小儿慢性腹泻营养支持治疗分析

Efficacy of nutrition support therapy in children with chronic diarrhea

摘要:

目的 研究营养支持治疗在慢性腹泻治疗的有效性。方法 回顾性研究2012年7月至2014年7月48例慢性腹泻患儿资料,病例根据年龄分为 <1岁组(27例)和 ≥1岁组(21例);将27例合并营养不良的患儿分为肠内营养(EN)组(10例)、部分肠外营养组(PPN+EN)(16例)、完全肠外营养(TPN)组(1例)。分析不同年龄组及不同治疗方式患儿的治疗过程和结局。结果 48例患儿中,短肠综合征、病毒性肠炎、肠道手术、吸收不良综合征等为较常见病因,50%(24例)病因不明。在入院营养评定方面,<1岁组的中度体重低下患儿所占比例高于≥1岁组 (P < 0.05)。EN组年龄别体质指数Z评分(BAZ)由治疗前的-2.2±1.5增加至治疗后的-1.8±1.0(P = 0.040),所供能量由治疗前的每日46±17 kcal/kg增加至每日83±32 kcal/kg (P = 0.012);PPN+EN组的年龄别体重Z评分(WAZ)由治疗前的-3.3±2.0增加至-2.8±1.8(P = 0.044),BAZ由治疗前的-2.8±1.4增加至-2.0±1.4 (P = 0.012)。TPN组仅1例,经治疗后腹泻症状改善。 接受营养治疗的27例患儿中,4例未好转,其余患儿症状缓解、营养状况改善。结论 在慢性腹泻的治疗过程中,肠内及肠外营养治疗作为综合治疗的一部分,可有效改善营养状况,缓解腹泻症状。

Abstract:

Objective To investigate the efficacy of nutrition support therapy in children with chronic diarrhea. Methods A retrospective analysis was performed for the clinical data of 48 children with chronic diarrhea who were hospitalized between July 2012 and July 2014. These children were divided into <1 year group (27 children) and ≥1 year group (21 children). Twenty-seven of these patients, who had malnutrition, were divided into enteral nutrition (EN) group (10 children), partial parenteral nutrition (PPN)+EN group (16 children), and total parenteral nutrition (TPN) group (1 child). The therapeutic process and outcome were compared between different age groups and children receiving different treatments. Results Among the 48 children, short bowel syndrome, viral enteritis, a history of intestinal surgery, and malabsorption syndrome were common causes of chronic diarrhea, and 24 children (50%) had unknown causes. In the aspect of nutritional assessment on admission, the <1 year group had a significantly higher proportion of children with moderate underweight than the ≥1 year group (P < 0.05). In the EN group, the BMI-for-age Z-score (BAZ) increased from -2.2±1.5 before treatment to -1.8±1.0 (P = 0.040), and the energy supplied increased from 46±17 kcal/kg per day before treatment to 83±32 kcal/kg per day (P = 0.012). In the PPN+EN group, the weight-for-age Z-score (WAZ) increased from -3.3±2.0 before treatment to -2.8±1.8 (P = 0.044), and BAZ increased from -2.8±1.4 before treatment to -2.0±1.4 (P = 0.012). There was only 1 child in the TPN group, whose symptoms of diarrhea were relieved after treatment. Among 27 children receiving nutritional therapy, 4 were not improved, and the other children achieved remission of symptoms and improvements in nutritional status. Conclusions Besides etiological treatment, nutrition support therapy can be applied as part of multimodality therapy in children with chronic diarrhea. This can effectively improve nutritional status and relieve the symptoms of diarrhea.