Objectives:To observe the clinical features,related factors,prevention and treauments of complications on early enteral nutrition(EN) in severe head injured patients.Methods:360 patients with severe head injuries were enrolled in this study.GCS score was used to assess the patient's situation.After nasogastric(jejunal) tube was inserted,enteral nutrition was started from 48 hours after injury.The maximal EN volume(mL/d) in the first week after injury,time used for reaching to TEN(d),number of patients that achieved TEN in the first week following injury,blood glucose,serum albumin and ALT were observed.The complications due to enteral nutrition were analyzed. Results:Features of complications with early EN were that the abdominal distension,vomiting and aspiration were found in the first week and diarrhea occurred in the following weeks.A positive correlation between abdominal distension,vomiting and nasogastric tube was noted,while diarrhea had a negative correlation to GCS score and albumin level. Conclusions:The complications related to early enteral nutrition after severe head trauma correlated inversely to the degree of injury and serum albumin level.Utilization of nasojejunal tube could decrease the incidences of abdominal distension and vomiting.

Objective To investigate the clinical value of early enteral nutrition (EN) on hospital acquired pneumonia (HAP) in postoperative patients with severe hypertensive cerebral hemorrhage.Methods One hundred and forty postoperative patients with severe hypertensive cerebral hemorrhage were divided into treatment group (70 cases) and controll group (70 cases) by random digits table. The treatment group was given EN from the second day after operation, while the control group was given total parenteral nutrition (TPN). The incidence and duration of HAP,the incidence of superinfection,the percent and duration of mechanical ventilation and the mortality rate of HAP was observed. Results The incidence of HAP, superinfection and using mechanical ventilation in treatment group [30.0% (21/70), 12.9% (9/70),35.7%(25/70)] were significantly lower than those in control group [47.1%(33/70) ,27.1%(19/70) ,47.1%( 33/70 )] (P ＜ 0.05 ). The duration of HAP and using mechanical ventilation in treatment group[(6.4 ± 2.3 ),(6.4 ± 0.5 ) d] were significantly lower than those in control group [( 15.6 ± 2.1 ), ( 11.4 ± 0.3 ) d] (P ＜ 0.01or ＜ 0.05 ). The mortality rate of HAP in treatment group was significantly lower than that in control group [8.6% (6/70) vs. 18.6% (13/70),P ＜0.05]. Conclusion Early EN not only effectively decreases the incidence of HAP and superinfection,but also decreases the incidence of mechanical ventilation, shortens the duration of mechanical ventilation and decreases the mortality rate of HAP.

ObjectiveTo discuss the clinical characteristic and perioperative management of colonic obstruction caused by colonic carcinoma in elderly.MethodsThe clinical characteristic and perioperative management of 30 patients with colonic obstruction caused by colonic carcinoma from January 2000 to November 2010 were collected and analyzed retrospectively.Among 30 cases,11 cases were accepted emergency operation,19 cases were accepted limited operation.Resection and anastomosis at stage Ⅰ was in 26 cases (86.7％),shortcut surgery and simple fistulation was in 4 cases ( 13.5％ ).ResultsThe length of stay was 22-56 days.Postoperative complication including wound infection in 5 cases,wound liquescence in 3 cases,wound dehisce in 2 cases,anastomotic fistula in 2 cases,pulmonary infection in 3 cases.Two cases died during perioperative period.Conclusions Besides diagnosis as early as possible,appropriate perioperative management should be taken to the elderly patients,including reasonable operative time and surgical approaches and these are the keys to improve clinical curative effect.

