[1]解弘宇,王丽杰.PICU病儿喂养不耐受危险因素及营养相关结局的研究[J].肠外与肠内营养杂志,2024,(05):268-274.[doi:DOI : 10.16151/j.1007-810x.2024.05.003]
　XIE Hong-yu,WANG Li-jie.Risk factors for enteral feeding intolerance and nutrition relatedoutcomes in critically ill pediatric patients[J].PARENTERAL & ENTERAL NUTRITION,2024,(05):268-274.[doi:DOI : 10.16151/j.1007-810x.2024.05.003]
点击复制

PICU病儿喂养不耐受危险因素及营养相关结局的研究()
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2024年05期
页码:
268-274
栏目:
论著
出版日期:
2024-10-10

文章信息/Info

Title:
Risk factors for enteral feeding intolerance and nutrition relatedoutcomes in critically ill pediatric patients
作者:
解弘宇1; 2; 王丽杰1
1. 中国医科大学附属盛京医院儿科重症监护室，辽宁沈阳110004；2. 廊坊市人民医院新生儿科，河北廊坊 065000
Author(s):
XIE Hong-yu1; 2;  WANG Li-jie1
1.Pediatrics Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004,China; 2. Department of Neonatology, The People’ s Hospital of Langfang City, Langfang 065000,China
关键词:
喂养不耐受 ; 肠内营养 ; 儿童 ; 重症监护
Keywords:
Feeding intolerance;  Enteral nutrition;  Pediatric patients;  Intensive care
分类号:
R725.9,R459.3
DOI:
DOI : 10.16151/j.1007-810x.2024.05.003
文献标志码:
A
摘要:
目的：分析危重病儿喂养不耐受（FI）的危险因素，以及 FI 对营养相关结局的影响。 方法：选取2022 年 9 月至 2023 年 12 月于中国医科大学附属盛京医院儿科重症监护室住院并行肠内营养（EN）的病儿作为研究对象，根据开始 EN 后 10 d 内是否新发生 FI 分组，采用多因素 Logistic 回归分析 FI 的危险因素；筛选入院 10 d 内均为配方粉喂养病儿，根据是否新发生 FI 比较营养相关结局。 结果：共纳入 744 例病儿，FI 发生率 19.5%（145 例）。因FI 造成喂养中断 154 次（49.0%），70 例 AGI II 级病儿经早期干预，胃肠道症状缓解，未造成喂养中断。FI 组及非 FI组病儿在 BMI 指数、PRISM III 评分、EN 启动时间、平均气道压、Ramsay 评分、降钙素原、血清白蛋白、预防应用益生菌方面的比较差异有统计学意义（P < 0.05）。Logistic 回归分析表明低 BMI、高 Ramsay 评分、低白蛋白是 FI 的危险因素，预防应用益生菌为 FI 的保护因素。入院 10 d 内均为配方粉喂养病儿 471 例，其中 FI 组 125 例，非 FI 组 346 例。FI 组入院 10 d 达 80% 营养目标率低、平均每天摄入热卡占目标百分比低、蛋白质少（P < 0.05）。 结论：危重症病儿 FI 发生率高，早期干预可减少喂养中断发生。低 BMI、高 Ramsay 评分、低白蛋白更易发生 FI，预防应用益生菌可能减少 FI 的发生，合并 FI 的病儿营养相关结局差。
Abstract:
Objective: To determine the risk factors for feeding intolerance in critically ill children in the pediatricintensive care unit (PICU) of our hospital, and to analyze the differences in the nutrition-related outcomes. Methods:Children who were hospitalized and received enteral nutrition in the pediatric intensive care unit of Shengjing Hospitalaffiliated with China Medical University from September 2022 to December 2023 were screened. They were divided intotwo groups based on whether FI occurred within 10 days after the start of EN, and multivariate logistic regressionanalysis was used to explore the risk factors of FI; children who were fed powdered milk within 10 days of admissionwere excluded, and their nutritional compliance rate and average daily intake of calories and protein were compared.Results: A total of 744 children were included, with an incidence of FI of 19.5%(145 cases). There were 154 (49%) casesof feeding interruptions due to FI during the observation period, and 70 children with AGI II had remission ofgastrointestinal symptoms after a change in feeding regimen. There were statistically significant differences in BMI,PRISM III score, EN initiation time, MAP, Ramsay score, procalcitonin, serum albumin, and proportion of probioticprophylaxis between children in the FI group and those in the non-FI group (P < 0.05). Logistic regression analysis showed that low BMI, high Ramsay score, and low albumin were risk factors for FI, and probiotic prophylaxis was aprotective factor for FI. Within 10 days of admission, a total of 471 children were fed formula powder, including 125 inthe FI group and 346 in the non-FI group. The FI group had a lower nutritional compliance rate, a lower percentage ofdaily calorie intake, and a lower protein intake compared to non-FI group (P < 0.05). Conclusion: The incidence offeeding intolerance is high in critically ill children. Early intervention can reduce the occurrence of FI. Low BMI, highRamsay score, and low albumin are risk factors for feeding intolerance, and probiotic prophylaxis may be a protectivefactor. Children with concomitant FI have worse nutritional outcomes.

