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Objective To evaluate the effects of enteral immunonutrition on cell immunity level and clinical efficacy in patients with severe tuberculosis. Methods Sixty patients with severe tuberculosis were admitted to the department of tuberculosis intensive care unit of Hangzhou Red Cross Hospital from June 2015 to June 2017, and they were randomly divided into a conventional enteral nutrition group (EN group) and a enteral immunonutrition group (EIN group), each group 30 cases. Based on the patients' gastrointestinal tolerance condition, the EN group was treated with therapies of normal nutrition support, anti-tuberculosis, anti-infection, etc.; the EIN group was treated with enteral immunonutrition (TPF-T), and simultaneously with anti-tuberculosis, anti-infection, etc. therapies according to the disease situation. The target energy maintained at 104.6 kJ·d-1·kg-1and the therapeutic course was 14 days in the two groups. The levels of interleukins (IL-6, IL-10) and interferon-γ (IFN-γ), white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), cell immune indexes (T cell subgroup CD4+, CD8+) were observed before treatment and on day 14 after treatment in the patients of two groups; the changes of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment and after treatment and 28-day mortality rate were recorded in the two groups. Results After treatment, the levels of WBC, CRP, PCT were obviously lower than those before treatment, while the levels of IL-6, IFN-γ, CD4+in the two groups were significantly higher than those before treatment, and the changes of the EIN group were more significant than those in the EN group [WBC (×109/L): 8.0±3.1 vs. 10.0±2.4, CRP (mg/L): 30.3±9.1 vs. 45.8±6.6, PCT (μg/L): 2.2±1.8 vs. 4.3±2.2, IL-6 (mg/L): 182.53±8.52 vs. 168.42±7.62, IFN-γ (mg/L): 32.52±3.5 vs. 25.41±2.6, CD4+: 0.56±0.06 vs. 0.45±0.08, all P < 0.05]. The level of CD8+after treatment in the two groups was higher than that before treatment (the EN group: 0.28±0.06 vs. 0.27±0.07, the EIN group: 0.27±0.08 vs. 0.26±0.09), the APACHE Ⅱ scores in the two groups were lower than those before treatment (the EN group: 11±6 vs. 18±4, the EIN group: 10±3 vs. 17±6), the 28-day mortality in the EIN group was lower than that in the EN group [13.3% (4/30) vs. 16.7% (5/30)], no statistical significant difference in CD8+, APACHE Ⅱscore, 28-day mortality between the two groups being found (all P > 0.05). Conclusion Enteral immunonutrition can improve the level of cell immunity and decrease the degree of inflammatory response, and increase the clinical curative effect in patients with severe tuberculosis.
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Objective To analysis the short-term quality of life and clinical outcome of early enteral immunonutrition(EIN)used after operation in patients with totally endoscopic esophagectomy.Methods This randomized controlled trial enrolled 110 patients receiving totally endoscopic esophagectomy in department of thoracic surgery of the fourth hospital of Hebei medical university between May 2015 and November 2016.The patients were randomly divided into enteral immunonutrition group (EIN group,n =56) and parenteral nutrition group (PN group,n=54).The scale scores of quality of life,the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative infections and the length of hospitalization were compared between the two groups before operation and after operation.Results (1) There were no significant differences in age,gender,education,marital status,tumor location,clinical stage,intraoperative bleeding between the two groups (P＞0.05).(2) There were no significant differences in the quality of life before operation (P＞0.05);All functional scale scores of EIN group were significantly higher than PN group (P＜0.05),while the symptom scale score were significantly lower than PN group(P＜0.05).(3) There were significant differences in the time of first postoperative anal exhaust,the time of removal of drainage tube,the number of postoperative pneumonia compliCations and the length ofhospitalization in the two groups (P＜ 0.05).There was no significant difference in the incidence of anastomotic fistula between the two groups(x2=0.621,P=0.431 4) The scale scores of quality of life (the overall health status as the representative) had a negatively linear relationship with the clinical outcome(P =0.000),the absolute value of correlation coefficient in EIN group was higher than that in PN group.The higher score of the quality of life,the shorter time of the postoperative anal exhaust,removal of drainage tube and the length of hospitalization.Conclusion Enteral immunonutrition can improve the quality of life,improve the prognosis and promote the rapid recovery of patients with totally endoscopic esophagectomy.
