| BackgroundRadical gastrectomy as the treatment of choice for gastric carcinoma was evaluated by a number of centres, which can cause the change of patients’physical structure, so postoperative patients with gastric carcinoma were unable to meet their nutritional requirements through the mouth, needing administration of nutritional support. Enteral nutrition (EN) has been the first-line choice for nutrition support patients. Unfortunately, a number of factors render the provision of optimal/prescrib-ed enteral nutrition, so that patients always being enteral underfeeding, especially early enteral nutrition (EEN) underfeeding. Then, patients have to use parenteral nutrition (PN), even total parenteral nutrition, which may potentially increase patients’safety problems and health care costs.How to improve the condition of EEN underfeeding was a general question in the clinical, and to which has been paid more attention, while a large number of researches were limited to critically ill patients, and domestic research on nursing intervention study was few. Therefore, related research should be started to improve the quality of enteral nutrition and to prevent the postoperative EEN underfeeding. Objective1.To investigate the situation of enteral underfeeding in early enteral nutrition feeding patient after radical gastrectomy, and analyze the main reason or factor of enteral underfeeding.2.To systematically review the effect or value of early chewing gum on gastrointestinal recovery after gastrointestinal surgery.3.To evaluate the effect of systematic intervention on gastrointestinal recovery after gastrointestinal surgery.Methods1.From2011-01to2011-07, a total of82patients after radical gastrectomy were observed with a self-designed questionnaire, which focused on the first feeding time and the dose of EN feeding. To start EN within24hours after surgery is the ideal time (EEN), up to60%of individual energy demand [104.6kJ(25kcal)/(kg-d)]at the third day as the ideal EN supply(the EN supply goal).2.A search for randomized, controlled trials studying elective gastrointestinal surgery was undertaken using the databases of PubMed, EMbase, Chinese Science and Technology Periodical Databases(VIP), China National Knowledge Infrastructure (CNKI) Cochrane Library and Google, all studies of comparing chewing gum with other procedures were included. After selection and critical appraisal of the retrieved studied, a quantitative systemic review (Meta-analyses) was performed by RevMan4.3.2software.3.Combined EN guidelines with the measure of chewing gum, a systematic intervention was designed, which include:①chewing gum within24hours after surgery;②using feeding protocol;③EEN (within24hours after surgery);④adequacy(low dose) of EN at the beginning;⑤Semi-recumbent position(30° 45°);⑥Standardized functional exercises. Systematic intervention was used in the research group (2011-10to2012-02), then, historical control was made between from2011-01to2011-07and from2011-10to2012-02, to study the intervention’s effect in protecting the enteral underfeeding in EEN feeding patient.Results1.After an observation of328EN days,82patients started EN from24～120(53.05±20.10) h after the surgery, only11patients started EEN, and17(20.73%) patients up to60%at the third day, the2nd and3rd days’energy supply were higher than not up to goal group (P<0.05;P<0.01); After comparison, there was a significant differences on the factors of EN intolerance (χ2=4.44,P=0.04) and without improving EN does (χ2=6.92,P=0.01), abdominal distention/pain is the most common symptoms in EN intolerance.2. Seven studies with366patients were included. For time to first flatus the analysis favored treatment with a WMD of13.4h reduction (95%CI-22.12to-4.76; P=0.002). For time to first bowel motion, treatment was favored with a WMD of30.1h reduction (95%CI-37.11to-17.02;P<0.00001). For time to first passage of feces the analysis favored treatment with a WMD of11.2h reduction (95%CI-20.56to-1.75;P=0.02). For length of hospital stay, treatment with a WMD of38.2h reduction (95%CI-61.47to-14.82;P=0.001).3.After systematic intervention, the patients in research group started EN from24-48(25.48±5.81) h after the surgery, which were earlier than contract group(t=63.07,P<0.05); After comparison, the3rd days’energy supply up to (45.21±25.71)%, which were higher than contract group (t=-2.51,P<0.05), while there was no difference between the first two days; Excluding unplanned extubation patients, there was a significant difference on the incidence of EN intolerance (χ2=4.41, P=0.04) and abdominal distention/pain (χ2=8.31,P=0.00).Conclusions1.The survey indicated that condition of enteral underfeeding in EEN feeding patient after radical gastrectomy needs to be further improved. The factors are multiple and wide. The main reasons for enteral underfeeding were:prolonged fasting time (slow initiation EN) and low infusion dose. The major factors for low infusion dose were:EN intolerance, without improving EN dose, abdominal distention/pain was the most common in EN intolerance.2.Meta-analysis:therapy of early chewing gum following gastrointestinal surgery is beneficial in promoting the recovery of gastrointestinal function and reducing length of hospital stay, which can be used in improving patients’EN tolerance.3.Systematic intervention can improve the condition of enteral underfeeding in EEN feeding patient after radical gastrectomy. |
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