RESUMO
Objective To explore the effect of enteral nutrition (EN) initiation time on the treatment and prognosis of acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. Methods A retrospective study was conducted. 116 adult ARDS patients with mechanical ventilation admitted to the intensive care unit (ICU) of the Sixth Division Hospital of Xinjiang from January 2016 to December 2017 were enrolled. There was no difference in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) at admission. Patients were divided into early enteral nutrition group (E-EN group, 66 cases, starting EN within 48 hours) and late enteral nutrition group (L-EN group, 50 cases, starting EN after 7 days later) according to the EN initiation time. Both groups of patients achieved the standard nutrition after 3-5 days of EN. Nutritional indicators [albumin (ALB), pre-albumin (PA)], liver function [total bilirubin (TBIL)], infection index [procalcitonin (PCT)], insulin dosage, respiratory mechanics and pulmonary function [airway peak pressure (PIP), airway plateau pressure (Pplat), mean airway pressure (MPaw), effective static total compliance (Cst), oxygenation index (PaO2/FiO2)], critical scores [APACHEⅡ, multiple organ dysfunction score (MODS), Murray lung injury score, and systemic inflammatory response syndrome (SIRS) score], duration of mechanical ventilation, the length of ICU stay, incidence of multiple organ dysfunction syndrome, 14-day mortality, and ICU hospitalization expenses were collected before treatment and 1, 3, 7, 10, 14 days after treatment. Results There was no difference in biochemical indicators, respiratory mechanics, pulmonary function, or critical scores between the two groups before ICU treatment. Compared with before treatment, ALB and PA were significantly increased, TBIL and MPaw were significantly decreased, insulin dosage was significantly decreased, PIP, Pplat, MPaw were significantly decreased, Cst and PaO2/FiO2were significantly increased, and the critical scores were significantly decreased. Compared with L-EN group, E-EN group had lower TBIL and PCT after treatment [TBIL (μmol/L): 13.21±1.03 vs. 29.02±1.38, PCT (ng/L): 5.36±1.58 vs. 11.33±1.95], lower insulin dose (U: 16.37±1.01 vs. 27.01±1.92), lower PIP, Pplat, MPaw [PIP (cmH2O, 1 cmH2O = 0.098 kPa): 17.7±3.5 vs. 22.5±4.3, Pplat (cmH2O):10.5±1.4 vs. 15.6±1.2, MPaw (cmH2O): 5.5±0.7 vs. 8.2±0.8], higher Cst, PaO2/FiO2[Cst (mL/cmH2O): 128.6±16.5 vs. 93.7±11.9, PaO2/FiO2(mmHg, 1 mmHg = 0.133 kPa): 242.9±27.9 vs. 188.6±25.9, all P < 0.05], however, there was no significant difference in ALB, PA and critical care scores [ALB (g/L): 37.09±1.49 vs. 35.88±1.77, PA (mg/L): 387.29±10.93 vs. 369.27±11.44, APACHEⅡ: 13.9±3.5 vs. 14.5±5.0, Murray: 5.6±0.9 vs. 5.2±1.4, MODS: 1.1±0.4 vs. 1.2±0.3, SIRS: 2.9±0.5 vs. 3.1±0.9, all P > 0.05]. Compared with L-EN group, incidence of multiple organ dysfunction syndrome was significantly decreased in E-EN group [31.8% (21/66) vs. 48.0% (24/50), P < 0.05], duration of mechanical ventilation and the length of ICU stay were significantly shortened (days: 5.5±0.7 vs. 9.2±0.8, 8.6±1.5 vs. 18.3±1.9, both P < 0.05), ICU hospitalization expenses was significantly reduced (10 000 yuan:6.324±0.009 vs. 11.419±0.010, P < 0.05), but there was no significantly difference in 14-day mortality between two groups [15.2% (10/66) vs. 16.0% (8/50), P > 0.05]. Conclusions Early and reasonable application of EN supportive therapy can improve the clinical efficacy of ARDS patients, reduce the incidence of infection, make it easier to control blood sugar, improve lung function, shorten the duration of mechanical ventilation and the length of ICU stay, and reduce hospitalization expenses. However, no significant difference has been found in the prognosis of the recent 14 days.
RESUMO
Enteral nutrition (EN) is an effective method to meet the nutritional requirements in patients who have a deteriorated nutritional status. Objectives: To compare clinical and nutritional performance of two groups: Early Enteral Nutrition (EEN) versus Late Enteral Nutrition (LEN) of patients undergoing to total gastrectomy for gastric cancer. Material and Methods: 18 patients with resectable gastric cancer were studied with anthropometric, functional and biochemical parameters to assess nutritional status in the preoperative and postoperative period. They received a polimeric enteral formula (1 kcal/ml) in the postoperative period. They were randomly assigned to the type of nutrition (early or late). Results: The group with EEN had a significant improvement in the bicipital fold adequacy percentage and dynamometry. The LEN group had a significant decrease of albumin. The bloating was more frequent in the group with EEN. Conclusion: Early enteral nutrition is a safe nutritional support, effective and that brings nutritional benefits compared with late enteral nutrition in patients undergoing to total gastrectomy for gastric cancer.
La nutrición enteral (NE) es un método efectivo para cubrir los requerimientos nutricionales en pacientes que presentan un estado nutricional deteriorado. Objetivos: Comparar la Nutrición Enteral Precoz (NEP) versus Nutrición Enteral Tardía (NET) en la evolución clínica y nutricional de pacientes sometidos a gastrectomía total por Cáncer Gástrico. Material y Método: 18 pacientes con cáncer gástrico resecable, fueron estudiados con parámetros antropométricos, funcionales y bioquímicos que evalúan el estado nutricional, en el período preoperatorio y postoperatorio. Recibieron una fórmula enteral polimérica (1 kcal/ml) en el período postoperatorio. De manera aleatoria fueron asignados al tipo de nutrición (precoz o tardía). Resultados: El grupo con NEP presentó mejoría significativa del porcentaje de adecuación del pliegue bicipital y dinamometría. El grupo con NET presentó disminución significativa de la albuminemia. La distensión abdominal fue más frecuente en grupo con NEP. Conclusión: La Nutrición Enteral Precoz es un soporte nutricional seguro, eficaz y que trae consigo ventajas nutricionales en comparación con la Nutrición Enteral Tardía en el grupo de pacientes gastrectomizados totales por presentar cáncer gástrico.