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Objective To discuss the clinical effects of enteral immunonutrition on patients with hyperlipidemic acute pancreatitis and its influence on levels of immunologic function and nutrition indicators.Methods 2015,100 patients with hyperlipidemic acute pancreatitis Selected from department of general surgery between January 2012 and December were randomly divided into observation group and control group,and each group had 50 cases.All patients were treated with conventional treatment,monitored for vital signs,fasting water,gastrointestinal decompression,anti-infection,acid suppression therapy and suppression of trypsin activity,balance of water electrolyte and acid-basewere included.After bowel function in patients with recovery,two groups were given enteral nutrition support,observation group were received enteral immunonutrition therapy.At the same time,we added the immune enhancement components.After treatment for 10 days,we compare two groups of patients with therapeutic effect,for APACHE-Ⅱ score,nutrition indicators (ALB,PAB),immune index(TLC,IgA,IgG,IgM) changes.Results After two groups of patients were given different enteral nutrient solution,the clinical total effective rate of observation group was obviously higher than that of control group(P ＜ 0.05).After treatment for 10 days,the indicators were obviously improved.The APACHE-Ⅱ score of the observation group were significantly fallinger than that of the control group (t =3.311,P ＜0.05).The ALB and PAB levels of the observation group were significantly higher than those of the control group (t =2.217,6.622,P ＜ 0.05).At the same time,the TLC,IgA,IgG,IgM of the observation group were improved significantly better than the control group (t =3.600,4.867,3.270,3.911,P ＜ 0.05).Conclusion Enteral immunonutrition can improve the nutrition indicators and immunological function of patients with hyperlipidemic acute pancreatitis,thus improve prognosis and promoting recovery of the patient.
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Objective:TTo evaluate the nutritional status,immune function and clinical effectiveness of early enteral immunonutrition in patients receiving totally endoscopic esophagectomy.Methods:There were 90 patients receiving totally endoscopic esophagectomy enrolled in Department of Thoracic Surgery of The Fourth Hospital of Hebei Medical University between May 2015 and October 2016.The patients were randomly divided into three groups,enteral immunonutrition group (EIN group,n =30),common enteral nutrition group(EN group,n =30)and parenteral nutrition group (PN group,n =30).The levels of nutritional indexes,immune indexes,C-reactive protein (CRP) were measured preoperation and 1day,3days,7days after surgery.We also observed the first postoperative anal exhaust time,infectious complications and the length of hospital stay.Results:There were no significant differences in age,gender,tumor location,clinical stage,CRP,the nutritional indexes and immune indexes between the three groups before operation.On the first day after operation,the nutritional indexes and immune indexes of the three groups were significantly lower than those before operation,then all the indexes began to recover.Otherwise,CRP of the three groups were significantly higher than those before operation,then fell down in the following days,the rate of EIN group and EN group was faster than that of PN group on the day 3 after surgery and the EIN group was the fastest on the day 7 after surgery.There were significant differences in the first postoperative anal exhaust time,pneumonia and the length of hospital stay.And there was no significant difference in the incidence of anastomotic fistula between the three groups(x 2=1.071,P =0.585).Conclusions:Postoperative early enteral immunonutrition can improve the nutritional status and the immune response,promote the rapid recovery in the patients receiving totally endoscopic esophagectomy.
