| Objective: To investigate the effect of glutamine combined with early enteral nutrition and the related influence of application of Chinese medicine Dachaihu Tang by studying the postoperative liver function,nutritional status,infection control and gastrointestinal function recovery in patients with malignant obstructive jaundice,providing theoretical basis for the clinical application of perioperative nutritional support and traditional Chinese medicine for patients with malignant obstructive jaundice in the future.Methods: 45 patients with surgical treatment of malignant obstructive jaundice in our department from March 2016 to December 2017 were randomly divided into 3 groups: enteral nutrition group(group A,N=15),glutamine combine with enteral nutrition group(group B,N=15),glutamine combined enteral nutrition + Chinese medicine group(group C,N=15).Group A is only given ordinary enteral nutrition,group B is given enteral nutrition supplemented with glutamine,In group C,glutamine was added into enteral nutrition preparations and added Chinese medicine preparation(Dachaihu Tang)on the second day after operation.Blood samples were taken on the 1st,4th and 7th day after operation respectively to detect patient's infection indicators,liver function indicators,nutritional indicators,while observing and recording gastrointestinal function recovery indicators,including the recovery time of bowel sounds,the first time through the anus exhaust time,the first defecation time.Results: The total number of leukocytes and neutrophil in all 3 groups of patients decreased after operation,and decreased more obviously on the 4th day to the 7th day after operation(P <0.05).Compared with group A and B,group C decreased significantly.There was no significant difference in liver function,coagulation function and the recovery time of bowel sounds among the 3 groups(P> 0.05),but the liver function indexes of the 3 groups showed a decreasing trend,and the decrease of C group was more obvious than the former two groups.Nutritional indicators of 3 groups showed an upward trend,and there were significant differences in the rising trend of Prealbumin from the 4th day to the 7th day after operation(P <0.05).The total protein and albumin in group C increased up to normal values earlier than those in group A and B.There was a significant difference between defecation time and anal exhaust time(P <0.05),and the time in group C was significantly shorter than that in group A and B,and the time in group B was slightly shorter than that in group A.Discussion:1?Early enteral nutrition support has long been accepted as superior to simple parenteral nutrition both at home and abroad.Now it has been widely recognized and applied in clinic because it is more in line with the physiological needs of human nutrition absorption.The experiment shows that patients can tolerate enteral nutrition support in the early postoperative period,so it can be ieferred that other complex abdominal surgery can also choose to give early enteral nutrition support.And it is needed to discussion about the opportunity of the beginning of early enteral nutrition.2?Exogenous addition of glutamine could promote the protein levels,gastrointestinal function recovery after surgery,and had some effect on the improvement of liver function,but have no statistical significance,which may be related to the less experimental data.Further research can be done by further gathering more clinical data.Based on the previous studies,this experiment indirectly verified that glutamine can protect the intestinal barrier and regulate immune,but also provided the basis for clinical exogenous glutamine through enteral administration.3?Timely dialectic of Dachaihu Decoction adjuvant therapy can make its bowel relief function recovery,biliary patency,jaundice diminished,and improve liver function,promote gastrointestinal function recovery,which conducive to nutrient absorption,while its effectiveness in the actual discharge of the endotoxin can be limited to the intestine and promote its excretion as soon as possible,which will help control the infection. |
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