Effect Of Enteral Nutrition To Nutritional Status And Level Of Endotoxin On Severe Patients

Objective Mostly severe patients are complicated by nutritional and metabolic disorders, and the body is in stress and high metabolic conditions. Nutritional support is a necessary condition for successful rehabilitation, there are many methods of nutritional support, but enteral nutrition support is mostly conform to the body’s physiological and nutritional needs. But there were a lot of controversy in the application of enteral nutrition support in the severe patients. This article investigated the effects of the application of enteral nutrition(EN) in improving the nutritional status and the influences on the level of endotoxin in severe patients.Methods64cases of severe patients who had disturbance in foodintake by oral cavity were randomly divided into total parenteral nutrition(TPN) groups and parenteral nutrition(PN) combined with enteral nutrition(EN)(PN+EN) groups, TPN group were given total parenteral nutrition, and PN+EN group were given enteral nutrition all or part time. The triceps skin fold thickness, arm circumference, liver function, serum endotoxin, and inflammatory mediator were detected before and after the treatment, and contrasted between the two groups.Results There was no no significantly differences on triceps skin fold thickness, arm circumference, alanine aminotransferase (ALT), aspartate aminotransferase(AST), direct bilirubin (DBIL), total bilirubin(TBIL), serum endotoxin, IL-6, and TNF-a before the treatment between the two groups(P>0.05).1week after the treatment, the triceps skin fold thickness of TPN group was (5.95±1.20)mm, significantly higher than PN+EN group (6.78±1.06)mm(P<0.05); the arm circumference of PN+EN group was (28.0±4.9) cm, significantly higher than TPN group (24.2±5.10) cm(P<0.05); ALB of PN+EN group was(36±4.7) g/L, higher than TPN group (31±4.2)g/L; PA of PN+EN group was (232±28.6) mg/L, lower than TPN group (187±25.4) mg/L; ALT of TPN group was (76.3±8.6)U/L, significantly higher than PN+EN group (55.4±7.9)U/L(P<0.05); AST of TPN group was (89±13.2)U/L, significantly higher than PN+EN group (52±10.9) U/L (P<0.05); indirect bilirubin (IBIL) of TPN group was (29.6±4.9) mmol/L, significantly higher than PN+EN group (18.4±4.7)mmol/L(P<0.05); DBIL of TPN group was (16.5±4.6) mmol/L, higher than PN+EN group (9.0±2.2)mmol/L; IL-6of TPN group was (315.7±39.4) ng/L, significantly higher than PN+EN group (182.4±22.6)mmol/L(P<0.05); TNF-a of TPN group was (204.6±36.5) ng/L, significantly higher than PN+EN group (97.2±18.4) mmol/L(P<0.05); serum endotoxin of TPN group was (66.4±11.4) ng/L, significantly higher than PN+EN group (31.7±10.5) mmol/L (P<0.05).Conclusion Enteral nutrition support can improve the nutritional status, reduce liver injury, improve the nutritional status of the gastrointestinal mucosa, reduce the generation of bacterial endotoxin and release of the inflammatory mediators, it has important significance for nutrition therapy in severe patients.