摘要
目的探索家庭营养支持在肠衰竭患儿中的应用。方法回顾性分析上海交通大学医学院附属新华医院小儿消化营养科和小儿外科自2009年1月起收治肠衰竭患儿实施家庭营养情况、目前营养状况及家庭肠外营养(home parenteral nutrition,HPN)相关并发症情况。结果实施HPN患儿10例,其中短肠综合征(short bowel syndrome,SBS)患儿7例,慢性假性肠梗阻患儿3例,其中7例SBS患儿剩余小肠长度(36.7±32.4)cm。开始HPN年龄(5.4±4.7)岁,随访时间(3.1±2.1)年。HPN开始前,在我院进行肠外营养(391.8±340.1)d,出院后HPN(619.5±669.1)d。家庭肠内营养(home enteral nutrition,HEN)途径均采用管饲喂养,其中3例治疗中转为经口喂养,HEN(536.1±429.6)d。每天家庭营养摄入总热量与指南推荐患儿需要量的占比为104.0%±39.0%,其中HPN摄入总热量与每天患儿需要量的占比为46.5%±21.3%,HEN摄入总热量与每天患儿需要量的占比为57.5%±29.2%。随访发现,3例患儿为重度营养不良,5例为中度营养不良,2例为轻度营养不良。4例患儿HPN发生导管相关的机械性并发症,5例发生导管相关性血流感染,10例患儿均未发生肠衰竭相关性肝病。结论开展HPN是可行的,但有待国家医疗保险政策支持。目前HPN仍存在较多营养供给不足及营养相关并发症。建议营养支持团队指导更科学的营养筛查及营养管理。
Objective To explore the application of home nutrition support in children with intestinal failure.Methods Children with intestinal failure admitted to Division of Pediatric Gastroenterology and Nutrition and Department of Pediatric Surgery in Xinhua Hospital were retrospectively enrolled since January 2009.The details of home nutrition support,nutritional status and home parenteral nutrition(HPN)associated complications were collected.Results A total of 10 children received HPN support,7 of whom were with short bowel syndrome(SBS)and the other 3 with pediatric intestinal pseudo-obstruction.The average length of remnant small bowel in 7 SBS children was(36.7±32.4)cm.The average age at HPN onset was(5.4±4.7)years.The average duration of follow-up was(3.1±2.1)years.The average duration of HPN was(619.5±669.1)days after(391.8±340.1)days of parenteral nutrition support in our hospital.All 10 cases started home enteral nutrition(HEN)with tube feeding(3 cases transited to oral feeding during treatment).The average duration of HEN was(536.1±429.6)days.Daily calorie intake was 104.0%±39.0%of the recommended intake according to the guideline,with 46.5%±21.3%via HPN and 57.5%±29.2%via HEN.During follow-up,3 cases were found with severe malnutrition,5 with moderate malnutrition and 2 with mild malnutrition.Four children suffered from catheter-related thrombosis and five children were identified with catheter-related blood stream infection.No intestinal failure associated liver disease was observed.Conclusions HPN is feasible but needs the support of national medical insurance policy.At present,there are still frequent nutritional deficiencies and complications in HPN.Nutrition support team(NST)should provide guidance for more scientific nutrition screening and nutrition management.
作者
褚怡青
冯海霞
陶怡菁
陆丽娜
颜伟慧
王莹
蔡威
Chu Yiqing;Feng Haixia;Tao Yijing;Lu Lina;Yan Weihui;Wang Ying;Cai Wei(Division of Gastroenterology and Nutrition,Xin Hua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China;Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition,Shanghai 200092,China;Department of Pediatric Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China;Shanghai Institute for Pediatric Research,Shanghai 200092,China)
出处
《中华临床营养杂志》
CAS
CSCD
2021年第4期226-231,共6页
Chinese Journal of Clinical Nutrition
基金
国家自然科学基金资助项目(81974066,81630039)
上海申康医院发展中心临床创新三年行动计划资助项目(SHDC2020CR2010A)
上海市卫生健康系统重要薄弱学科建设计划项目(2019ZB0101)
上海市“科技创新行动计划”长三角构建区域创新共同体项目(19495810500)。
关键词
儿童
肠衰竭
家庭营养支持
家庭肠外营养
家庭肠内营养
营养支持团队
Pediatric
Intestinal failure
Home nutrition support
Home parenteral nutrition
Home enteral nutrition
Nutrition support team
