不同喂养方案治疗新生儿乳糜胸及乳糜腹的临床疗效研究  

Clinical efficacy of different feeding regimens in the treatment of neonatal chylothorax and chylous ascites

作　　者：李奔 张榕 刘银芝 占彩霞 马金霞 肖倬君 彭小明 Li Ben;Zhang Rong;Liu Yinzhi;Zhan Caixia;Ma Jinxia;Xiao Zhuojun;Peng Xiaoming(Department of Neonatology,the Affiliated Children's Hospital of Xiangya School of Medicine,Central South Universty(Hunan Children's Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)新生儿科,长沙410007

出　　处：《中华新生儿科杂志(中英文)》2025年第2期65-70,共6页Chinese Journal of Neonatology

基　　金：湖南省科技创新计划项目(2021SK50504)。

摘　　要：目的比较乳糜胸/乳糜腹专用配方奶喂养和其他喂养方式(深度水解配方奶、母乳)治疗新生儿乳糜胸及乳糜腹的临床疗效。方法选择2015年1月至2023年2月湖南省儿童医院新生儿科收治的新生儿乳糜胸和(或)乳糜腹患儿临床资料进行回顾性分析。按照是否采用富含中链甘油三酯(medium chain triglycerides,MCT)的乳糜胸/乳糜腹专用配方奶喂养分为MCT专用配方奶组和其他喂养方式组。比较两组患儿的一般资料、临床表现、辅助检查结果、治疗方式及预后。结果共纳入43例患儿,MCT专用配方奶组21例,其他喂养方式组22例。两组一般资料、胎儿水肿、呼吸困难、单侧胸腔积液、合并气胸及单纯乳糜胸/乳糜腹比例比较,差异均无统计学意义(P>0.05)。MCT专用配方奶组使用奥曲肽比例高于其他喂养方式组[42.9%(9/21)比13.6%(3/22),P=0.033]。两组胸(腹)腔穿刺次数、闭式引流比例、累计胸/腹水引流量、禁食天数、建立全肠内喂养时间、呼吸支持情况、输注白蛋白及丙种球蛋白比例、体重增长速率、住院时间、胸/腹腔积液吸收时间及治愈/好转率比较,差异均无统计学意义(P>0.05)。随访成功42例,其中3例死亡(化脓性脑膜炎、严重心脏畸形、21三体综合征各1例),39例存活患儿均无复发,1例有营养不良及发育迟缓。结论对于新生儿乳糜胸/乳糜腹的患儿,在无法及时获取乳糜胸/乳糜腹专用配方奶时,可尝试使用深度水解配方奶、母乳喂养,两者长期临床疗效差异无统计学意义。ObjectiveTo study the clinical efficacy of chylothorax(CT)/chylous ascites(CA)specialized formula and other feeding regimens[extensively hydrolyzed formula(EHF)and breast milk]in the treatment of neonatal CT/CA.MethodsFrom January 2015 to February 2023,neonates with CT/CA admitted to our hospital were retrospectively analyzed.Neonates fed with medium-chain triglycerides(MCT)-enriched CT/CA specialized formula were assigned into the MCT group and others(EHF and breast milk)into the control group.The general data,clinical symptoms,lab results,treatments and prognosis were compared between the two groups.ResultsA total of 43 neonates were enrolled,including 21 in the MCT group and 22 in the control group.No significant differences existed between the two groups in the general data,incidences of fetal hydrops,respiratory distress,unilateral pleural effusion,comorbidity of pneumothorax and isolated CT/CA(P>0.05).The MCT group had higher incidence of octreotide usage than the control group[42.9%(9/21)vs.13.6%(3/22),P=0.033].No significant differences existed between the two groups in the following items:the incidences of thoracic/abdominal puncture and closed drainage,the cumulative amount of thoracic/abdominal drainage,the number of fasting days,time needed to establish total enteral nutrition(TEN),respiratory support,albumin and gamma globulin infusion,velocity of weight gain,length of hospital stay,absorption time of pleural/peritoneal effusion and cure/improvement rates(all P>0.05).42 cases were follow-up of which three died(1 pyogenic meningitis,1 severe cardiac defect and 1 trisomy 21 syndrome).39 surviving neonates had no recurrence of CT/CA,with only one case had malnutrition and developmental delay.ConclusionsFor neonates with CT/CA,if specialized MCT formula unavailable in time,EHF or breast milk can be considered as alternatives,as no significant differences existed in long-term clinical efficacy between these feeding regimens.

关 键 词：新生儿 乳糜胸 乳糜腹 乳糜胸及乳糜腹专用配方奶 

分 类 号：R722.1[医药卫生—儿科]