摘要
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2～74d，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，l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。
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 nasoieiunal tube nlacement. The chilrlran＇gtolerance 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 imorovement of the nutritional status of children.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第2期136-140,共5页
Chinese Journal of Pediatrics
基金
世界健康基金会“上海儿童医学中心一雅培/世界健康基金会临床营养发展中心（AFJNs）项目”（AFINS-HOPE-2012-10）
关键词
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
Acute pancreatitis
Enteral nutrition
Malnutrition
Child
Endoscopic-assistednasojejunal tube placement
