With the successful launch of the Tiangong-1 target vehicle into space via the Long March II FT1 rocket from the Jiuquan Launch Center, the world gave great praise to China’s space technology and every Chinese felt proud. As a gastroenterologist, I am also encouraged by the boost that aerospace medicine has given to digestive diseases.
The most direct example is the improvement of the chemical formulation of enteralnutrition (EN), which provides all the nutrients required for metabolism and various other nutrients through the gastrointestinal tract. The chemical composition of this formula is well defined and does not contain residues, so it can be absorbed without digestion, and is called an elemental diet. The application results show that normal people can maintain normal nutrition and physiological status within 6 months with this formula alone. This formula provides ideal nutritional support for patients with advanced malignant tumors, gastrointestinal obstruction, after various major surgeries, and in cases of extreme exhaustion.
Indications for enteral nutrition of digestive system diseases.
① Difficulty in swallowing and chewing
② Impaired consciousness or coma
③Gastrointestinal fistula
④Short bowel syndrome
⑤Intestinal inflammatory diseases
⑥Acute pancreatitis
⑦ Hypermetabolic state
⑧Chronic wasting disease
⑨ Correction and prevention of malnutrition before and after surgery, etc.
In Chinese medicine, it is said that “the spleen is the essence of the afterlife”, and the spleen here refers to the digestive system. With the in-depth research on the structure and function of the gastrointestinal tract in recent years, we gradually realize that the gastrointestinal tract is not only a digestive and absorption organ, but also an important immune organ. Abnormal gastrointestinal function not only affects nutrient absorption, but also decreases systemic immunity and increases the possibility of various infections.
Briefly introduce several gastrointestinal nutritional agents.
1. Whole protein type enteral nutrition agent (powder)
Usage and dosage: Oral or tube feeding.
In a clean container filled with 500 mL of warm boiled water, add the product 1 listen (320 g), mix thoroughly. After the powder is completely dissolved, add warm boiling water to 1500 mL and stir gently to mix well. Also use the attached spoon, take 9 level spoonfuls, dissolve in 50 mL of warm boiling water and mix thoroughly, after completely dissolved, add warm boiling water to 200 mL to meet the requirement of small amount use. For tube feeding, first place a feeding tube to the upper part of the stomach, duodenum or jejunum. The normal drip rate is 100-125 mL per hour (a slow drip rate at the beginning is desirable).
For general patients, 2000 kcal per day is sufficient to meet the body’s requirement for nutrients. In hypermetabolic patients (burns, polytrauma), up to 4000 kcal per day can be used to accommodate the increased energy requirements of the organism. For patients on initial gastrointestinal feeding, the initial dose is best started at 1000 kcal per day and gradually increased to the required amount over a period of 2-3 days. The dose and the method of use will be prescribed by the physician according to the patient’s needs.
2.Enteral nutrition emulsion (TPF-T)
Dosage:
This product is used by tube feeding or orally, the daily dosage should be calculated according to the patient’s body weight and nutritional status.
a Patients who use this product as the only source of nutrition: the recommended dose is 20-30ml(26-39kcal)/kg/day, the average dose is 1500ml(1950kcal)/day.
b Patients who are supplemented with this product: The recommended dose is 400-1200 ml (520-1460 kcal)/day according to the patient’s needs.
When administered by tube, the dose should be gradually increased, the rate of the first day is about 20ml/h, and then increase 20ml/h day by day, the maximum drip rate is 100ml/h. Adjust the infusion rate by gravity or pump.
3.Enteral nutrition powder (TP)
Oral: Prepare 250ml dose, add 200ml warm water in a cup. Add Ensure powder (55.8g) under slow stirring. Stir until dissolved. 400 g of Ensure powder can be used to prepare seven 250 ml standardized doses.
Tube feeding: Use as directed by the physician. Adjust the drip rate, dosage and concentration according to the patient’s condition and tolerance. Additional fluid requirements should be made up by giving warm water at each meal and between meals. It is given by regular tube feeding at the time of administration, and may also be supplemented by warm water given before and after treatment. The residue in the stomach should be checked every 2 or 4 hours for continuous tube feedings; for intermittent tube feedings, check before each tube feeding.
If the patient shows intolerance (e.g., nausea, abdominal cramps, bloating, or diarrhea), the rate of administration should be reduced to 25 ml/h, followed by a slow increase to a normal rate. At this point the patient should be supplied at full concentration. The rate and concentration should not be changed simultaneously. If the patient still cannot tolerate it, the formula can be diluted.
4.Short peptide type enteral nutrition
Oral or tube feeding.
Fill 50 mL of cold water in a clean container, add 1 bag of this product (125 g) and mix it thoroughly. After the powder is completely dissolved, add cold water to 500 mL and stir gently to mix well. For tube feeding, place a feeding tube to the upper part of stomach, duodenum or jejunum first. The normal drip rate is 100-125 mL per hour (a slow drip rate is preferred at the beginning). For general patients, 2000 kcal (4 bags) per day is sufficient to meet the body’s requirements for nutrients.
In hypermetabolic patients (burns, polytrauma), up to 4000 kcal (8 sachets) per day can be used to accommodate the increased energy requirements of the organism. For patients on initial gastrointestinal feeding, it is best to start with an initial dose of 1000 kcal (2 sachets) per day and gradually increase to the required amount over 2-3 days. The dose and method of administration is based on the patient’s needs and prescribed by the physician.
For patients who cannot eat normally, enteral nutrition not only prolongs the patient’s survival, but also better improves their immunity and greatly improves their quality of life.