短肽型肠内营养制剂对行机械通气肺炎患儿的营养支持研究

Nutritional support in children with pneumonia on mechanical ventilation by short-peptide enteral nutrition formula

摘要:

目的 观察儿童重症监护室（PICU）行机械通气的重症肺炎患儿营养不良及营养风险发生情况，探讨短肽型肠内营养制剂的营养支持效果。方法 选取2017年10月至2018年10月于PICU住院治疗且需机械通气的重症肺炎患儿68例为研究对象，采用前瞻性随机对照法将患儿随机分为对照组和试验组。通过鼻饲管分别给予试验组短肽型肠内营养制剂，对照组整蛋白型肠内营养制剂。评估两组患儿的年龄别体重Z值、STRONGkids营养风险评分和小儿危重病评分。检测两组患儿入院时、出院前的血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）水平，观察两组患儿的胃肠耐受性和临床治疗效果指标。结果 68例机械通气患儿中有26例（38%）存在营养不良，包括中度营养不良10例（15%），重度营养不良16例（24%）；出院时有10例（15%）存在营养不良。63例（93%）患儿存在中、高营养风险，包括中度营养风险21例，高度营养风险42例，极危重组和危重组中的中、高营养风险检出率明显高于非危重组（P < 0.05）。与对照组相比，试验组患儿的机械通气时间、总住院时间缩短，血清PA水平和体重增长率增加，在胃肠道耐受性方面试验组优于对照组（P < 0.05）；两组呼吸机相关肺炎发生情况及疾病转归情况比较差异无统计学意义（P > 0.05）。结论 行机械通气肺炎患儿的营养不良及营养风险检出率较高。短肽型肠内营养制剂有助于改善行机械通气肺炎患儿的治疗效果，更适用于需机械通气危重患儿的营养支持治疗。

Abstract:

Objective To observe the incidence of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation in the pediatric intensive care unit (PICU), and to explore the nutritional support effect of short-peptide enteral nutrition formula. Methods A total of 68 children with severe pneumonia who were hospitalized in the PICU from October 2017 to October 2018 and required mechanical ventilation were enrolled for a prospective randomized controlled study. The children were randomly divided into a control group and an experimental group. Through the nasogastric feeding tube, the experimental group received the short-peptide enteral nutrition formula, and the control group received the intact-protein enteral nutrition formula. The weight-for-age Z score, STRONGkids nutritional risk score, and pediatric critical illness score of the two groups were evaluated. The serum levels of total protein, albumin, and prealbumin (PA) on admission and before discharge were measured. The gastrointestinal tolerance and clinical outcome indicators of the two groups were observed. Results Among the 68 mechanically ventilated children, 26 (38%) had malnutrition, including moderate malnutrition (10 cases, 15%) and severe malnutrition (16 cases, 24%); 10 cases (15%) had malnutrition at discharge. Sixty-three children (93%) had nutritional risk, including moderate nutritional risk in 21 cases and high nutritional risk in 42 cases. The moderate and high nutritional risk rates of the critical and extreme critical groups were significantly higher than those of the non-critical group (P < 0.05). Compared with the control group, the experimental group had significantly shorter duration of mechanical ventilation and total length of hospital stay, significantly higher serum PA level and weight growth rate, and significantly better gastrointestinal tolerance (P < 0.05). There were no significant differences in the incidence of ventilator-associated pneumonia and disease outcome between the two groups (P > 0.05). Conclusions The detection rates of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation are relatively high. Short-peptide enteral nutrition formula can help improve their treatment outcome and are more suitable for nutritional support in critically ill children on mechanical ventilation.