Effect of early combined enteral and parenteral nutrition support on postoperative nutritional parameters, inflammatory immunity, and prognosis in patients with severe heart valvular disease

Abstract

BACKGROUND Postoperative rehabilitation of patients with severe valvular heart disease is very critical. Postoperative malabsorption of nutrients is prone to occur, which seriously affects the quality of life of patients. Early combined enteral and parenteral nutrition support plays an appreciated role in improving the physical recovery of patients after surgery. AIM To investigate the effect of early combined enteral and parenteral nutrition support on postoperative nutritional parameters, inflammatory immunity, and prognosis in patients with severe heart valvular disease (HVD). METHODS From August 2017 to October 2020, 86 patients with severe HVD at our hospital were selected for a prospective randomized controlled study. They were randomly divided into either a combined enteral and parenteral nutrition group (n = 43) or a parenteral nutrition group (n = 43). Both groups underwent heart valve replacement surgery. The parenteral group was given parenteral nutrition support 3 to 4 h after entering the ICU following anesthesia awaking, and the combination group was given both enteral and parenteral nutrition support. Both groups were treated for 1 wk. The nutritional parameters before treatment, 5 d after treatment, and 1 wk after treatment [hemoglobin (Hb), albumin (ALB), prealbumin (PA), triceps skinfold thickness (TSF), and upper arm muscle circumference (AMC)], inflammatory response indicators [high-sensitivity-C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)], immune function (CD4+ T cells, CD8+ T cells, and CD4+ /CD8+ ratio), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and prognosis (complication rate, ICU stay in hospital, total hospital stay, and hospital deaths) were compared between the two groups. RESULTS The levels of serum Hb, ALB, and PA as well as TSF and AMC at 5 d and 1 wk after treatment were significantly higher in the combination group than in the parenteral nutrition group (P < 0.05). The levels of CD8+ T cells and serum hs-CRP, IL-6, and TNF-α at 5 d and 1 wk after treatment were significantly lower, and the levels of CD4+ T cells and CD4+/CD8+ ratio were significantly higher in the combination group than in the parenteral nutrition group (P < 0.05). APACHE score, SOFA score, and the incidence of vomiting, diarrhea, and lung infections at 5 d and 1 wk after treatment in the combination group were lower than those of the parenteral nutrition group. The length of ICU hospitalization and total hospital stay were significantly shorter in the combination group than in the parenteral nutrition group (P < 0.05). CONCLUSION Early enteral and parenteral nutrition support can help regulate the inflammatory immune response in patients with severe HVD, reduce malnutrition, and improve the prognosis.