Objective To evaluate the effectiveness of enteral immunonutrition for patients with acute pancreatitis. Methods The randomized controlled trials (RCTs) about enteral immunonutrition for patients with acute pancreatitis were searched in following databases: PubMed (1966 to August 2012), MEDLINE (Ovid, 1946 to August 2012), CENTRAL (Issue 3, 2012), CBM (1978 to August 2012), CNKI (1979 August 2012), VIP (1989 to August 2012), and WanFang Data (1977 to August 2012). The relevant materials and each reference of literature were also searched manually. Two reviewers independently screened the literature according to the predefined inclusion and exclusion criteria, extracted the data and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 197 patients were included. The results of meta-analysis showed that there were no significant differences between the enteral immunonutrition group and the routine enteral nutrition group in following aspects: infectious complications and mortality rate, length of stay, level of C-reactive protein and numeration of leucocyte after treatment, and APACHE II score. Conclusion At present, no evidence shows enteral immunutrition is superior to routine enteral nutrition in acute pancreatitis. For the quantity and quality limitation of the included studies, more high-quality and large-sample RCTs are required to investigate the proper ingredients and dosage of enteral immunonutrition suitable for patients with acute pancreatitis.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
【摘要】 目的 探讨比较全肠内营养支持和全肠外营养支持对急性重症胰腺炎（severe acute pamcreattis，SAP）预后的影响。 方法 将2003年1月-2008年12月收治的54例SAP患者于入院后第1周内随机分为两组:全肠内营养（A）组27例；全肠外营养（B）组27例。两组患者均静脉给予广谱抗生素预防感染。入院时CT扫描及C反应蛋白水平显示两组患者具有可比性。 结果 B组22例患者发生器官衰竭，明显高于A组（5例）。B组22例患者接受了手术治疗，A组手术患者6例（Plt;0.05）。A组患者胰腺坏死后感染发生率明显低于B组（Plt;0.05）。B组患者死亡率高于A组（Plt;0.05）。 结论 全肠内营养支持，不仅可以促进肠道功能的恢复和营养状况的维持，还可减少肠源性感染的发生率，对减少SAP的感染性并发症和病死率具有积极作用。【Abstract】 Objective To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP). Methods A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups. Results Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05). Conclusion Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.
目的探讨肝脏移植术后早期肠内营养支持的价值。方法在术中将鼻肠管放置至屈氏韧带或空肠输出袢下30 cm， 术后第2天开始恒速灌注瑞素，量由500 ml/d逐渐增加到1 200 ml/d，速度由20 ml/h增至100 ml/h。分别于术后第2天及第8天观察患者的白蛋白、前白蛋白、转铁蛋白、尿尿素氮和氮平衡。结果前白蛋白、转铁蛋白和氮平衡均有显著改善，白蛋白无明显变化。结论肝脏移植术后早期肠内营养支持可以有效改善患者的营养状况和促进患者的恢复，并且可以减少患者的营养支持费用。
ObjectiveTo investigate the clinical advantages of enteral nutrition (EN) for acute pancreatitis（AP）comparing with parenteral nutrition (PN) and its prospect. MethodsLiteratures using MESH Browser in Medline were collected and reviewed. ResultsBeing of much higher cost and complications, total parenteral nutrition (TPN) ever regarded as most importantly for AP nutritional support, is now challenged by EN. Clinical evidence suggests enteral (jejunal) nutrition may diminish intestinal permeability to endotoxin and diminish bacterial translocation, thus reducing the cytokine drive to the generalized inflammatory response and preventing organ dysfunction, as well as achieving “pancreatic rest” equivalent to the TPN. Conclusion Early enteral nutrition should be used preferentially for patients with severe acute pancreatitis without paralytic ileus.
肠内或称经肠营养(enteral nutrition)是经胃肠道用口服或管饲来提供可满足、超过或补充代谢需要的营养基质及其他各种营养素的营养方式［1］。经过漫长的临床实践与技术发展，肠内营养的优越性越来越为人们所重视。“如果肠道有功能，就应使用肠道”的原则已为大多数临床医师所接受。近年来外科术后早期肠内营养（early enteral nutrition）的研究亦有较多的进展。
ObjectiveTo evaluate the effect of the early enteral nutrition（EEN） on the natural course in dogs with severe acute pancreatitis（SAP）.MethodsSAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000-10 000 BAEE units trypsin/ml into pancrease via pancreatic duct.Fifteen dogs were divided into parenteral nutrition(PN) group and EEN group.Two groups were isonitrogenous and isocaloric.EEN was used at postoperative 24 h.Systemic plasma endotoxin level was quantified by the chromogenic limulus amebocyte lysate technique.Both portal and systemic blood sample were obtained before and 1，4，7 d following SAP, and cultured for aerobic as well as anaerobic bacterial.Serum glucose, calcium,amylase and lysosomal enzymes were determined.All dogs were injected with 1.85×106 Bq 125IBSA 4 h before sacrificed.The 125IBSA index of the pancreas/muscle and pancreas/blood was measured,and pancreas pathology was observed.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenata were cultured as blood mentioned above.The thickness of mucosa,the whole gut layer,the height of intestinal villi and their protein and DNA contents in the intestinal and transverse colon were determined.ResultsThe study showed that EEN significantly reduced the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ,serum glucose in PN group was higher than that in EEN after SAP 4 d.There were no difference between two groups in the data of serum calcium,amylase and lysosomal enzymes,pathologic index and 125IBSA index of pancreas/muscle and pancreas/blood.EEN improved the gut barrier function by increasing the thickness of mucosa,the whole gut layer and the height of intestinal villi,increasing its protein and DNA contents in the bowel.ConclusionOur results suggest that EEN is safe and effective,and can decrease the rate of intestinal bacterial translocation.