参考文献/References:


[1] Verger J. Nutrition in the pediatric population in the intensivecare unit[J]. Crit Care Nurs Clin North Am, 2014, 26(2): 199-215.
[2] Mehta NM, Bechard LJ, Chahill N, et al. Nutrition practices andtheir relationship to clinical outcomes in critically ill children-aninternational multicenter cohort study[J]. Crit Care Med, 2012, 40(7): 2204-2211.
[3] Martinez EE, Douglas K, Nurko S, et al. Gastric dysmotility incritically ill children: pathophysiology, diagnosis, andmanagement[J]. Pediatr Crit Care Med, 2015, 16(9): 828-836.
[4] 吴国豪 . 临床营养现状与挑战[J]. 中华消化外科杂志, 2021, 20(1): 94-97.
[5] Mehta NM, Skillman HE, Irving SY, et al. Guidelines for theprovision and assessment of nutrition support therapy in thepediatric critically ill patient: society of critical care medicine andAmerican society for parenteral and enteral nutrition[J]. JPEN JParenter Enteral Nutr, 2017, 41(5): 706-742.
[6] 危重症儿童营养评估及支持治疗指南(中国)工作组, 钱素云, 陆国平, 等 . 危重症儿童营养评估及支持治疗指南(2018,中国,标准版)[J]. 中国循证儿科杂志, 2018, 13(1): 1-29.
[7] Tume LN, Eveleens RD, Verbruggen SCAT, et al. Barriers todelivery of enteral nutrition in pediatric intensive care: a worldsurvey[J]. Pediatr Crit Care Med, 2020, 21(9): e661-e671.
[8] Brown AM, Carpenter D, Keller G, et al. Enteral nutrition in thePICU: current status and ongoing challenges[J]. J PediatrIntensive Care, 2015, 4(2): 111-120.
[9] Jabbar A, Chang WK, Dryden GW, et al. Gut immunology andthe differential response to feeding and starvation[J]. Nutr ClinPract, 2003, 18(6): 461-482.
[10] McClave SA, Heyland DK. The physiologic response andassociated clinical benefits from provision of early enteralnutrition stephen[J]. Nutr Clin Pr, 2009, 24(3): 305-315.
[11] Panchal AK, Manzi J, Connolly S, et al. Safety of enteral feedingsin critically ill children receiving vasoactive agents[J]. JPEN JParenter Enteral Nutr, 2016, 40(2): 236-241.
[12] Martinez EE, Pereira LM, Gura K, et al. Gastric emptying incritically ill children[J]. JPEN J Parenter Enteral Nutr, 2017, 41(7): 1100-1109.
[13] Eveleens RD, Joosten KFM, de Koning BAE, et al. Definitions,predictors and outcomes of feeding intolerance in critically illchildren: a systematic review[J]. Clin Nutr, 2020, 39(3): 685-693.
[14] Reintam Blaser A, Malbrain MLNG, Starkopf J, et al.Gastrointestinal function in intensive care patients: terminology,definitions and management. Recommendations of the ESICMworking group on abdominal problems[J]. Intensive Care Med,2012, 38(3): 384-394.
[15] Van den Broeck J, Willie D, Younger N. The world healthorganization child growth standards: expected implications forclinical and epidemiological research[J]. Eur J Pediatr, 2009, 168(2): 247-251.
[16] de Onis M, Onyango AW, Borghi E, et al. Development of aWHO growth reference for school-aged children and adolescents[J]. Bull World Health Organ, 2007, 85(9): 660-667.
[17] WHO Multicentre Growth Reference Study Group. WHO childgrowth standards based on length/height, weight and age[J]. ActaPaediatr Suppl, 2006, 450: 76-85.
[18] Bouma S. Diagnosing pediatric malnutrition[J]. Nutr Clin Pract,2017, 32(1): 52-67.
