肠内营养支持治疗在小儿消化外科中的应用

Application of enteral nutrition in pediatric surgery

目的探讨肠内营养支持治疗在小儿消化外科中的应用价值及安全性。方法回顾性分析2007年6月至2013年5月安徽医科大学第一附属医院收治的56例不能经口进食或经口进食无法满足营养需求而采用鼻空肠营养管进行肠内营养治疗1周以上患儿的临床资料。1岁以内患儿给予肠内营养制剂主要成分为短肽或氨基酸的蔼儿舒。1岁以上患儿给予主要成分为短肽的小百肽或能全素。结果56例息儿原发病分别为胰腺炎20例，肝挫裂伤10例，十二指肠穿孔6例，十二指肠隔膜状狭窄9例，环状胰腺6例，肝母细胞瘤5例。所有患儿均顺利完成7-37（18．0±9．9）d肠内营养治疗，患儿恢复良好。治疗期间，5例（8．9％）患儿出现腹泻，3例（5．4％）出现恶心、呕吐，2例（3．6％）出现轻微腹胀，5例（8．9％）出现轻微腹痛，经调整营养液浓度、输注速度后症状均逐渐缓解。肠内营养治疗10d后，患儿营养状况较治疗前改善，体质量、血红细胞计数、血红蛋白、血清白蛋白及前白蛋白均较治疗前明显增加（P〈0．05）。结论肠内营养支持治疗在小儿消化外科中应用是安全、有效的，能够改善患儿的营养状态，促进疾病的恢复。

Objective To explore the value and safety of the application of enteral nutrition in pediatric surgery. Methods Clinical data of 56 children patients who could not undertake oral feeding or those who required enteral nutrition by nasojejunal tube over 7 days in our ward from June 2007 to May 2013 were retrospectively analyzed. Children younger than one year old received enteral nutritional formulation Ai Er Shu mainly composed of short peptides or amino acids, and children over one year received Small peptide or Nengquansu mainly composed of short peptide. Results Among these 56 children patients, primary disease was panereatitis in 20 cases, lacerated wound in 10, duodenal perforation in 6, duodenal septum-shape stenosis in 9, annular pancreas in 6, and hepatoblastoma in 5. All the patients successfully completed the enteral nutrition therapy within 7-37 （18±9.9） days with good recovery. During the treatment, 5 eases（8.9%） developed diarrhea, 3 cases（5.4%） nausea and vomiting, 2 cases （3.6%） mild abdominal distension, 5 cases （8.9%） mild abdominal pain, and the symptoms were relieved after adjustment of nutrient solution concentration and infusion rate. After enteral nutrition for 10 days, the nutritional status of children was improved, and weight, blood red cell count, hemoglobin, serum albumin, prealbumin increased significantly（P〈0.05）. Conclusion Application of enteral nutrition in pediatric surgery is safe and effective, which can improve the nutritional status of children and promote the recovery.