Objective To discuss the clinical value of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic Oddi sphincterotomy (EST) on treating choledocholithiasis with cholecystolithiasis. Method The clinical data of 48 patients with choledocholithiasis complicated by cholecystolithiasis treated with LC combined with ERCP/EST from January 2005 to August 2010 was collected and analyzed retrospectively. Results Forty-six patients achieyed success by ERCP,and 45 patients finished LC,all patients underwent LC combined with ERCP/EST were recovered more rapidly,with shorter hospital stays. No severe complications or residual stone and refluent cholangitis in the follow-up of 3-12 months of 46 patients. Conclusions Combining the advantages of LC with ERCP/EST treating patients with choledocholithiasis complicated by cholecystolithiasis,according to the theoretics of minimally invasive surgery, with less invasive and the advantages of shorter hospital stays and rapid recovery. It is the comparatively ideal choice for the treatment of choledocholithiasis complicated by cholecystolithiasis at present.

Objective To investigate the feasibility of fast-track surgery in colorectal surgery.Methods Eighty consecutive patients with colorectal cancer admitted for colorectal surgery were divided into two groups by random digits table with 40 cases each. Group A was treated with the new concept of fasttrack surgery and group B was treated with the traditional methods of operation. The time of postoperative bowel venting and defecation,hospital stay time, the rate of complication, the rate of readmission and the total cost during hospitalization were compared. Results The time of postoperative bowel venting and defecation,hospital stay time were shorter in group A [(2.7 ± 0.9), (2.9 ± 0.1 ), (5.8 ± 1.0) d,respectively]than those in group B [( 3.9 ± 0.5 ), (4.2 ± 0.3 ), ( 8.3 ± 1.2) d, respectively] and the rate of complication and the total cost during hospitalization in group A [7.5%(3/40), ( 1.83 ± 0.22) ten thousand yuan] were lower than those in group B[27.5%(11/40), (2.35 ± 0.36) ten thousand yuan](P＜ 0.05). Conclusion The new concept of fast-track surgery can accelerate recovery after colorectal resection,reduce the rate of overall complications and total cost during hospitalization.

Objective: To explore the effects of growth hormone (GH) added early enteral nutrition(EEN) on nutrition status and complications in postoperative hypertensive intra-cerebral hemorrhage(HICH) patients.Methods: 122 patients with postoperative HICH were randomized into the treat group and control group. The treatment group (61 cases) received enteral nutrition support on the 2nd day after operation, and growth hormone was combined for one week. The control group (61 cases) received total parenteral nutrition(TPN) support. The clinical effect and complications were observed between the two groups. Results: The patientss serum pre-albumin , transferrin ,albumin , and nitrogen balance in the treatment group were significantly better than those in the control group (P

Objective To discuss the clinical value of subglottic secretion drainage on pulmonary infection in severe craniocerebral injuried patients. Methods Eighty severe craniocerebral injuried patients in ICU with the requirement of tracheotomy were randomized into two groups. Forty patients received aspiration of subglottic secretions as the treatment group and the other 40 patients received usual care as control. Samples were taken from pharynx mop, subglottic secretion and lower respiratory tract secretion for bacterial culture at 48 hours, 7th day and 14th day past tracheotomy. Results The incidence of pulmonary infection was 22.5% in treatment group and 45.0% in control. The same rate of predominant flora in subglottic secretion and lower respiratory tract secretion was 63.0% in patients with pulmonary infection. Conclusions Transposition of the pathologic bacteria in the subglottic secretion is one of the important causes of pulmonary infection, subglottic secretion drainage can lower the incidence of pulmonary infection in severe craniocerebral injuried patients.

Objective To evaluate the value of magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of biliary obstruction diseases by comparison with endoscopic retrograde cholangiopancreatography (ER-CP). Methods A total of 36 patients with biliary obstruction diseases underwent both MRCP and ERCP. To review the images obtained from ERCP and MRCP ,the diagnosis were compared according to pathology. MRCP and ERCP in the diagnosis and treatment of biliary obstruction disease were analysed. Results 36 patients including 16 biliary tumors, 15 cholelithiases,and five other diseases were analysed. The diagnosis accuracy of MRCP and ERCP for bil-iary obstruction diseases were 86.1% and 91.7 %, there was no significant difference( P > 0.05). Conclusion MR-CP can accurately define the obstructively sites, identify the obstructive causes and is a noninvasive and reliable exam-ination for biliary obstruction diseases.