| Background and Objective:Extracorporeal membrane oxygenation is based on extracorporeal circulation system, adopting the technique of artificial heart and lung support for auxiliary treatment. ECMO can be effective in critically ill patients respiratory support, to win time for the recovery of cardiopulmonary function, which has been widely concerned in recent years.ECMO patients are severe, and undergo strong stress reaction, with gastrointestinal dysfunction which may lead to malnutrition. Therefore, effective and reasonable nutrition support treatment for ECMO patients is clinically significant. American Society for Enteral Parenteral Nutrition (ASPEN) guidelines recommend that when critically ill patients need nutrition support treatment, enteral nutrition is superior to parenteral nutrition. Compared with parenteral nutrition, early enteral nutrition can reduce the incidence of infection, shorten hospitalization time, reduce the cost of nutritional therapy, so it is significant to explore changes of inflammatory cytokines and gastrointestinal hormones, seek nutrition management measures, administrate early EN, promote recovery, and improve survival of ECMO patients who receive EN. This study showed level of inflammatory factors and gastrointestinal hormones of 16 ECMO patients with circulation or respiratory failure in Fuwai hospital from 2007 to 2009.Methods:Part 1:In 16 adults treated with venoarterial ECMO from 2007 to 2009, gutintestinal hormones were determined by radioimmunoassay at 1-day intervals. Blood samples were got respectively at the beginning(T1),1st day(T2),3rd day(T3),4th day(T4), and 5th day(T5) of ECMO. Serum concentration of interleukin 1β (IL-1β), Interleukin 6(IL-6), Interleukin 10 (IL-10) and tumor necrosis factor a(TNF-a) were measured.Part 2:Cases are the same of part 1.Blood samples were got respectively at the beginning(T1),1st day(T2),3rd day(T3),4th day(T4), and 5th day(T5) of ECMO. Serum concentration of motilin(MOT), gastrin(GAS), cholecystokinin(CCK) calcitonin gene related peptide(CGRP) were measured.Results:Part 1:Serum levels of the inflammatory cytokines at different time were compared. TNF-a at T2, the highest point, was3.16±1.1lpg/ml, T5, lowest 1.76±0.11pg/ml. IL-1β at T2, the highest point, was 0.94±0.30pg/ml, T5, lowest 0.46±0.13pg/ml. IL-6 at T2, the highest point, was 184.61±19.65 pg/ml, T5, lowest 117.51±20.09pg/ml. IL-10 at T3, the highest point, was 85.02±24.80pg/ml, T1, lowest 63.07±19.68pg/ml. Part 2:Serum levels of the gutintestinal hormones at different time were compared. GAS at T3, the highest point, was 339.37±41.95pg/ml, T1, lowest 163.38±26.14pg/ml. MOT at T3, the highest point, was 365.15±55.50pg/ml, T1, lowest 162.17±20.71pg/ml. CCK at T3, the highest point, was 3.38±0.43pg/ml, T1, lowest 2.11±0.17pg/ml. CGRP at T2, the highest point, was 114.89±23.81pg/ml, T5, lowest 58.69±9.18pg/ml.Conclusions:1. Early EN can affect the concentration of inflammatory factors of ECMO patients by gradually reducing inflammatory responses, which can improve gastrointestinal function and other viscera function.2. Early EN can affect the concentration of gastrointestinal hormones of ECMO patients, which can improve gastrointestinal function, promote gastrointestinal peristalsis, improve nutritional status of ECMO patients, reduce the incidence of complications related to gastrointestinal tract and accelerate patients recovering.3. Although early EN can help gastrointestinal function recover for ECMO patients, provide favorable nutrition support, but time for EN and EN tolerance should be considered.
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