肠内营养耐受性管理方案在严重脓毒症患儿早期肠内营养中的应用

Application of enteral nutrition tolerance management program in early enteral nutrition for children with severe sepsis

目的探讨应用肠内营养(EN)耐受性管理方案对严重脓毒症患儿早期EN耐受性的影响。方法选择2015年3月~2017年9月于宜宾市第一人民医院儿科重症监护病房(PICU)住院的96例严重脓毒症患儿为研究对象,按入院时间的先后顺序将患儿分为观察组和对照组,各48例。两组在入住PICU 24~48 h内予以EN。对照组予以常规方案观察和处理,观察组采用自行设计的EN耐受性评估和管理方案定时评估。比较两组EN期间的耐受性情况、入住PICU时及1周后营养指标[血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、纤维连接蛋白(FN)、转铁蛋白(TF)、血红蛋白(Hb)和体重指数(BMI)]、住PICU时间、住院费用和28 d病死率。结果观察组患儿EN期间不耐受例数低于对照组(P<0.05);观察组患儿EN期间耐受率高于对照组(P<0.05);观察组EN 1周后血清TP、ALB、PA、TF和Hb高于对照组(P<0.05);观察组患儿住PICU时间、住院费用和28 d病死率低于对照组(P<0.05)。结论采用EN耐受性评估管理方案对接受EN支持治疗的严重脓毒症患儿进行评估与处理,可有效提高患儿EN的耐受性,改善其营养指标和预后。

Objective To explore the effect of enteral nutrition （EN） tolerance management on early EN tolerance in children with severe sepsis. Methods Ninety-six children with severe sepsis in pediatric intensive care unit （PICU） of the First People＇s Hospital in Yibin from March 2015 to September 2017 were selected as the subjects. According to the order of admission time, the children were divided into the observation group and the control group, 48 cases in each group. Children of the two groups were given EN within 24-48 h after admission to PICU. The control group was given routine observation and treatment, and the observation group was evaluated by self-designed EN tolerance evaluation and management program. The tolerability during EN, nutrition index at PICU and 1 weeks after admission [serum total protein （TP）, albumin （ALB）, prealbumin （PA）, fibronectin （FN）, transferrin （TF）, hemoglobin （Hb） and body mass index （BMI）], stay PICU time, hospitalization expenses and 28 d fatality rate were compared between two groups. Results The number of intolerance cases in the observation group during EN was lower than that in the control group （P 〈 0.05）; the tolerance rate of EN in the observation group was higher than that in the control group （P 〈 0.05）; the serum levels of TP, ALB, PA, TF and Hb in the observation group 1 week after EN were higher than those in the control group （P 〈 0.05）; the PICU stay time, hospitalization expenses and 28 d fatality rate of the observation group were lower than those of the control group （P 〈 0.05）. Conclusion Assessment and management of severe sepsis in children receiving EN support therapy using EN tolerance assessment management program can effectively improve EN tolerance, improve nutritional indicators and prognosis of children with severe sepsis.