儿童肠内营养47例临床分析

Clinical analysis of enteral nutrition in 47 children

目的 探讨肠内营养在儿童消化系统疾病中应用的价值、安全性及家庭营养实施的可行性.方法 回顾性分析浙江大学附属儿童医院消化内科自2014年7月至2015年3月进行肠内营养的患儿的疾病谱,肠内营养途径、制剂、速度与时间以及不良反应、转归,配对t检验法分析肠内营养前后患儿营养指标的变化.结果 肠内营养患儿47例,男27例（57％）,女20例（43％）,中位年龄0.8（0.3,4.0）岁.其中诊断为机械性或化学性食管损伤9例,炎症性肠病（包括溃疡性结肠炎及克罗恩病）7例,慢性腹泻6例,急性胰腺炎5例,急性腹泻合并重度营养不良3例,短肠综合征3例,喂养不当3例,喂养困难3例,蛋白丢失性肠病3例,肠造瘘术后2例,小肠结肠炎2例,胃食管反流1例.经口服肠内营养22例,经鼻胃管管饲营养28例,经鼻空肠管管饲营养4例,胃造口经胃管饲1例,胃造口经空肠管饲1例.管饲方式中采用连续滴注20例,间歇滴注21例.11例患儿以氨基酸配方作为肠内营养制剂,21例选用短肽配方,16例选用整蛋白配方,其中6例选用3.3～4.2 kJ/ml较高能量密度配方,10例选用包括母乳在内的普通能量密度配方制剂.47例肠内营养患儿中有21例出现了不同程度的不良反应,包括呕吐7例,腹痛腹胀3例,腹泻12例,继发呼吸道感染5例.5例患儿因原发疾病疗效欠佳自动出院,3例因疾病需要转科继续治疗,15例带管出院行家庭营养治疗并专科门诊随诊,余24例均病情好转出院.本组患儿体重别年龄Z评分（WAZ）（-2.3±1.9比-1.9±1.8,t=4.156,P=0.000）,体重别身高Z评分（WHZ）（-1.9±1.7比-1.2±1.5,t=3.714,P=0.001）,白蛋白[（35±9）g/L比（39 ±6） g/L,t=3.017,P=0.005],前白蛋白[（0.11±0.05） g/L比（0.18 ±0.07）g/L,t=5.144,p=0.000]在肠内营养前后差异均有统计学意义.结论 肠内营养适用于多种儿童消化系统疾病,改善患儿的营养状况,方法简单,依从性好,适合临床应用,实施家庭肠内营养具有可行性.

Objective To explore the efficacy and safety of the application of enteral nutrition （EN） in gastrointestinal disease in children,and to explore the possibility of the implementation of family EN.Method Retrospective analysis of disease spectrum,EN approach,preparation,speed and time as well as adverse reactions and outcomes in 47 pediatric patients with gastrointestinal disease underwent EN therapy during July 2014 to March 2015.The nutrition indicators before and after EN therapy were compared by paired t-test.Result A total of 47 patients were selected,27 male （57%） and 20 female （43%）,aged 0.8 （0.3,4.0） years,9 with mechanical or chemical damage to the esophagus,7 with inflammatory bowel disease （including ulcerative colitis and Crohn＇s disease）,6 with chronic diarrhea,5 with acute pancreatitis,3 with acute diarrhea and severe malnutrition,3 with short bowel syndrome,3 with improper feeding,3 with feeding difficulties,3 with protein losing enteropathy,2 with post-enterostomy,2 with enterocolitis,1 with gastroesophageal reflux,were diagnosed.Of 47 cases,22 were given oral nutrition,28 were fed with nasogastric tube and 4 with nasojejunal tube feeding,2 with percutaneous endoscopic gastrojejunostomy tube feeding for each.In these tube-feeding cases,20 cases were treated with continuous infusion and 21 cases with intermittent infusion.Eleven cases were fed with amino acid formula;21 cases took the choice of peptide formulations;16 cases chose whole protein formula,including six cases who chose 3.3-4.2 kJ/ml higher energy density formula,10 cases selected common energy density formula including breast milk.Twenty-one cases suffered from different degrees of adverse reactions,including vomiting in 7 cases,abdominal pain and bloating in 3,diarrhea in 12,secondary respiratory infections in 5.Five patients were discharged after giving up of treatment by parents due to poor efficacy on primary disease;3 cases were transferred to other departments for further treatment;15 cases were discharged with a feeding tube for family nutrition and specialist out-patient treatment.The rest 24 cases were all improved and discharged.There were significant differences in nutrition indicators before and after EN,weight-for-age Z score （WAZ）（-2.3 ± 1.9 vs.-1.9 ± 1.8,t =4.156,P =0.000）,weight-for-height Z score （WHZ） （-1.9 ± 1.7 vs.-1.2±1.5,t=3.714,P=0.001）,albumin （（35 ±9）g/L vs.（39 ±6） g/L,t=3.017,P=0.005） and prealbumin （（0.11 ±0.05）g/L vs.（0.18 ±0.07）g/L,t=5.144,P=0.000）.Conclusion EN is suitable for a variety of children＇s digestive diseases,which can improve the nutritional status of the patients and was safe for clinical application.As the implementation of EN is simple and has good compliance,family EN is proven to be feasible.