营养不良婴儿持续肠内营养支持的疗效评价

Clinical evaluation of continuous enteral nutrition in malnourished infants

目的评估持续肠内营养支持治疗婴儿营养不良的疗效。方法 30例<1岁的中、重度营养不良婴儿,给予持续肠内营养支持,比较其治疗前与治疗10、20、30 d时,血液生化指标、血氨基酸谱,以及各项人体测量指标的变化。结果给予持续肠内营养支持10 d时,婴儿血清转铁蛋白、前白蛋白、视黄醇结合蛋白、纤维连接蛋白、瘦素水平显著高于治疗前(P均<0.01);谷氨酰胺、组氨酸、异亮氨酸、丙氨酸、缬氨酸、精氨酸、亮氨酸、赖氨酸、必需氨基酸,必需氨基酸/非必需氨基酸,支链氨基酸较治疗前升高(P均<0.05);酪氨酸、苯丙氨酸和总芳香族氨基酸较治疗前降低(P均<0.05)。肠内营养20 d时,婴儿血红蛋白较治疗前升高(P<0.05);身长、体质量等体格生长指标也较治疗前升高(P<0.05)。30 d时,婴儿血清白蛋白较治疗前明显升高(P<0.05)。结论持续肠内营养支持可改善患儿营养状态,部分血液生化指标和血氨基酸谱分析可以更敏感地反映患儿营养状况。

Objective To evaluate the effect of continued enteral nutrition therapy in malnourished children.Methods Between 2009 and 2010 thirty malnourished inpatients,who were younger than 1 year old,were recruited.Serum albumin（ALB）,transferrin（TRF）,prealbumin（PA）,retinol-binding protein（RBP）,fibronectin（FN）,leptin（LP）,routine blood test,amino acid and anthropometric indicators were determined before and 10 days,20 days,30 days following the treatment of continued nasogastric feeding.Results Serum TRF,PA,RBP,FN,LP were significantly higher after 10 days treatment than before treatment（P 0.01）.Glutamine,histidine,isoleucine,alanine,valine,arginine,leucine,lysine,essential amino acids（EAA）,EAA/non-essential amino acids（NEAA）,branched-chain amino acids（BCAA）were higher after treatment than before treatment（P 0.05）.Tyrosine,phenylalanine,and total aromatic amino acids decreased significantly after the treatment（P 0.05）.Hemoglobin（HB） was significantly higher after 10 days treatment than before treatment（P 0.05）.ALB increased significantly after 30 days treatment（P 0.05）.PA,FN,LP,RBP and TRF increased gradually during the treatment（P 0.01）.Conclusions Continued nasogastric feeding can promote intestinal absorption and improve the nutritional status.TRF,PA,RBP,FN,LP and amino acids are sensitive indicators for the effectiveness of enteral nutrition.