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Objective:To explore the effects of myosteatosis and blood glucose (BG) on postoperative complications in non-diabetic gastric cancer patients receiving supplemental parenteral nutrition (SPN) after gastrectomy.Methods:Patients who underwent radical gastrectomy between March 2017 and June 2021 in the Department of Surgical Oncology, the First Hospital of Lanzhou University were included in this study. Various preoperative inflammatory and nutritional indicators, including skeletal muscle metrics at the third lumbar level on CT, were collected retrospectively. Postoperative BG within 3 days and complications within 30 days were monitored. Patients were divided into two groups according to the presence or absence of myosteatosis (assessed via skeletal muscle density [SMD]) and the differences in postoperative BG and complication incidence were compared. Mediation model was used to analyze the mediating effect of BG in the association between SMD and postoperative complications.Results:A total of 357 patients were included in the study. Compared with the 299(83.8%) patients without myosteatosis , the incidence of hyperglycemia, mean BG, maximal BG, and BG fluctuation while on SPN in the 58(16.2%) patients with myosteatosis were higher, and the comprehensive complication index (CCI) and the incidence of complication were higher ( P<0.05). More importantly, BG showed the mediation effect of -0.0892 in the effect of SMD on CCI ( P<0.05), with the effect size of 19.3％. Conclusion:Myosteatosis and postoperative hyperglycemia are associated with higher incidence of complications, and BG plays an intermediary role in the association between myosteatosis and CCI.
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Objective:To investigate the effects of supplemental parenteral nutrition on postoperative nutritional status, immune function and inflammatory response in patients with esophageal cancer after operation.Methods:A prospective study was performed on 72 patients with esophageal cancer who visited the Department of Thoracic and Cardiovascular Surgery of the Affiliated Hospital of Putian University from June 2018 to June 2020. According to the random table of new drug data statistics and processing software, they were randomly divided into experimental group (supplementary parenteral nutrition group) and the control group (complete enteral nutrition group), with 36 cases in each group. The experimental group was given enteral nutrition (EN) from the first day after operation, and EN and parenteral nutrition (PN) was given on the 4th to 8th day after operation. In the control group, EN was started on the first day after operation. The changes of nutritional status, immune function and inflammatory indexes in the perioperative period were compared between the two groups. Mann-Whitney U test was used for measurement data that did not meet the normality standard, and t test was used to compare measurement data that met the normality standard between groups. Nutrition indicators, inflammatory indicators and immune indicators used repeated measures analysis of variance. For enumeration data, Mann-Whitney U test was used for hierarchical classification data, and χ 2 test was used for unordered multi-classification data. Results:On the 1st day after operation, the prealbumin concentration ((95.34±37.93) mg/L and (81.60±37.68) mg/L) in the experimental group and the control group was significantly higher than that before the operation ((144.86±46.79) mg/L and (130.39±50.91) mg/L), and the differences were statistically significant (all P<0.001), and there was no significant difference between the two groups (all P>0.05). Immunoglobulin (Ig) A ((0.48±0.39) g/L and (0.41±0.30) g/L), IgG ((4.21±3.44) g/L and (4.08±2.98) g/L), IgM( (0.32±0.26) g/L and (0.30±0.27) g/L) in the experimental group and the control group were compared with preoperative ((0.55±0.45) g/L and (0.47±0.39) g/L, (5.16±3.36) g/L and (5.48±3.30) g/L, (0.38±0.32) g/L and (0.35±0.30) g/L), and the difference was not statistically significant (all P>0.05), and there was no significant difference between the two groups (all P>0.05). In the experimental group and the control group, CD3 ((31.75±11.81) % and (28.03±9.30)%) were lower than those before operation ((40.86±12.50)% and (42.31±8.09)%), CD4 ((14.19±5.39)% and (16.06±9.08)%) were lower than those before operation ((21.69±8.54)% and (24.11±12.09)%), CD4/CD8 ((0.24±0.09) and (0.29±0.18)) were lower than those before operation ((0.42±0.16) and (0.50±0.28)), and CD8 ((59.03±8.14)% and (56.39±7.42)%) were lower than those before operation ((51.25±6.64)% and (49.14±6.53)%), the differences were statistically significant (all P<0.05). There was no significant difference in C3, C4 and C reactive protein (CRP) compared with preoperatively (all P>0.05), and there was no significant difference between the two groups (all P>0.05). On the 7th day after operation, the prealbumin concentration ((186.70±40.88) mg/L) in the experimental group was higher than that before operation and on the 1st day after operation, and the difference was statistically significant (all P<0.05), which was higher than that in the control group ((131.62±53.37) mg/L), the difference was statistically significant (all P<0.05); the prealbumin concentration in the control group ((131.62±53.37) mg/L) was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05). IgA ((0.88±0.42) g/L), IgG ((10.70±4.39) g/L) in the experimental group was higher than that before operation, and the difference was statistically significant (all P<0.05), and it was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05), lower than those in the control group ((0.59±0.44) g/L and (4.08±2.98) g/L), the difference was statistically significant (all P<0.05). In the test group, CD3 ((45.92±14.31)%), CD4 ((27.06±10.53)%), CD4/CD8 (0.66±0.33) increased and and CD8 (43.64±11.34%) decreased compared with the first day after operation, with statistically significant differences (all P<0.05). The elevated levels of CD4 and CD4/CD8 were statistically significant compared with the control group (all P<0.05). The CRP ((8.90±7.56) mg/L) in the experimental group on the 7th postoperative day was lower than that before operation and on the 1st postoperative day, and the difference was statistically significant (all P<0.05), which was lower than the control group ((16.24±13.53) mg/L), the difference was statistically significant (all P<0.05). The incidence of postoperative pulmonary infection (22.22% (8/36)), the incidence of anastomotic leakage (5.56% (2/36)), and the postoperative hospital stay ((14.17±4.79) d) in the experimental group were lower than those in the control group (44.44% (16/36), 25.00% (9/36), (18.47±6.34) d), the total hospitalization expenses in the experimental group ((71 261.94±11 503.50) yuan) were higher than those in the control group ((65 226.81±10 106.43) yuan), the difference was statistically significant (the statistical values were χ 2=4.00, χ 2=5.26, t=3.74, t=2.37; P values were 0.046, 0.022, <0.001 and 0.021, respectively). Conclusion:Supplemental parenteral nutrition for perioperative esophageal cancer patients can effectively maintain nutritional status, improve immune function, and reduce the inflammatory stress response.
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Objective To explore the effect of early supplemental parenteral nutrition on the outcomes of critically ill patients.Methods Totally 302 patients admitted in the intensive care unit (ICU) of Taizhou Hospital of Zhejiang Province from 2015 to March 2017 were enrolled and divided into two groups:the enteral nutrition group and the supplemental parenteral nutrition group.The clinical data of the two groups were retrospectively analyzed and the outcomes was compared between the two groups.Results The time of ICU stay,mechanical ventilation days,nosocomial infections in ICU and the rate of feeding intolerance were significantly lower in the supplemental parenteral nutrition group than in the enteral nutrition group (P＜0.05).There was no statistically significant difference in the mortality rate in 28 days between the two groups.Conclusion Supplemental parenteral nutrition has many advantages like reduce the duration of ventilation,ICU stay and the rate of feeding intolerance,and it does not affect the 28-day mortality rate of critically ill patients with NRS2002 score＞5,or increase the complication of infection.
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In recent years,the scientific literatures have revealed exponential advances in the understanding of molecular basis of nutritional support therapy and evolution of clinical protocols aimed at treating artificial nutritional support as a therapeutic intervention,preventing loss of lean body mass and metabolic deterioration to improve clinical outcomes in the critical illness.According to the evidence-based medicine,this review will summarize recent findings,highlight areas of consensus and controversy and define priorities for further researches.