儿童急性胰腺炎鼻空肠营养置管及肠内营养时机的探讨

Timing of nasojejunal feeding tube placement and enteral nutrition in children with acute pancreatitis

目的探讨儿童急性胰腺炎鼻空肠营养管置管及肠内营养的时机对临床预后的影响。方法回顾性分析2008年1月至2013年7月31例行鼻空肠营养的急性胰腺炎患儿的临床资料,探讨患儿腹部症状、体征是否缓解及血清淀粉酶水平是否正常与鼻空肠营养置管耐受性、肠内营养成功率的关系;比较早期肠内营养组(肠内营养距发病时间≤7 d)和晚期肠内营养组(肠内营养距发病时间>7 d)的治疗有效性及不良反应和并发症发生率。结果患儿腹部症状、体征是否缓解及血清淀粉酶是否正常与鼻空肠营养置管耐受率、肠内营养成功率无关。早期肠内营养组较晚期肠内营养组血清淀粉酶降至正常时间缩短,系统并发症发生率、住院天数、住院费用明显减少,但体重增加低于晚期组(均P<0.05)。两组置管耐受率及肠内营养成功率差异无统计学意义;肠内营养前后白蛋白增加量、肠内营养持续时间及不良反应发生率、局部并发症发生率差异亦无统计学意义。结论腹部症状、体征及血清淀粉酶水平不能作为衡量能否鼻空肠置管及肠内营养的指标;早期肠内营养能更好地改善儿童急性胰腺炎的临床预后,且具有可行性。

Objective To investigate the impact of timing of nasojejunal feeding tube placement and enteral nutrition on clinical outcomes in children with acute pancreatitis. Methods A retrospective analysis was performed on the clinical data of 31 children with acute pancreatitis, who received nasojejunal feeding between January 2008 and July 2013, to investigate the relationship of abdominal symptoms/signs and serum amylase level with the tolerability of catheterization and success rate of enteral nutrition. The treatment outcome and incidence of adverse reactions and complications were compared between the early enteral nutrition group （≤7 days from the onset of the disease） and late enteral nutrition group （〉7 days from the onset of the disease）. Results Abdominal symptoms/signs and serum amylase level were independent of the tolerable rate of catheterization and success rate of enteral nutrition. Compared with the late enteral nutrition group, the early enteral nutrition group had a shortened time to normal serum amylase level, signiifcantly reduced incidence of systemic complications, length of hospital stay, and hospitalization expenses, and less weight gain. The tolerable rate of catheterization and success rate of enteral nutrition showed no signiifcant difference between the two groups. Similarly, no signiifcant differences were found in the increase in albumin level after enteral nutrition, duration of enteral nutrition, incidence of adverse reactions, and incidence of local complications. Conclusions Abdominal symptoms/signs and serum amylase level cannot be used as a measure of whether nasojejunal feeding tube placement and enteral nutrition can be performed. Early enteral nutrition can better improve clinical outcomes in children with acute pancreatitis, and it is feasible.