in 7 days. Methods: A total of 271 patients treated by warfarin were studied. The CYP4F2 gene polymorphisms were assessed by real-time PCR, the average initial warfarin doses in 7 days and the time of international normalized ratio (INR) ifrst arrived to therapeutic range were recorded. The differences of initial warfarin doses and the time of INR ifrst arrived to therapeutic range among CYP4F2 gene polymorphisms of CC, CT and TT genotypes were analyzed by statistical method. Results: The average initial warfarin doses among CYP4F2 polymorphisms of TT and CT/TT were higher than CC, P Conclusion: CYP4F2 polymorphisms inlfuenced the initial warfarin doses in 7 days in relevant patients.
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Objective To investigate effect of early enteral nutrition supplemented with probiotics on gastrointestinal motility disturbance and nutritional status in patients with severe craniocerebral trauma.Methods Forty patients with severe craniocerebral trauma were randomized into study group (18patients) and control group (22 patients).Patients of both groups received enteral nutrition via nasogastric tube at 24-72 hours after admission,but the patients of study group were also supplemented with probiotics simultaneously.Rate of abdominal distention,vomiting,gastro-oesophageal reflux,gastric retention,constipation and diarrhea were recorded during the whole study.Time to first defecation and time to targeted nutritional goals were also recorded.Prealbumin and transferrin in serum were detected at days 0,4,7,and 15 after the beginning of enteral nutrition.Length of ICU stay was compared between groups.Results There were no significant differences of the two groups in terms of rate of abdominal distention,vomiting,gastric retention and diarrhea.However,less gastro-oesophageal reflux or constipation patients were observed in study group,as compared with control group (P ＜ 0.05).Time to first defecation and time to targeted nutritional goals were shorter in study group,as compared with control group (P ＜ 0.05).Levels of prealbumin and transferrin had no significant differences between the two groups at days 0,4,and 7,but study group showed both were higher than control group at day 15 (P＜0.05).Moreover,length of ICU stay showed no significant difference between the two groups.Conclusions Compared with simple enteral nutrition,early enteral nutrition with probiotics improves gastrointestinal motility,facilitates the delivery of enteral nutrition,and further ameliorates nutritional status in patients with severe craniocerebral trauma.