Objective We aimed to evaluate the security and application value of early combined parenteral and enteral nutrition support for non-operative intestinal obstruction in patients aged over 80 years old. Methods Data on 191 older patients who were receiving combined parenteral and enteral nutrition support from August 2008 to July 2019 were retrospectively recorded and examined. According to the starting time of enteral nutrition support, we divided the patients into two groups: early parenteral nutrition combined with enteral nutrition (ECPEN, n = 85) and delayed parenteral nutrition combined with enteral nutrition (DCPEN, n = 106). According to all groups’ history data, NRS2002 and mini nutritional assessment (MNA) were employed for nutritional risk screening and malnutrition classification. After propensity score matching (PSM), 79 sets of data were included in further statistics. The comparison results included intestinal obstruction treatment, nutritional support, infection index, biochemical index and complications. Results A total of 79 pairs were selected after 1:1 propensity score matching based on gender, age, BMI, nutritional score, history of abdominal surgery, complications, and performance status. The baseline levels of patients with ECPEN and DCPEN were basically balanced. There were no significant differences in the inhibitor use time or the time of first flatulation and defecation between the two groups, but the duration of total parenteral nutrition (TPN) in the DCPEN group was longer, while the time of combined application of PN and EN was shorter. Enteral nutrition (EN) was applied earlier in the ECPEN group than in the DCPEN group, and EN gradually increased to 60% of the target energy requirement. In the ECPEN group, the average hospitalization days were less and the medical expenses were low. After seven days of non-surgical treatment, the white blood cells, lymphocytes, IL-6, PCT, ALB, blood sodium, blood potassium, and blood phosphorus of the two groups all improved, with significant differences compared with before the treatment. Blood glucose content in the ECPEN group gradually declined to an acceptable range from a high and fluctuated level, with a smaller standard deviation and better stability compared to the DCPEN group. The ALT and AST values in the ECPEN group returned to a normal range, but the liver function indexes in the DCPEN group were still higher than the upper limit of the normal range. Within 30 and 180 days after operation, there were fewer class I-IV complications in the ECPEN group than in the DCPEN group, and the incidence of class II complications was the most significantly different (10 vs. 22 and 15 vs. 25, respectively). After 30, 90, and 180 days of treatment, the readmission rate of patients in the ECPEN group was also lower than that in the DCPEN group, with statistical significance. Conclusion Old age is not a contraindication to early enteral nutrition for incomplete intestinal obstruction. Estimating the time to apply EN accurately and arranging total amount of intravenous fluid based on the patient’s organic function can benefit elderly patients and also be an important nutritional support for incomplete ileus through non-operative treatment.
Chen et al. (Tue,) studied this question.
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