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Objective:To investigate the effects of enteral immunonutrition on the intestinal barrier function and immune function in patients with severe pneumonia.Methods:Ninety patients with severe pneumonia were randomly divided into experimental group (n =45) and control group (n =45).All patients were received conventional therapy.In addition,patients in experimental group were given enteral immunonutrition,while patients in control group were given regular enteral nutrition.The changes of general conditions,intestinal barrier function index and immune function index were determined before treatment,on day 5 and 10 after treatment.The time of invasive mechanical ventilation,APACHE Ⅱ score and clinical effects of two groups were determined on day 10 after treatment.Results:Compared with those before treatment,in both groups,body temperature,respiration,heart rate,white blood cell count were all significantly decreased on day 5 and 10 after treatment (P ＜ 0.05).The above parameters were significantly lower in experimental group than control group on day 10 after treatment (P ＜ 0.05).The levels of serum ET,DAO were significantly decreased on day 5 and 10 after treatment in two groups compared with those before treatment (P ＜ 0.05),and these parameters were significantly lower in experimental group than control group(P ＜0.05).The number of CD3 and CD4 positive cell and the ratio of CD4 +/CD8 + were significantly increased on day 5 and 10 after treatment in two groups when compared with those before treatment (P ＜ 0.05),and these parameters were higher in experimental group than those in control group(P ＜ 0.05).The time of invasive mechanical ventilation,APACHE Ⅱ score were lower in experimental group than those in control group on day 10 after treatment (P ＜ 0.05).The rate of clinical response were higher in the experimental group than that in the control group on day 10 after treatment (P ＜ 0.05).Conclusion:Enteral immunonutrition is more effective in protecting the intestinal barrier function,improving the immune status,enhancing the immunity,reducing the time of invasive mechanical ventilation,and achieving the clinical effects of patients with severe pneumonia.
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Objective To study the effects and mechanisms of major immune nutrients and to introduce the progresses of clinical applications about enteral immunonutrition.Methods The related literatures about the effects and clinical applications of enteral immunonutrition were reviewed.Results Infection rate can be reduced and the hospitalization can be shortened as a result of the improved nutritional status and immune competence of patients which can be enhanced by reasonable enteral immune nutrition.Most of the patients suffering from serious diseases can benefit from enteral immunonutrition,such as gastrointestinal cancers,post-transplantation complications,chronic liver disorders,acute pancreatitis and so on.However,as a new nutrition therapy,the clinical use of enteral immunonutrition in critically ill patients is still controversial.Conclusions Enteral immunonutrition plays an important role in the nutritional support of patients with serious diseases,such as gastrointestinal cancers,organ failures.However,much work remains to be done.
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Objective To study the effect of preoperative immunonutrition on nutritional status and immunity for the patients with gastrointestinal cancer, and to evaluate whether the administration of immunonutrition could reduce the rate of postoperative complication and thus shorten the days of postoperative hospitalization. Methods Sixty patients with different gastrointestinal cancer were randomized to receive either immunonutrition (containing Arginine, RNA and ?-3 polyunsaturated fatty acids) for 7 days before surgery (EN, n=30) or a conventional diet (CONT, n=30). Variables of nutritional status and immunity, postoperative complications, infection and the days of postoperative hospitalization were measured. Results There were no significant differences in the immunological and nutritional variables between two groups before surgery. The serum concentrations of prealbumin(PALB) and transferrin(TRF) were lower than those before surgery in the CONT group on postoperative day 3 (P
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Objective To evaluate the effect of perioperative enteral immunotrition(IMPACT) on liver regeneration in cirrhotic rats with hepatectomy. Methods Forty-eight cirrhotic rats were randomly divided into two groups: Group A, perioperative standard enteral nutrition group(n=24), receiving standard enteral nutrient NUTRISON during hepatectomy. Group B, perioperative enteral immunonutrition group(n=24), receiving enteral immunonutrient IMPACT after hepatectomy. According to the different time of taking specimens, each group was separated into four subgroups, each subgroup had six rats. The rats in the two groups received equal daily nutritional supplement intragastrically, which was 690kJ/kg per day. Before the 68% hepatectomy, the rats were fed with enteral nutrient for 8 days, and after operation were fed until the day of taking specimens. On the day before hepatectomy and 1st, 4th and 8th postoperative day(POD), MI (mitotic index) of liver cell and PCNA (proliferating cell nuclear antigen) labeling index of hepatocyte were determined. Results MI increased significantly in both group on 4th and 8th postoperative day(P