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Prolonged PEJ tube nutrition tends to result in copper deficiency, and cocoa supplementation is effective for treating such copper deficiency.

Predominant copper deficiency during prolonged enteral nutrition through a jejunostomy tube compared to that through a gastrostomy tube

Nishiwaki S,et al.Clin Nutr. 2011 Oct;30(5):585-9.

GI physiology is amazingly complex and intricately designed to maximize the efficient transfer of nutrients into the body via interactions between ingested particles with each other and the intestinal epithelium, various segmental contractile forces through the length of the GI tract that mix the digesta and present nutrients for absorption, and neurohormonal regulation. The postoperative setting, neural interruption, sympathetic hyperactivity, variable expression of GI hormones and inflammatory mediators, and pharmacologic effects, particularly opioid analgesia, all contribute to GI symptoms and postoperative ileus. The beneficial effects of early EN have been clearly elucidated, with significant impact on healing, infectious complications, and protein kinetics, particularly in the critically ill patient. Choice of initial oral diet has been less well studied, although no study suggests a significant benefit to the traditional clear liquid diet over a regular solid meal postoperatively. There is great potential benefit to beginning with a regular diet, including earlier increased caloric intake, reduced weight loss and protein catabolism, shortened LOS, and improved patient satisfaction. It seems that a certain percentage of patients will develop GI morbidity or prolonged ileus regardless of choice of diet or rate of advancement. Clinicians should consider the physiologic evidence of early resumption of bowel activity and motility as well as the clear clinical evidence that early enteral feeding is well tolerated and beneficial when deciding when and how to advance the diet of their patients after abdominal and intestinal surgery. Further study with appropriate standardization and randomization.

Postoperative diet advancement: surgical dogma vs evidence-based medicine

Warren J,et al.Nutr Clin Pract. 2011 Apr;26(2):115-25.

The biological consequences of arginine depletion remain incompletely understood. These data are consistent with data showing that patients given arginine-containing diets experience reduced morbidity. Understanding of arginine metabolism after ST may lead to therapies aimed at improving clinical outcome after ST.

Systemic arginine depletion after a murine model of surgery or trauma.

Pribis JP,et al.JPEN J Parenter Enteral Nutr. 2012 Jan;36(1):53-9.

PN attenuates sPLA2 activity in intestinal fluid, consistent with suppressed innate mucosal defense. Stress suppresses luminal fluid sPLA2 activity in chow but not the immunoglobulin A response; PN impairs both. Stress significantly elevates serum sPLA2 in PN-fed mice, consistent with known increased neutrophil priming with PN. PN reduces innate bactericidal immunity of the gut but upregulates serum proinflammatory products poststress.

Route and type of nutrition and surgical stress influence secretory phospholipase A2 secretion of the murine small intestine

"Pierre JF,et al.JPEN J Parenter Enteral Nutr. 2011 Nov;35(6):748-56.

Despite making decisions related to nutritional support regularly, surgical doctors in the UK demonstrated less knowledge of the fundamental principles of nutritional support than dieticians.

Knowledge and attitudes of surgical trainees towards nutritional support: food for thought.

Awad S,et al.Clin Nutr. 2010 Apr;29(2):243-8.

In conclusion, at dose taken, omega 3 enhanced formulas with different omega3/omega6 ratios improved blood protein concentrations in ambulatory postoperative head and neck cancer patients.

A randomized clinical trial with two omega 3 fatty acid enhanced oral supplements in head and neck cancer ambulatory patients

D.A. de Luis et al.Eur Rev Med Pharmacol Sci.2008;12(3):177-81

食管癌病人术后早期进行肠内营养有利于病人恢复及减少并发症发生。

食管癌术后早期肠内营养及护理

巨亚丽,等.现代肿瘤.2009;17(8):1604-6

高龄良性梗阻性黄疸患者术后治疗重点是营养支持,抗感染,肝功能恢复。早期实施肠内营养具有保护肠道粘膜屏障, 防止肠道细菌易位的发生,应用空肠营养管使食物未刺激胰腺外分泌,使胰腺处于休息状态,这样又可避免诱发急性胰腺炎发生。有报道认为急性重症患者早期机体可以很好接受要素 类肠内营养,肠内营养价廉物美,出现并发症少。我们的体会是维持肠内营养液的温度40℃左右,控制好泵注营养液的速度80~100 mL/h,鼻肠管置于屈氏韧带下15~20 cm为宜,维持1周后恢复普食。另外本研究还证实早期肠内营养治疗可以促进消化道功能的早恢复,肠鸣音恢复及肛门排气分别需 48、72 h,较什N组及对照组明显缩短。EEN所需费用仅是PN的1/2左右。有报道认为肝功能损害的病人术后EEN可 有效改善病人营养状况,EEN较TPN有利于血清胆红素水平下降;早期肠内营养还能改善病人蛋白质代谢、促进蛋白质合成、改善病人营养状况,提高免疫力。因此,EEN更符合生理结构和功能的营养补充,特别是体质差、年龄大、重大疾病手术后的病人实施具有现实意义。

高龄梗阻性黄疸患者术后早期肠内营养的研究

胡虞乾,等.第三军医大学学报.2005;27(18):1904-1907

高龄食管癌患者术后早期肠内营养能明显改善患者营养状况、增强 机体免疫力、减少并发症的发生率。

高龄食管癌患者术后早期肠内营养的临床研究

夏晓明,等.中国综合临床.2010;26(11):1198-1204

膳食纤维(DF)对于机体有极为重要的生理意义,是EN中重要的组成部分。在一定程度上可以减少消化道并发症的发生。

胃癌术后含膳食纤维的早期肠内营养与消化道并发症的关系

王强,等.山东医药.2008:48(45):63-66

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