胃肠功能障碍患儿肠内早期营养支持时机选择的临床研究

Clinical research on the timing of early enteral nutrition support in patients with gastrointestinal dysfunction

目的探讨胃肠功能障碍(AGD)患儿给予肠内早期营养支持(EEN)时机选择的临床价值研究。方法选取本院儿童重症监护病房(PICU)2014年3月-2015年10月小儿危重病例评分(PCIS)78分~90分同时发生AGD的患儿101例,随机分为治疗组(51例)和对照组(50例)。观察2组患儿的AGD症状消失时间、治疗优良率、胃肠不良反应发生率、入住PICU时间、总住院时间、住PICU期间感染率、住PICU营养不良发生率、是否增加肠外营养治疗费用等的差异性。结果治疗组的治疗优良率高于对照组;治疗组胃肠道不良反应发生率、AGD症状消失时间、入住PICU时间、住PICU期间感染率、肠外营养治疗费用等低于对照组,差异均有统计学意义(P<0.05)。治疗组总住院时间、住PICU营养不良发生率等比较对照组差异无统计学意义(P>0.05)。结论胃肠功能障碍患儿于24 h或48 h内给予早期肠内营养,可以显著提高治疗有效率,减少胃肠道不良反应发生,缩短入住PICU时间,减少住PICU期间感染率,降低肠外营养治疗费用等,值得临床推广应用。

Objective To explore the clinical value on the timing of early enteral nutrition support in patients with acute gastrointestinal dysfunction（ AGD）. Methods Select 101 children with critical illness score of 78-90 points and occurring AGD in pediatric intensive care unit from March 2014 to October 2015,who were randomly divided into two groups： treatment group（ 51cases） and the control group（ 50 cases）. The differences of the symptoms of gastrointestinal dysfunction were observed in the two groups on disappearing time,the excellent rate of treatment,the incidence rate of gastrointestinal adverse reactions,time of staying in PICU,total hospitalization time,the infection rate during PICU,the incidence rate of malnutrition,and whether to increase parenteral nutrition therapy cost,etc. Results The excellent rate of treatment group was higher than that of the control group. The incidence of gastrointestinal adverse reactions,the disappearance time of gastrointestinal dysfunction,check in PICU time,the infection rate of PICU during the period of time,the treatment cost of parenteral nutrition in the treatment group were lower than that of the control group,and the differences had statistical significance（ P〈0. 05）. The total hospital stay time and the incidence rate of malnutrition in PICU of the treatment group had little difference with the control group,but the difference was not statistically significant（ P〈0. 05）. Conclusion Acute gastrointestinal dysfunction children were given early enteral nutrition within 24 hours or 48 hours,which can improve the efficiency of treatment,reduce the gastrointestinal adverse reaction,and shorten the stay time in PICU,reduce the infection rate during the period of PICU,and reduce the cost of parenteral nutrition treatment,so it is worthy of clinical application.