[19] Stechmiller J, Treloar DM, Derrico D, et al. Interruption ofenteral feedings in head injured patients[J]. J Neurosci Nurs,1994, 26(4): 224-229.
[20] 姚德贞, 王丽杰 . PICU 危重病儿营养管理现状单中心调查[J].肠外与肠内营养, 2022, 29(2): 69-74.
[21] Ranasinghe RN, Biswas M, Vincent RP. Prealbumin: the clinicalutility and analytical methodologies[J]. Ann Clin Biochem, 2022,59(1): 7-14.
[22] Reintam A, Parm P, Redlich U, et al. Gastrointestinal failure inintensive care: a retrospective clinical study in three differentintensive care units in Germany and Estonia[J]. BMCGastroenterol, 2006, 6: 19.
[23] Liu R, Paz M, Siraj L, et al. Feeding intolerance in critically illpatients with COVID-19[J]. Clin Nutr, 2022, 41(12): 3069-3076.
[24] Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, andclinical consequence of enteral feeding intolerance in themechanically ventilated critically ill: an analysis of a multicenter,multiyear database[J]. Crit Care Med, 2021, 49(1): 49-59.
[25] Reintam A, Parm P, Kitus R, et al. Gastrointestinal failure score incritically ill patients: a prospective observational study[J]. CritCare, 2008, 12(4): R90.
[26] Yu KR, Guo N, Zhang DD, et al. Prevalence and risk factors ofenteral nutrition intolerance in intensive care unit patients: aretrospective study[J]. Chin Med J (Engl), 2022, 135(15): 1814-1820.
[27] 张庆男, 钱宵佳, 陈 洁 . 危重症患者肠内营养喂养不耐受的影响因素及对策[J]. 中国老年学杂志, 2019, 39(18): 4516-4518.
[28] 陈小颉, 段 霞, 郑微艳, 等 . 肠内营养病人喂养不耐受风险预测模型的系统评价[J]. 肠外与肠内营养, 2024, 31(2): 107-113.
[29] DeHaven-Hudkins DL, DeHaven RN, Little PJ, et al. Theinvolvement of the mu-opioid receptor in gastrointestinalpathophysiology: therapeutic opportunities for antagonism at thisreceptor[J]. Pharmacol Ther, 2008, 117(1): 162-187.
[30] Zhang J, Yu WQ, Wei T, et al. Effects of short-peptide-basedenteral nutrition on the intestinal microcirculation and mucosalbarrier in mice with severe acute pancreatitis[J]. Mol Nutr FoodRes, 2020, 64(5): e1901191.
[31] Mundi MS, Velapati S, Kuchkuntla AR, et al. Reduction inhealthcare utilization with transition to peptide-based diets inintolerant home enteral nutrition patients[J]. Nutr Clin Pract,2020, 35(3): 487-494.
[32] Seres DS, Ippolito PR. Pilot study evaluating the efficacy,tolerance and safety of a peptide-based enteral formula versus ahigh protein enteral formula in multiple ICU settings (medical,surgical, cardiothoracic)[J]. Clin Nutr, 2017, 36(3): 706-709.
[33] Green B, Sorensen K, Phillips M, et al. Complex enterally tubefed community patients display stable tolerance, improvedcompliance and better achieve energy and protein targets with ahigh-energy, high-protein peptide-based enteral tube feed: resultsfrom a multi-centre pilot study[J]. Nutrients, 2020, 12(11): 3538.
[34] Mehta NM, Bechard LJ, Zurakowski D, et al. Adequate enteralprotein intake is inversely associated with 60-d mortality incritically ill children: a multicenter, prospective, cohort study[J].Am J Clin Nutr, 2015, 102(1): 199-206.
[35] Mehta NM, Bechard LJ, Cahill N, et al. Nutritional practices andtheir relationship to clinical outcomes in critically ill children--aninternational multicenter cohort study[J]. Crit Care Med, 2012, 40(7): 2204-2211.
[36] 姚德贞, 王丽杰 . 危重患儿肠内营养中断的临床研究[J]. 中国小儿急救医学, 2022, 29(1): 45-49.

