| ObjectivesTo investigate the perioperative ulcerative colitis (UC) patients’ nutritional status and analyze the characters of nutritional metabolism in the patients who had got the disease; to explore the multiple affected infectors in postoperative recovery and evaluate the clinical interventional effect of individual nutrition therapy proposal on it.MethodsAn investigational study and a para-experimental study were used in this study. From April2011to October2012,43patients who suffer from UC and stayed in general surgery department of Tianjin Medical University General Hospital and48UC patients who were in the same department during January2005to April2011were invited to be as subjects.Our study was worked as two parts. The first part is an investigational study. We worked to collect the43interventional group patients’history of diet, human body dimensions index, serological index, serum vitamin and trace elements, the food intolerance and the nutritional metabolism and combine patients’ disease to explore their preoperative nutritional status and characters of metabolism.The second part was the para-experimental study. On the basis of result of investigational study, we enacted an individual nutrition therapy proposal for every patient. The intervention content including individual UC healthy education handbook which contain the brief introduction of UC, the personal nutritional diagnosis and therapy, the perioperative therapeutic alliance and an individual recommend cookbook; an enteral nutrition (EN) guidance book which contain the taking guidance of EN preparation and uncomfortable record. We organized the patients to take part in the communication meeting (IBD home) and evolve the education of disease, stoma nursing and some amusement activity and then made the long-term diet education in the postoperation. The48patients’ who were in historical group clinical data were collected via referring to case history. These patients haven’t accepted the individual nutrition interventional proposal but only the common practice of surgery nursing. Finally, we collected both group’ s postoperative recovery condition which including the eating time in postoperative, gastrointestinal symptom, the complication of stoma, infection, total parenteral nutrition time in postoperative and hospitalization time to make the comparison.The main study tools were clinical laboratory instrument. Besides that, the human body component analysis instrument, caliper rule, metre rule, pinch meter and nutritional metabolism car also were used. The patients’ sociological data, disease data and diet relative data were collected by both questionnaires which were self-made by the researchers. T-test, correlations analysis,’ multiple linear regression analysis and Non-parametric analysis were performed to analyze the data with SPSS17.0.Results1. Patients’ condition and nutritional status:Patients who visited surgery department had a long-term course of disease, and high endoscope classify. The disease also mostly occupy active phase. in43patients who had accepted investigation,19(44.19%) patients’average albumin (34.3±4.4g/l) were lower than the normal value. The prealbumin levels (16.42±3.74mg/dl) also were lower than the normal value in27(62.80%) patients. There as65%patients had low prealbumin (16.42±3.74mg/dl). In addition, in the past6months, patients’weight descended obviously. The average BMI (20.5±2.325) was low. Hand strength descending was found much more obviously in women with18(94.74%) patients.2. The results of diet history investigation:After pathogenesis, patients’ quotidie average intaking of protein, fat, carbohydrate and energy became obviously descending than before pathogenesis as following:protein intaking level was shown to be80.63±2.92g/d before pathogenesis and57.46±3.21g/d after pathogenesis; fat intaking level was shown to be73.22±6.92g/d before pathogenesis and48.49±7.92g/d after pathogenesis; carbohydrate intaking level was shown to be408.54±13.96g/d before pathogenesis and326.87±12.32g/d after pathogenesis; energy intaking level was shown to be2523.7±360.34kcal/d before pathogenesis and2278.2±642.70kcal/d after pathogenesis. The difference had statistical significance (P<0.05). 3. The results of nutritional metabolism:the average resting metabolic rate (1656.42±329.28kcal/d) which determined via Metabolic Car was obviously higher than the prediction value (1451.83±207.69kcal/d). The difference had statistical significance (T=2.41, P=0.037). The stepwise multiple regression analysis shown, the main influence factors were patients’ body height, course of disease and the usage time of hormone.4. The results of food intolerance:43patients in intervention group undergone the food intolerance detection and35(81.39%) of them had much more serious or lightly food intolerance, which is higher than health people. Among them,14(32.56%) patients had lightly intolerance,15(34.88%) patients had midrange intolerance and6(13.95%) patients had highly intolerance. The intolerance foods were egg (16patients), cow’s milk (11patients), shrimp/clams (8patients), and wheat (8patients) and so on.5. The serum vitamin and trace elements levels:Patients serum trace elements level had been descending. The most obviously descending elements were vitamin D3(24.29±3.44ug/1), zinc (11.05±4.98μmol/l), calcium (2.10Π0.37mmol/1), and chrome (0.11±0.08μmol/l).6. The results of nutrition intervention:An individual nutrition intervention can improve the patients’postoperative condition; shorten the time of eating in postoperation (intervention group:3.07±0.769d, control group:3.90±0.725) Patients of intervention group proceeded gastrointestinal reactions such as nausea, vomit, diarrhea, abdominal distention were less than the control group, the postoperative complications of stoma and infection also shown to be less. The postoperative disconnecting time (intervention group:6.93±1.605, control group:7.33±1.875) and length of stay (intervention group:30.76±10.314, control group:37.69±10.063) were shortening in intervention group patients.ConclusionUC patient who visit the doctors’ office often had a long-term course of disease and high endoscope classify. The disease also mostly occupy active phase. Patients had bad nutritional status.Most of patients had low serum protein, hand strength and pantatrophy. Under the morbidity, the three main nutrient substance and energy what patients taking had cut down. However, they had higher resting metabolic rate which had a relationship with course of diseases, body height and the usage time of hormone. A part of patients had food intolerance in different levels. Some trace element such as the serum vitamin D3, zinc, calcium, and chrome level had been lower than the reference value.An individual nutrition intervention which following the guideline of fineness nutritional evaluation will improve the patients’ postoperative condition much more obviously. It can cut down the postoperative infection; encourage the early-use of gastrointestinal function, and also shortening the length of stay. |
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