序贯式营养治疗对5例先天性婴幼儿乳糜胸的效果评价  

The effect of sequential nutrition support on 5 congenital chylothorax infants

作　　者：王文俏 王玉琪 隆琦[1] 张婷[1] 陈菲 陈与知 马鸣[1] Wang Wenqiao;Wang Yuqi;Long Qi;Zhang Ting;Chen Fei;Chen Yuzhi;Ma Ming(Department of Clinical Nutrition,the Children Hospital,Zhejiang University of Medicine/National Clinical Research Center for Child Health,Hangzhou 310052,Zhejiang,China;Department of Respiratory Medicine,the Children Hospital,Zhejiang University of Medi-cine/National Clinical Research Center for Child Health,Hangzhou 310052,Zhejiang,China)

机构地区：[1]浙江大学医学院附属儿童医院临床营养科/国家儿童健康与疾病临床医学研究中心,杭州310052 [2]浙江大学医学院附属儿童医院呼吸内科/国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《肿瘤代谢与营养电子杂志》2021年第1期82-86,共5页Electronic Journal of Metabolism and Nutrition of Cancer

摘　　要：目的探讨序贯式营养治疗在先天性婴幼儿乳糜胸治疗中的应用效果,为规范化治疗提供依据。方法回顾性采集2017年1月至2019年12月在浙江大学医学院附属儿童医院呼吸科诊断为先天性乳糜胸患儿的临床资料,并总结序贯式营养治疗方案及效果。结果本研究共收集5例先天性乳糜胸患儿,确诊日龄为(75±17)d,男性2例、女性3例。5例均以咳嗽、气促为首发表现,1例伴有呕吐、腹泻等消化道症状。4例为右侧胸腔积液,1例为双侧胸腔积液,胸腔积液量为(3.6±1.8)cm。5例患儿均接受序贯式营养治疗(全肠外营养‑高中链甘油三酯肠内营养‑普通肠内营养)的保守治疗方法治愈,5例患儿均呈顺势增长,治疗前后身高、体重分别为(61.9±2.2)cm和(67.0±2.0)cm(t=-23.3,P<0.001),(5.7±0.6)kg和(7.2±0.6)kg(t=-12.7,P<0.001)。治疗前后年龄别身长Z评分(HAZ)、年龄别体重Z评分(WAZ)和身长别体重Z评分(WHZ)平均值分别为:1.45和1.48(t=-0.35,P=0.75)、0.004和-0.39(t=-2.91,P=0.04)、-0.83和-0.59(t=-0.58;P=0.59),营养不良例数治疗前后分别为3例和1例。前白蛋白、白蛋白干预前后分别为(0.12±0.04)g/L和(0.16±0.02)g/L(t=-4.67,P=0.01)、(41.6±3.4)g/L和(42.1±3.1)g/L(t=-0.75,P=0.49)。治疗后前白蛋白水平显著增加,白蛋白无统计学差异。5例患儿出院后随访时间为(62±6)d,营养状况改善,乳糜胸均无复发。结论先天性乳糜胸患儿有较高的营养不良风险,长期的营养管理是保守治疗的重要部分。5例患儿经序贯式营养治疗后临床症状和营养状况均得到改善。Objective This research aims to explore the effect of sequential nutritional support on congenital chylothorax in infants,and to provide the basis for standardized treatment.Methods We collected five infants who were diagnosed with congenital chylothorax at Children′s Hospital of Medicine of Zhejiang University from January 2017 to December 2019,and retrospectively summarized clinical manifestation and analyzed the effect of the sequential nutritional support.Results A total of five infants with congenital chylothorax were recruited,including two males and three females.The average age of diagnosis was(75±17)days.All the 5 patients were characterized by cough and tachypnea,with 1 case accompanied by gastrointestinal symptoms(vomiting and diarrhea).The prenatal ultrasound detected pleural effusion in five patients,four of which presented with right pleural effusion,and the remaining one with bilateral pleural effusion.The average hydrothorax volume was(3.6±1.8)cm.All the five patients received sequential nutritional support(total parenteral nutrition to high MCT enteral nutrition)and recovered from conservative treatment.The height and weight of patients were both increased after treatment[(61.9±2.2)cm vs(67.0±2.0)cm,t=23.3,P<0.001;(5.7±0.6)kg vs(7.2±0.6)kg,t=12.7,P<0.001,respectively].The average values of length for age Z score(HAZ)、weight for age Z score(WAZ)、weight for length Z score(WHZ)before and after treatment were 1.45 and 1.48(t=0.35,P=0.75),0.004 and-0.39(t=2.91,P=0.04),-0.83 and-0.59(t=-0.58,P=0.59),and the incidence of malnutrition was 60%and 20%,respectively.The level of prealbumin in patients increased significantly after treatment[(0.12±0.04)g/L vs(0.16±0.02)g/L,t=-4.67,P=0.01];while the change of albumin level had no statistical significance[(41.6±3.4)g/L vs(42.1±3.1)g/L,t=-0.75,P=0.49].Through follow⁃up of two months,all the patients had no relapse of pleural effusion.Conclusion Patients with congenital chylothorax have high malnutrition risk.Nutritional support is an essential

关 键 词：先天性乳糜胸 序贯式营养治疗 乳糜胸 

分 类 号：R725.6[医药卫生—儿科]