相似文献/References:

[1]潘灵爱,黄晓波,王艺萍.超声监测胃残余量在风心病合并恶液质病人术后肠内营养中的应用[J].肠外与肠内营养杂志,2018,(01):43.[doi:10.16151/j.1007-810x.2018.01.012]
　PAN Ling-ai,HUANG Xiao-bo,WANG Yi-ping.Application of bedside ultrasound monitoring of gastric residual volume in postoperative patients with rheumatic heart disease complicated with cachexia with enteral nutrition support[J].PARENTERAL & ENTERAL NUTRITION,2018,(05):43.[doi:10.16151/j.1007-810x.2018.01.012]
[2]闫凯旋,曹 铖,杨 磊,等.糖尿病专用型肠内营养混悬液对重型脑损伤病人 营养指标以及免疫功能的影响[J].肠外与肠内营养杂志,2018,(02):76.[doi:10.16151/j.1007-810x.2018.02.004]
　YAN Kai-xuan,CAO Cheng,YANG Lei,et al.Effects of TPF-DM on Nutrient Indexes and Immune Function in Severe Traumatic Brain Injury Patients[J].PARENTERAL & ENTERAL NUTRITION,2018,(05):76.[doi:10.16151/j.1007-810x.2018.02.004]
[3]高学金,章 黎,田 锋,等.床边电磁导航下放置鼻肠管在胃肠外科重症病人中的作用[J].肠外与肠内营养杂志,2018,(05):277.[doi:10.16151/j.1007-810x.2018.05.006]
　GAO Xue-jin,ZHANG Li,TIAN Feng,et al.Electromagnetically guided bedside placement of nasojejunal feeding tubes in gastrointestinal critical ill surgical patients[J].PARENTERAL & ENTERAL NUTRITION,2018,(05):277.[doi:10.16151/j.1007-810x.2018.05.006]
[4]高 卉,吕蓓蓓,李 琳,等.围手术期口服营养补充对老年股骨转子间骨折术后营养状况及生活质量的影响[J].肠外与肠内营养杂志,2018,(05):296.[doi:10.16151/j.1007-810x.2018.05.010]
　GAO Hui,L? Bei-bei,LI Lin,et al.Effects of perioperative oral nutrition supplement on nutritional status and quality of life after femoral intertrochanteric fracture in the elderly[J].PARENTERAL & ENTERAL NUTRITION,2018,(05):296.[doi:10.16151/j.1007-810x.2018.05.010]
[5]赵成.肠道菌群研究促进膳食纤维的应用[J].肠外与肠内营养杂志,2019,(01):8.[doi:10.16151/j.1007-810x.2019.01.003]
[6]郑嘉烁.血流动力学不稳定的休克病人不宜早期使用肠内营养[J].肠外与肠内营养杂志,2019,(01):16.[doi:10.16151/j.1007-810x.2019.01.007]
[7]解好好.高能量密度肠内营养：有益或有害？[J].肠外与肠内营养杂志,2019,(01):20.[doi:10.16151/j.1007-810x.2019.01.009]
[8]夏 焱,吴圣楠,刁英飞,等.低热量高蛋白肠内营养对急性脑梗死病人营养指标及并发症的 影响[J].肠外与肠内营养杂志,2019,(03):161.[doi:DOI : 10.16151/j.1007-810x.2019.03.007]
