中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
2期
136-140
,共5页
马鸣%陈洁%李甫棒%楼金玕%彭克荣%赵泓%陈飞波
馬鳴%陳潔%李甫棒%樓金玕%彭剋榮%趙泓%陳飛波
마명%진길%리보봉%루금간%팽극영%조홍%진비파
急性胰腺炎%肠道营养%营养不良%儿童%胃镜辅助下鼻空肠置管
急性胰腺炎%腸道營養%營養不良%兒童%胃鏡輔助下鼻空腸置管
급성이선염%장도영양%영양불량%인동%위경보조하비공장치관
Acute pancreatitis%Enteral nutrition%Malnutrition%Child%Endoscopic-assisted nasojejunal tube placement
目的 评价鼻空肠置管和空肠营养治疗在儿童急性胰腺炎中应用的可行性和有效性.方法 2009至2012年在浙江大学医学院附属儿童医院消化科和外科住院的急性重症胰腺炎或者急性轻症胰腺炎但经口喂养不耐受,进行STONGkid营养风险筛查,存在高度营养风险,需要进行营养干预者22例,男9例,女13例,其中急性重症胰腺炎13例,急性轻症胰腺炎9例.年龄5～15岁,平均(9.1±2.8)岁.对所有的入选患儿通过人体学测量,进行营养不良评价.通过胃镜辅助,进行22例24例次的鼻空肠置管(2例为拔管后胰腺炎复发再次置管).所有患儿在运用常规的禁食、制酸、抑制胰酶的分泌、抗感染的同时,均进行了鼻空肠营养治疗,观察鼻空肠置管的成功率,近期和远期并发症发生率；观察鼻空肠营养患儿的耐受性、不良反应,以及肠内营养治疗前后的营养学指标的改善情况(体重、血淋巴细胞、血清白蛋白、血红细胞计数、血肌酐、血尿素氮).结果 22例患儿治疗前进行24例次营养评价,无营养不良16例次,轻度营养不良2例次,中度营养不良5例次,重度营养不良1例次.鼻空肠置管共进行了24例次,22例次一次置管成功.所有患儿置管后均无明显不良反应.24例次中23例次进行了规范的空肠营养,1例置管后2d出现梗阻性黄疸,考虑胰胆管畸形伴梗阻行内镜下逆行胰胆管造影术下支架治疗,未予肠内营养治疗.23例次中22例次耐受空肠营养.空肠喂养时间2～74 d,平均(27.0±18.3)d,空肠喂养过程中出现不良反应:堵管2例、便秘2例、腹痛5例、腹泻2例、呕吐2例、空肠潴留1例,无鼻咽部溃疡、消化道穿孔、消化道出血、再喂养综合征、感染等.空肠营养治疗前后体重、血淋巴细胞计数、血清白蛋白的改善差异均有统计学意义(P＜0.05).血红细胞计数,血清肌酐,尿素氮的改变无统计学意义(P＞0.05).23例次患儿中20例次治愈,2例次好转,1例次未愈.结论 鼻空肠置管技术对于急性胰腺炎患儿安全可行,鼻空肠营养治疗对于存在重度营养风险的急性胰腺炎患儿是有效可行的,对于患儿营养状况的改善具有明显的效果.
目的 評價鼻空腸置管和空腸營養治療在兒童急性胰腺炎中應用的可行性和有效性.方法 2009至2012年在浙江大學醫學院附屬兒童醫院消化科和外科住院的急性重癥胰腺炎或者急性輕癥胰腺炎但經口餵養不耐受,進行STONGkid營養風險篩查,存在高度營養風險,需要進行營養榦預者22例,男9例,女13例,其中急性重癥胰腺炎13例,急性輕癥胰腺炎9例.年齡5～15歲,平均(9.1±2.8)歲.對所有的入選患兒通過人體學測量,進行營養不良評價.通過胃鏡輔助,進行22例24例次的鼻空腸置管(2例為拔管後胰腺炎複髮再次置管).所有患兒在運用常規的禁食、製痠、抑製胰酶的分泌、抗感染的同時,均進行瞭鼻空腸營養治療,觀察鼻空腸置管的成功率,近期和遠期併髮癥髮生率；觀察鼻空腸營養患兒的耐受性、不良反應,以及腸內營養治療前後的營養學指標的改善情況(體重、血淋巴細胞、血清白蛋白、血紅細胞計數、血肌酐、血尿素氮).結果 22例患兒治療前進行24例次營養評價,無營養不良16例次,輕度營養不良2例次,中度營養不良5例次,重度營養不良1例次.鼻空腸置管共進行瞭24例次,22例次一次置管成功.所有患兒置管後均無明顯不良反應.24例次中23例次進行瞭規範的空腸營養,1例置管後2d齣現梗阻性黃疸,攷慮胰膽管畸形伴梗阻行內鏡下逆行胰膽管造影術下支架治療,未予腸內營養治療.23例次中22例次耐受空腸營養.空腸餵養時間2～74 d,平均(27.0±18.3)d,空腸餵養過程中齣現不良反應:堵管2例、便祕2例、腹痛5例、腹瀉2例、嘔吐2例、空腸潴留1例,無鼻嚥部潰瘍、消化道穿孔、消化道齣血、再餵養綜閤徵、感染等.空腸營養治療前後體重、血淋巴細胞計數、血清白蛋白的改善差異均有統計學意義(P＜0.05).血紅細胞計數,血清肌酐,尿素氮的改變無統計學意義(P＞0.05).23例次患兒中20例次治愈,2例次好轉,1例次未愈.結論 鼻空腸置管技術對于急性胰腺炎患兒安全可行,鼻空腸營養治療對于存在重度營養風險的急性胰腺炎患兒是有效可行的,對于患兒營養狀況的改善具有明顯的效果.
