Ecoimmunonutrition Management After Surgical Operation: Basic And Clinical Research

[Objectives] To investigate the effect of ecoimmunonutrition supplement by gut on nutritional status, immuninal function, intestinal epithelial tight junctions, and barrier function after surgical operation.[Methods] The surgical trauma model was made in 70 SD rats. These animals were randomly divided into four groups: 1) placebo group, 2) total parenteral nutrition(TPN) group, 3) enteral nutrition(EN) group and 4) ecoimmunonutrition(SEN) group. The four regimens were isocaloric and isonitrogenous. Nutrients were administered via the neck vein and the needle jejunostomy for five days. The homogenated tissue of liver, lung, and mesenteric lymph nodes were cultured to determine the bacterial translocations. The transmembrane binding proteins(occludin) were measured with immunohistochemistry. The ultrastructure and morphology of intestinal epithelial tight junctions in the intestine were observed by electron microscope. The feces in cecum were cultured for anaerobic bacterial growth and analysed by SEN group. The proliferation of the peripheral lymphocytes was observed.[Results] The amounts of lactobacteria and bifydobacteria in SEN group were significantly higher than in TPN group. The expressions of occludin of SEN group in the small intestines were prevail to those of TPN group. Furthermore, the intestinal epithelial tight junction and microvilli of SEN group were more intact compared with TPN group. The bacterial translocations of liver, lung and mesenteric lymph nodes were significantly lower in SEN group than in the TPN group. The proliferation rates of the peripheral lymphocyte in both EN group and SEN group were similar to that in the control group. After nutritional treatment, the proliferation rates of the peripheral lymphocytes were significantly lower in TPN group than in control group. The proliferation rates of the peripheral lymphocyte were significantly decreased after operation in TPN group.[Conclusion] The application of ecoimmunonutrition may protect intestinal mucosal barrier of post-wounded rat, increase the expression of transmember binding proteins, maintain the gut epithelial tight junction, eliminate gut bacterial translocation, improve nutritional status and immunosuppression. Objective: To observe the effect of Enriched nutrition support on clinical outcome and blood glucose in postoperative patients.Methods: Informed consent was obtained from each prospective subject. A total of 50 consecutive patients undergoing the abdominal operations were divided randomly into the glutamine group or the placebo group. The glutamine group was given daily intravenous glutamine-dipeptide 100ml from day 3 to day 9 after operation. The two groups had similar nutritional intakes. Body weight, blood cell count, liver and renel function, plasma albumin, prealbumin, transferrin and fibronectin were estimated on 1 d before as baseline and 3 d and 10 d after operation using standard laboratory techniques. Blood glucose, insulin and fatigue (Christensen score) were measured from 3 d to 9 d after operation.Results: On postoperative day 10, fatigue score in glutamine group was lower than that in control group (p＜0.05); the level of prealbumin, lower than that in control group(p＜0.05); the level of prealbumin, transferrin and fibronectin in glutamine group was significantly higher than that in control group (p＜0.05). Mean blood glucose levels were stable in the placbo group from 3 d to 6 d after operation(P＜0.05). There was no significant difference between two groups in weight loss after operation(p＞0.05).Conclusion: Glutamine together with nutrition support is effective and safe on promoting protein synthesis and nutritional status in postoperative patients. It is also beneficial to reduce the courses of POFS.