Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologica...Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.展开更多
AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and...AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients underg展开更多
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despit...Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despite the benefits and widespread use of enteral tube feeding,some patients experience complications.This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special aspects.We conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding syndrome.The literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,hyperglycemia.Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most common.Complications associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.展开更多
目的探究极低出生体重(very low birth weight,VLBW)早产儿校正月龄12个月内体重、身长、头围追赶生长特征及相关影响因素,为临床干预提供依据。方法采用回顾性研究,摘录2014年1月—2016年3月就诊于上海市某妇婴保健院新生儿重症监护室(...目的探究极低出生体重(very low birth weight,VLBW)早产儿校正月龄12个月内体重、身长、头围追赶生长特征及相关影响因素,为临床干预提供依据。方法采用回顾性研究,摘录2014年1月—2016年3月就诊于上海市某妇婴保健院新生儿重症监护室(neonatal intensive care unit,NICU)符合纳入和排除标准的VLBW早产儿的临床资料。分别与Fenton(2003)早产儿生长曲线及疾病预防控制中心(Centers for Disease Control and Prevention,CDC)足月儿生长曲线进行比较,探究VLBW早产儿校正月龄6个月及12个月体格生长发育的影响因素。结果共纳入113例VLBW早产儿,其中106例随访至校正月龄3个月及以上。与早产儿及足月儿相比,VLBW早产儿的身长、体重、头围差异均有统计学意义(P<0.05)。单因素分析显示,校正月龄6个月时,VLBW男婴身长发育不良与住院时间长、开始经口喂养月龄大、全经口喂养月龄大、开始经口母乳喂养月龄大相关,其体重发育不理想与住院时间长、开始经口母乳喂养月龄大相关(P<0.05)。校正月龄12个月时,VLBW女婴头围发育与母亲年龄和校正月龄6个月纯配方奶喂养有关,其体重发育不良与母亲年龄有关(P<0.05)。VLBW男婴头围发育不良与开始经口喂养及全经口喂养胎龄大有关,其身长发育不良与住院期间纯母乳喂养有关(P<0.05)。结论尽早过渡到全经口喂养,住院及随访期间母乳和早产儿配方奶混合喂养对VLBW早产儿体格生长起积极作用,提示患儿NICU住院期间及随访期间喂养指导的重要性。展开更多
国际早产儿喂养共识发表在2013年Journal of Pediatrics第3期增刊上,其内容涵盖了不同胎龄早产儿的能量、蛋白质、脂类和其他营养素的需求、早产儿生长的评估、早产儿母乳喂养、晚期早产儿和出院后早产儿的喂养推荐、小于胎龄儿的营养...国际早产儿喂养共识发表在2013年Journal of Pediatrics第3期增刊上,其内容涵盖了不同胎龄早产儿的能量、蛋白质、脂类和其他营养素的需求、早产儿生长的评估、早产儿母乳喂养、晚期早产儿和出院后早产儿的喂养推荐、小于胎龄儿的营养管理、重新认识围产期维生素A和维生素D的重要性、益生元与益生菌、免疫营养对肠黏膜防御机能的作用、早产儿喂养与远期代谢与心血管疾病等。共识的主要特点是:(1)以改善预后为目标,重视远期结局;(2)以胎龄为基础,个体化的营养策略;(3)以科学为依据,共识与争议并存。展开更多
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known...Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placeme展开更多
文摘Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.
文摘AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients underg
文摘Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake,chronic neurological or mechanical dysphagia or gut dysfunction,and patients who are critically ill.However,despite the benefits and widespread use of enteral tube feeding,some patients experience complications.This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding,together with associated complications and special aspects.We conducted an extensive literature search on PubMed,Embase and Medline using index terms relating to enteral access,enteral feeding/nutrition,tube feeding,percutaneous endoscopic gastrostomy/jejunostomy,endoscopic nasoenteric tube,nasogastric tube,and refeeding syndrome.The literature showed common routes of enteral access to include nasoenteral tube,gastrostomy and jejunostomy,while complications fall into four major categories:mechanical,e.g.,tube blockage or removal;gastrointestinal,e.g.,diarrhea;infectious e.g.,aspiration pneumonia,tube site infection;and metabolic,e.g.,refeeding syndrome,hyperglycemia.Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route,gastrointestinal complications are without doubt the most common.Complications associated with enteral tube feeding can be reduced by careful observance of guidelines,including those related to food composition,administration rate,portion size,food temperature and patient supervision.
文摘目的探究极低出生体重(very low birth weight,VLBW)早产儿校正月龄12个月内体重、身长、头围追赶生长特征及相关影响因素,为临床干预提供依据。方法采用回顾性研究,摘录2014年1月—2016年3月就诊于上海市某妇婴保健院新生儿重症监护室(neonatal intensive care unit,NICU)符合纳入和排除标准的VLBW早产儿的临床资料。分别与Fenton(2003)早产儿生长曲线及疾病预防控制中心(Centers for Disease Control and Prevention,CDC)足月儿生长曲线进行比较,探究VLBW早产儿校正月龄6个月及12个月体格生长发育的影响因素。结果共纳入113例VLBW早产儿,其中106例随访至校正月龄3个月及以上。与早产儿及足月儿相比,VLBW早产儿的身长、体重、头围差异均有统计学意义(P<0.05)。单因素分析显示,校正月龄6个月时,VLBW男婴身长发育不良与住院时间长、开始经口喂养月龄大、全经口喂养月龄大、开始经口母乳喂养月龄大相关,其体重发育不理想与住院时间长、开始经口母乳喂养月龄大相关(P<0.05)。校正月龄12个月时,VLBW女婴头围发育与母亲年龄和校正月龄6个月纯配方奶喂养有关,其体重发育不良与母亲年龄有关(P<0.05)。VLBW男婴头围发育不良与开始经口喂养及全经口喂养胎龄大有关,其身长发育不良与住院期间纯母乳喂养有关(P<0.05)。结论尽早过渡到全经口喂养,住院及随访期间母乳和早产儿配方奶混合喂养对VLBW早产儿体格生长起积极作用,提示患儿NICU住院期间及随访期间喂养指导的重要性。
文摘国际早产儿喂养共识发表在2013年Journal of Pediatrics第3期增刊上,其内容涵盖了不同胎龄早产儿的能量、蛋白质、脂类和其他营养素的需求、早产儿生长的评估、早产儿母乳喂养、晚期早产儿和出院后早产儿的喂养推荐、小于胎龄儿的营养管理、重新认识围产期维生素A和维生素D的重要性、益生元与益生菌、免疫营养对肠黏膜防御机能的作用、早产儿喂养与远期代谢与心血管疾病等。共识的主要特点是:(1)以改善预后为目标,重视远期结局;(2)以胎龄为基础,个体化的营养策略;(3)以科学为依据,共识与争议并存。
文摘Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placeme
