| Background:Early postoperative gastrointestinal motility dysfunction is a common complication early after gastrointestinal operation. It can result small bowel obstruction, serious infection and a second operation. It also can prolong hospital stay and increase hospital expensive. Gastrointestinal operation also can cause damage of gastrointestinal mucosa as well as long-term parenteral nutrition. Studies about early stage enteral nutrition were published in recent years, but only few of them focus on the effects of enteral nutrition by different pathway on gastrointestinal hormones and gastrointestinal mucosa.Objective:To establish the rat gastrointestinal motility dysfunction model of supplying enteral nutrition by different pathway after abdominal operation. Study the effects of enteral nutrition by different pathway on gastrointestinal hormones and gastrointestinal mucous in ratsMethods:96SD rats were randomly divided into normal group (n=6), laparotomy group (n=18), gastrostomy group (n=36) and jejunostomy group (n=36). According to the time of sacrifice, laparotomy group was divided into POD3group (n=6), POD7group (n=6) and POD12group (n=6); gastrostomy and jejunostomy group was divided into POD3group (n=6), POD7group (n=24) and POD12group (n=6). According to the time after enteral nutrition, gastrostomy and jejunostomy POD7group was divided into30min group (n=6),60min group (n=6) and120min group (n=6). Gastrostomy and jejunostomy group was supplied total enteral nutrition after operation On each corresponding time, the rats was sacrificed and serum gastrin, motilin, cholecystokinin, morphological parameters of gastrointestinal mucosa were measured.Results:1. After gastrostomy or jejunostomy of rats, the serum GAS and MTL level were redused significantly on POD3(p<0.01), comparing to the normal group, and Jejunostomy group is lower than gastrostomy group(P<0.01); on POD7and POD12there was no difference comparing to the normal group or to each other. After gastrostomy or jejunostomy of rats, the serum CCK level was no difference comparing to the normal group or to each other on POD3, POD7, POD12.2. On the7th day after postoperative EN of rat, the serum GAS level increased significantly30min,60min after EN infusion(P<0.01),60min was higher than30min(P<0.01), and gastrostomy group rose more than jejunostomy group(P<0.01).120min after EN infusion serum GAS level was no difference than before. Two pathways were no difference. The serum MTL and CCK level was increased significantly30min after EN infusion (P<0.01), gastrostomy group rose more than jejunostomy group.60min,120min after EN infusion serum MTL and CCK level was no difference than before. Two pathways were no difference.3. After gastrostomy or jejunostomy of rats, the morphological parameters of gastrointestinal mucosa were reduced significantly on POD3(p<0.01), comparing to the normal group, Two pathways were no difference. The morphological parameters of gastrointestinal mucosa of gastrostomy group were no difference on POD7, comparing to the normal group. In jejunostomy group, morphological parameters of gastric and duodenal were reduced comparing to the normal group and lower than gastrostomy group, but jejuna and caecal were no difference, comparing to the normal group. On POD12the morphological parameters of gastrointestinal mucosa were no difference comparing to the normal group.Conclutions:After gastrointestinal operation the serum GAS and MTL level were decreased significantly. EN infusion can help them recover to normal level on7th day, and the recovery of gastric EN infusion is faster. After long-term EN infusion, gastric and jejuna EN can stimulate secretion of GAS, MTL and CCK in short time. The effects of gastric EN are stronger. After gastrointestinal operation, mucosa of each segment of gastrointestine was damaged. These damages can be repaired after long-term EN infusion and Gastric EN infusion can repair the mucosa of gastric and duodenal more rapidly. Objective:The aim of this study was to evaluate the rate of nutrition risk in elderly patients in general surgeny department by NRS-2002and MNA, to assess the correlations between nutrition risk and nutrition related hemological levels, applications of nutrition support and health economical indexes and compare NRS-2002and MNA.Methods:In this prospective study, patients older than65in general surgery department were included from Jul2010to Apr2011,284cases of gastrointestinal cancer, thyroid tumour, hernia and cholelithiasis, respectively. Patients received NRS-2002and MNA nutrition risk screening at the admission. Data aslo was recorded on nutrition related hemological levels, applications of nutrition support and health economical indexes.Results:The average rate of nutrition risk in elderly patients in general surgery department screened by NRS-2002and MNA was37.7%and26.8%. The average rate of nutrition risk in gastrointestinal tumor patients is higher than those of thyroid tumour, hernia and cholelithiasis. The average level of total serum protein, albumin, PA, RBC, hemoglobin, lymphocyte, BMI of gastrointestinal tumor patients at nutrition risk was lower than that at no nutrition risk. Hospitalized time and medical expenses of patients at nutrition risk is higher than that at no nutrition risk. Compared with those without preoperation nutrition support, the post operation days at nutrition risk is lower than patients received preoperation nutrition support. The application of NRS-2002and MNA at elderly patients shows great consistency but significant difference in elderly gastrointestinal tumor patients. For those patients screened by NRS-2002as nutrition risk but screened by MNA as no nutrition risk, hospitalized time and medical expenses of patients received preoperation nutrition support is lower compare to patients didn’t received preoperation nutrition.Conclutions:Elderly Patients in general surgery department, especially elderly ones, had a relatively higher rate of nutrition risk. Those with nutrition risk had lower RBC, HGB, LY, ALB, TB, PA, BMI and higher hospitalized time and medical expeses. Preoperation nutrition support didn’t rise medical expeses but may reduce the rate of postoperative complications. Preoperation nutrition support decrease post operation days of patients at high nutrition risk. NRS-2002and MNA on elderly patients shows great consistency but significant difference in elderly gastrointestinal tumor patients. NRS-2002may be more suitable for elderly patients in general surgery department than MNA. |
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