摘要
目的探讨重症儿童继发高胰酶血症肠内营养的安全性和有效性，为重症高胰酶血症患儿营养支持提供依据。方法前瞻性收集2014年1月至2015年12月湖南省儿童医院重症监护室收治的90例高胰酶血症患儿，在常规治疗的基础上，随机（随机数字法）分为禁食组（禁食时间超过3d给予静脉营养）30例、普通奶粉组30例、特殊奶粉组（1岁以内给予蔼儿舒，1岁以上给予小百肽）30例。采取χ2检验、成组t检验、F检验或非参数检验分析各组患儿临床资料与生化指标，评估重症高胰酶血症患儿肠内营养的安全性和有效性。结果（1）各组患儿病程中出现与营养支持相关的症状如腹泻、电解质紊乱、血糖紊乱比例差异有统计学意义（χ2=6．975、6．074、6．300，P=0．031、0．048、0．043）。（2）血淀粉酶或脂肪酶大于正常上限值比例在人院第3天的差异有统计学意义（χ2=7．081，P=0．029）。各组粪弹性蛋白酶-1〈200μg／g的比例在入院24h、第3、7天比较差异均无统计学意义（P〉0．05）。各组降钙素原水平在第7天差异有统计学意义（H=6．251，P=0．044）。各组氧合指数在人院第3天差异有统计学意义（F=3．119，P=0．049）。各组乳酸水平在第7天差异有统计学意义（F=6．449，P=0．040）。各组白蛋白水平变化在第3、7天差异均具有统计学意义（F=5．451，P=0．006；H=24．861，P=0．000）。（3）各组住PICU时间和住院时间差异均有统计学意义（F=3．222、3．891，P=0．045、0．024）。各组存活率差异有统计学意义（Z=6．240，P=0．044）。结论早期正确的肠内营养对重症儿童继发高胰酶血症是安全和有效的，适合高胰酶血症的特殊奶粉（如蔼儿舒和小百肽）可有效的给予高胰酶血症患儿营养支持，改善病情并促进疾病恢复，缩短住院时间和改善预后。
Objective To investigate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea including hyperamylasemia and hyperlipasemia in order to provide the rationale of nutritional support for such critically ill children. Methods A total of 90 critically ill children with hyperpancreorrhea admitted in pediatric intensive care unit were enrolled for prospective study in a period from January 2014 to December 2015. The patients were randomly（random number） divided into fasting group （n=30）, and in those with fasting time exceeded three days, intravenous nutrition was given; ordinary milk group （n=30） and special milk group （n=30） and in this group, those with age〈l year were given AiErShu, while those with age 〉1 year were given small hundred peptides in addition to the basis of routine treatment. Clinical data and biochemical findings in different groups were analyzed by χ2test, t test, F test or non-parametric test to evaluate the safety and efficacy of enteral nutrition in critically ill children with hyperpancreorrhea. Results （1） There were statistically significant differences in rates of nutrition support-related symptoms such as diarrhea, electrolyte imbalance, blood glucose disorder among groups （χ2=6.975,6.074,6.300, P=0.031,0.048,0.043）. （2） There were statistically significant difference in rates of serum amylase or lipase levels more than upper limit on the third day among different groups （χ2=7.081, P=0.029）. There was no statistically significant difference in rates of fecal elastase-1〈200 μg/g 24 hours after admission, on the 3rd day and on the 7th day among different groups （P〉0.05）. There was statistically significant difference in procalcitonin on the 7th day among different groups （H=6.251, P=0.044）. There was statistically significant difference in oxygenation index on the 3rd day among different groups （F=3.119, P=0.049）. There was statistically significant difference in lactate on the 7th day among different groups （F=6.449, P=0.040）. There was statistically significant differences in albumin on the 3rd day and on the 7th among different groups （F=5.451, P=0.006; H=24.861, P〈0.01）. （3） There were statistically significant differences in PICU stay and hospital stay among different groups （F=3.222,3.891, P=0.045 ; 0.024）. There was statistically significant difference in survival rate among different groups （Z2=6.240, P=0.044）.Concluslons Early and right enteral nutrition was safe and effective for critically ill children with hyperpancreorrhea, and the special milk powder such asr AiReShu and small hundred peptides suitable for children with hyperpancreorrhea could effectively support nutrition for critically ill children with hyperpancreorrhea, improve the status of illness, promote disease recovery, shorten hospital stay and improve the prognosis.
作者
刘萍萍
卢秀兰
肖政辉
仇君
龚玲
Liu Pingping;Lu Xiulan;Xiao Zhenghui;Qiu Jun;Gong Ling(Emergency Center, Hunan Children＇s Hospital, Changsha 410007, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第6期615-620,共6页
Chinese Journal of Emergency Medicine
基金
“十二五”国家科技支撑计划（2012BAI04B01）,湖南省卫生计生委一般项目（B2017111）
关键词
重症儿童
高胰酶血症
脓毒症
肠内营养
营养支持
安全性
有效性
预后
Critically ill children
Pancreatic hyperenzymemia
Sepsis
Enteral nutrition
Nutritional support
Safety
Efficacy
Prognosis
作者简介
通信作者：卢秀兰，Email：luxiulan2014@163．com