목적 평개비공장치관화공장영양치료재인동급성이선염중응용적가행성화유효성.방법 2009지2012년재절강대학의학원부속인동의원소화과화외과주원적급성중증이선염혹자급성경증이선염단경구위양불내수,진행STONGkid영양풍험사사,존재고도영양풍험,수요진행영양간예자22례,남9례,녀13례,기중급성중증이선염13례,급성경증이선염9례.년령5～15세,평균(9.1±2.8)세.대소유적입선환인통과인체학측량,진행영양불량평개.통과위경보조,진행22례24례차적비공장치관(2례위발관후이선염복발재차치관).소유환인재운용상규적금식、제산、억제이매적분비、항감염적동시,균진행료비공장영양치료,관찰비공장치관적성공솔,근기화원기병발증발생솔；관찰비공장영양환인적내수성、불량반응,이급장내영양치료전후적영양학지표적개선정황(체중、혈림파세포、혈청백단백、혈홍세포계수、혈기항、혈뇨소담).결과 22례환인치료전진행24례차영양평개,무영양불량16례차,경도영양불량2례차,중도영양불량5례차,중도영양불량1례차.비공장치관공진행료24례차,22례차일차치관성공.소유환인치관후균무명현불량반응.24례차중23례차진행료규범적공장영양,1례치관후2d출현경조성황달,고필이담관기형반경조행내경하역행이담관조영술하지가치료,미여장내영양치료.23례차중22례차내수공장영양.공장위양시간2～74 d,평균(27.0±18.3)d,공장위양과정중출현불량반응:도관2례、편비2례、복통5례、복사2례、구토2례、공장저류1례,무비인부궤양、소화도천공、소화도출혈、재위양종합정、감염등.공장영양치료전후체중、혈림파세포계수、혈청백단백적개선차이균유통계학의의(P＜0.05).혈홍세포계수,혈청기항,뇨소담적개변무통계학의의(P＞0.05).23례차환인중20례차치유,2례차호전,1례차미유.결론 비공장치관기술대우급성이선염환인안전가행,비공장영양치료대우존재중도영양풍험적급성이선염환인시유효가행적,대우환인영양상황적개선구유명현적효과.
Objective To evaluate the feasibility and effectiveness of placement of nasojejunal feeding tube and nasojejunal nutrition feeding in children with acute pancreatitis.Method Twenty-two patients (of whom 13 had severe acute pancreatitis and 9 acute mild pancreatitis) who needed nutritional intervention were selected.They were from Department of Gastroenterology and Surgery during the years 2009-2012,and they were at high nutritional risk after STONGkid nutrition risk screening.The average age of them was 5-15 years (9.1 years ± 2.8 years).Assisted by endoscopy,the nasojejunal feeding tube was placed in 22 of 24 patients (in 2 cases of recurrent pancreatitis the tubes were placed again after extubation).Besides the use of regular fasting,antacids,inhibitors of trypsin secretion,and anti-infective treatment,23 cases of all children got nasojejunal nutrition treatment as well.The outcome measures included the success rate,complications of endoscope-assisted nasojejunal tube placement.The children's tolerance and nutrition indicators (weight,blood lymphocytes count,erythrocytes count,serum albumin,serum creatinine,blood urea nitrogen) were observed before and after enteral nutrition therapy.Result Malnutrition evaluation was done 24 times before treatment among 22 patients,incidence of malnutrition was 33％ in 22 cases.Placement of nasojejunal tube placement was attempted for a total of 24 times and was successful on first placement in 22 cases,in two cases the placement was successful on the second placement,so the success rate of the first attempt for placement was 92％.No significant complications were observed in any of the cases.Twenty-three of 24 cases were given standardized enteral nutrition (one case was not given enteral nutrition therapy but underwent ERCP due to obstructive jaundice).Twenty-two of 23 cases could tolerate enteral nutrition well,only 1 case was unable to tolerate enteral nutrition due to the pancreas schizophrenia,paralytic ileus.The treatment of jejunal feeding success rate was 96％.The feeding duration was 2-74 d(27.0 d ± 18.3 d).The adverse reactions include plugging of the tube in two cases,constipation in two cases,five cases had abdominal pain,diarrhea in 2 cases,vomiting in 2 cases and 1 case of jejunum retention.No case had nasopharynx ulcers,gastrointestinal perforation,gastrointestinal bleeding,re-feeding syndrome and infection etc.Blood erythrocytes count,serum creatinine,blood urea nitrogen were not significantly changed.Twenty of 23 cases were cured,2 cases were improved and 1 case was unchanged.Conclusion Endoscope-assisted nasojejunal tube placement for children with acute pancreatitis is safe and feasible.Nasojejunal nutrition therapy is effective for acute pancreatitis patients who are at severe nutritional risk,especially for the improvement of the nutritional status of children.