　XIA Yan,WU Sheng-nan,DIAO Ying-fei,et al.Effect of low calorie and high protein enteral nutrition on nutritional indexes and complications in patients with acute cerebral infarction[J].PARENTERAL & ENTERAL NUTRITION,2019,(05):161.[doi:DOI : 10.16151/j.1007-810x.2019.03.007]
[9]黄金莉,朱晓菲,李华军.肠内营养中肠道菌群作用的研究进展[J].肠外与肠内营养杂志,2019,(03):189.[doi:DOI : 10.16151/j.1007-810x.2019.03.013]
　HUANG Jin-Li,ZHU Xiao-Fei LI Hua Jun.Advances in research on the role of intestinal microbiota in enteral nutrition[J].PARENTERAL & ENTERAL NUTRITION,2019,(05):189.[doi:DOI : 10.16151/j.1007-810x.2019.03.013]
[10]吴 雷,彭 艳.重型颅脑损伤病人肠内营养相关性腹泻规范化处理流程的应用研究[J].肠外与肠内营养杂志,2019,(04):228.[doi:DOI : 10.16151/j.1007-810x.2019.04.008]
　WU Lei,PENG Yan.Application of enteral nutrition-related diarrhea standardized management process in patients with severe craniocerebral injury[J].PARENTERAL & ENTERAL NUTRITION,2019,(05):228.[doi:DOI : 10.16151/j.1007-810x.2019.04.008]
[11]李 丹,周 华,等.针刺在改善重症病人经胃喂养耐受性及喂养 效果的前期研究[J].肠外与肠内营养杂志,2020,(01):16.[doi:10.16151/j.1007-810x.2020.01.005]
　LI Dan,ZHOU Hua,HE Wei,et al.Acupuncture in critically ill patients improves gastric feeding tolerance and effect: a preliminary study[J].PARENTERAL & ENTERAL NUTRITION,2020,(05):16.[doi:10.16151/j.1007-810x.2020.01.005]
[12]朱金凤,罗 月,姚惠萍,等.基于信息化的肠内营养耐受性动态管理对 重症病人喂养效果的影响[J].肠外与肠内营养杂志,2020,(02):104.[doi:10.16151/j.1007-810x.2020.02.009]
　ZHU Jin-feng,LUO Yue,YAO Hui-ping,et al.The impact of informatization dynamic management on enteral nutrition tolerance in critically ill patients[J].PARENTERAL & ENTERAL NUTRITION,2020,(05):104.[doi:10.16151/j.1007-810x.2020.02.009]
[13]张 伟,江海娇,姜小敢,等.危重病人肠内营养喂养不耐受危险因素的Meta分析[J].肠外与肠内营养杂志,2020,(05):313.[doi:10.16151/j.1007-810x.2020.04.013]
　ZHANG Wei,JIANG Hai-jiao,JIANG Xiao-gan,et al.Risk factors of enteral feeding intolerance in critical ill patients: a Meta-analysis[J].PARENTERAL & ENTERAL NUTRITION,2020,(05):313.[doi:10.16151/j.1007-810x.2020.04.013]

备注/Memo

备注/Memo:
作者简介 ：解弘宇，住院医师，医学硕士，主要从事危重症儿童营养的临床研究。E-mail：2450771536@qq.com通讯作者 ：王丽杰，E-mail：wlj682002@163.com
更新日期/Last Update: 1900-01-01