体外膜氧合期间危重症患儿超早期肠内营养支持的临床观察  

Clinical observation of ultra early enteral nutrition support in critically ill children undergoing extracorporeal membrane oxygenation

作　　者：李燕[1] 张育才 居敏洁 付聪慧 刘季 杨晓亚 崔云 徐婷婷 Li Yan;Zhang Yucai;Ju Minjie;Fu Conghui;Liu Ji;Yang Xiaoya;Cui Yun;Xu Tingting(Department of Critical Care Medicine,Shanghai Children′s Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院重症医学科,上海200062

出　　处：《中华儿科杂志》2025年第3期249-253,共5页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2021YFC2701704);上海市护理学会科研课题(2022QN-B01);上海交通大学医学院2023年护理学科人才队伍建设项目(沪交医护[2023]3号)。

摘　　要：目的探讨体外膜氧合(ECMO)支持下危重症患儿开展超早期肠内营养(≤24 h)的可行性及临床效果。方法回顾性队列研究。收集上海市儿童医院重症监护病房(PICU)2016年1月至2023年12月接受ECMO支持的43例危重症患儿临床资料,包括一般资料、营养支持方式和肠内营养耐受性。根据肠内营养启动时间分为ECMO支持后24 h内肠内营养组和24 h后肠内营养组,采用两独立样本t检验、Mann-Whitney U检验、χ^(2)检验和Fisher确切概率法比较两组患儿的营养指标、营养摄入情况、ECMO支持时间、机械通气时间和病死率等资料。结果43例患儿中男25例、女18例,年龄47(18,97)月龄。24 h内肠内营养组(21例)和24 h后肠内营养组(22例)患儿在年龄、体质指数Z值、ECMO支持前总蛋白、白蛋白、血红蛋白、ECMO支持时间、机械通气时间、住PICU时间、肠内营养不耐受发生次数、肠内营养中断次数、病死率方面差异均无统计学意义(均P>0.05)。24 h内肠内营养组在ECMO支持期间蛋白质摄入达标天数占比高于24 h后肠内营养组[0(0,21%)比0(0,0),U=175.00,P<0.05]。结论ECMO支持患儿超早期开展肠内营养支持是安全的,24 h内进行肠内营养支持可提高ECMO患儿蛋白质摄入达标天数占比,且不增加肠内营养不耐受、肠内营养中断的发生。Objective To investigate the feasibility and clinical effects of ultra early enteral nutrition(≤24 h)in critically ill children supported by extracorporeal membrane oxygenation(ECMO).Methods A retrospective cohort study was conducted.Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit(PICU)of Shanghai Children′s Hospital from January 2016 to December 2023 were collected,including general information,nutritional support modalities,and enteral nutrition tolerance.Based on the timing of enteral nutrition initiation,patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group.Nutritive indicators,nutritional intake,duration of ECMO support,duration of mechanical ventilation duration,and mortality rates were compared between the 2 groups using the two independent sample t test,Mann-Whitney U test,χ^(2)test and Fisher′s exact test.Results Among the 43 children,25 were male and 18 were female,with an age of 47(18,97)months.There were no statistically significant differences between the within 24 h enteral nutrition group(21 cases)and the after 24 h enteral nutrition group(22 cases)in terms of age,body mass index Z score,total protein,albumin,hemoglobin levels before ECMO support,duration of ECMO support,duration of mechanical ventilation,length of PICU stay,number of enteral nutrition intolerance events,number of enteral nutrition interruption,or mortality rate(all P>0.05).The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group(0(0,21%)vs.0(0,0),U=175.00,P<0.05).Conclusions Ultra early enteral nutrition is safe for children supported by ECMO.Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

关 键 词：肠道营养 营养支持 体外膜氧合作用 儿童 

分 类 号：R720.597[医药卫生—急诊医学] R459.3[医药卫生—儿科]