肠内营养的研究进展

Preventive effect of nasal administration of enteral nutrition suspension plus probiotics on diarrhea in elderly patients

AIM

To evaluate the effect of combined application of micro-ecological regulator and glutamine in the prevention of diarrhea in elderly patients.

METHODS

From February 2014 to March 2016, 82 elderly patients who received enteral nutrition therapy at our hospital were randomly divided into a treatment group and a control group. Both groups were treated by nasogastric administration of enteral nutrition suspension and probiotics, and the treatment group was additionally given glutamine. The incidence of diarrhea, humoral immune parameters before nasal administration and at 8 d after nasal administration, and the time required for enteral nutrition suspension to reach the desired amount were compared between the two groups.

RESULTS

Compared to the control group, the incidence of diarrhea decreased significantly in the treatment group (P < 0.05). IgG and IgM levels did not differ significantly between before and after nasal administration in both groups (P > 0.05); however, IgA levels were significantly increased after nasal feeding in the treatment group, and IgA levels after treatment were significantly higher in the treatment group than in the control group (P < 0.05). Compared with the control group, the time required for enteral nutrition suspension to reach the desired amount was significantly shorter in the treatment group than in the control group (P < 0.05).

CONCLUSION

The combination of micro-ecological regulator and glutamine is helpful to reduce the incidence of intestinal nutrition related diarrhea and improve the immune function in elderly patients.

Risk factors for diarrhea in critically ill patients during enteral nutrition

AIM: To investigate the risk factors for diarrhea in critically ill patients during enteral nutrition.

METHODS: One hundred and eighty-five critically ill patients treated at our intensive care unit (ICU) from January 2014 and December 2015 were enrolled for the study and divided into either an observation group (diarrhea) or a control group (non-diarrhea) according to the Hart diarrhea scoring method. General information, enteral nutrition and treatment data were compared between the two groups. Multivariate logistics regression analysis was performed to screen out risk factors for diarrhea.

RESULTS: Diarrhea occurred in 105 (56.8%) cases, most of which occurred in the first and second days after enteral nutrition and lasted 1-2 d. Hospital stay, the incidence of hypoalbuminemia, enteral nutrition infusion time, infusion volume, the rate of fasting before enteral nutrition, time of using antibiotics, application of a variety of antibiotics, the rates of using acid-inhibitory drug and oral potassium preparation in the observation group were significantly higher than those in the control group (P < 0.05), and the rate of gradually increasing enteral nutrition preparations in the observation group was significantly lower than that in the control group (P < 0.05). There was a significant difference in the infusion speed between the two groups (P < 0.05). Hypoalbuminemia, fasting before enteral nutrition, application of acid-inhibitory drug and oral potassium preparation were independent risk factors for diarrhea (P < 0.05), and gradually increasing enteral nutrition preparations was an independent protective factor (P < 0.05).

CONCLUSION: For critically ill patients given enteral nutrition, hypoalbuminemia, fasting before enteral nutrition, application of acid-inhibitory drug and oral potassium preparation could significantly increase the risk of diarrhea. Gradual increasing of enteral nutrition preparations is recommended to reduce the risk of diarrhea.

Placement of three lumen gastrojejunal tube under digital subtraction angiography

AIM: To evaluate the clinical feasibility and effectivess of placing three lumen gastrojejunal tube under digital subtraction angiography (DSA).

METHODS: One hundred patients who were diagnosed with severe acute pancreatitis, gastroparesis or anastomotic fistula after digestive tract operation were randomly divided into a three lumen gastrojejunal tube (study) group and a nasogastric tube combined with nasointestinal tube (control) group. The indwelling time, volume of drainage, tube blocking rate, adverse reaction rate and nursing satisfaction were compared between the two groups.

RESULTS: All patients of both groups were catheterized successfully under DSA. Compared with the control group, the three lumen gastrojejunal tube group had significantly shorter indwelling time (17.0 min ± 8.2 min vs 26.9 min ± 9.8 min, P < 0.05), larger volume of drainage (276 mL ± 43 mL vs 216 mL ± 34 mL, P < 0.05), lower tube blocking rate (0 vs 12%, P < 0.05), fewer adverse reaction rate (6% vs 24%, P < 0.05) and higher nursing satisfaction (98% vs 80%, P < 0.01).

CONCLUSION: Placing three lumen gastrojejunal tube under DSA has a high successful rate and can improve the prognosis of patients who need enteral nutrition.

Influence of gastric fluid reinfusion on enteral nutrition support in intensive care unit patients

AIM: To investigate the influence of gastric juice reinfusion on the effect of early enteral nutrition in intensive care unit (ICU) patients.

METHODS: Eighty patients with enteral nutritional support in ICU of our hospital were randomly divided into an observation group and a control group, with 40 cases in each group. Patients of two groups were both given enteral nutrition, and their gastric juice were collected with a nasogastric tube. In the observation group, the gastric juice after filtration with sterile gauze was reinfused to the jejunum via the nasogastric tube. The control group was given normal saline. Nutritional support related indicators such as serum albumin, plasma total protein and hemoglobin levels were compared in the two groups, and the qualification rate of nutritional support was evaluated. Complications in the two groups were observed and compared.

RESULTS: Serum albumin, serum total protein and hemoglobin levels were significantly improved in the two groups after enteral nutrition (P < 0.05), and the improvement of the observation group was better than that of the control group (P < 0.05). The qualification rate of nutritional support in the observation group was 97.5%, significantly higher than that of the control group (82.5%, P < 0.05). The incidences of abdominal distension, diarrhea, constipation, vomiting and electrolyte imbalance in the observation group were significantly lower than those of the control group (P < 0.05). Length of ICU stay and costs in the observation group were significantly shorter (less) than those of the control group (P < 0.05).

CONCLUSION: Gastric fluid reinfusion can significantly improve the effect of enteral nutrition in ICU patients, and it reduces the incidence of gastrointestinal dysfunctions such as diarrhea, abdominal distension and vomiting.

Effect of nutritional diet improvement on the digestive system of intensive care unit patients

AIM: To investigate the effect of improvement of nutritional diet on the digestive system of intensive care unit (ICU) patients.

METHODS: One hundred and twenty-six ICU patients treated from January and December 2014 at our hospital were randomly divided into an observation group and a control group, with 63 cases in each group. All cases received early enteral nutrition through a nasogastric tube. Nutrition was used in the control group, while an improved nutritional diet, which mixed Sanku compound nutrition and protein nutrition at 2:1, was used in the observation group. The incidences of gastrointestinal complications such as diarrhea, constipation, and gastric retention, score of gastrointestinal function and patient's

satisfaction were compared between the two groups.

RESULTS: The incidences of diarrhea, constipation, and gastric retention after nasal feeding in the observation group were significantly lower than those in the control group (P < 0.05). The scores of gastrointestinal function on 3 and 7 d after nasal feeding in the observation group were significantly lower than those in the control group (P < 0.05). The patients' satisfaction and total satisfaction rate in the observation group were significantly better than those in the control group (P < 0.05).

CONCLUSION: Nutritional diet improvement in ICU patients could significantly reduce the risk of gastrointestinal dysfunction, promote the recovery of digestive system function, and improve the patients' satisfaction.