Knafelz D, Gambarara M, Diamanti A, Papadatou B, Ferretti F, Tarissi De Iacobis I, Castro M
Gastroenterology Unit, Bambino Gesù Children Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
Transplant Proc. 2003 Dec;35(8):3050-1. doi: 10.1016/j.transproceed.2003.10.040.
When adequate nutrition cannot be provided by enteral route as a consequence of failure of intestinal functions, parenteral nutrition (PN) become the only way to maintain adequate nutrition; however, prolonged periods of PN can lead to severe complications. Furthermore, long hospital admissions for this form of nutrition can be detrimental for the child and the family. In the past 20 years, home parenteral nutrition (HPN) programs have been developed. The aim of our study was to retrospectively evaluate the kind and the frequency of complications in a HPN pediatric case series. We had 61 patients on HPN. Total duration of the program was 27,740 days (76 total years, mean 1.2 years per patient). We observed a total of 58 complications; mean 0.79 per patient per year with a prevalence of central venous catheter-related complications (mechanical, 52%; infective, 26%). We had a very low incidence of metabolic complications (3%) and a low incidence of PN-related hepatic complications (19%). None of the complications described was the cause of death. Half of our patients have been able to stop the program. We had a low incidence (0.20 per patient per year) of septic episodes, lower than we had in patients on hospital PN in the same period (0.38 per patient per year). We had to replace 20 catheters, 18 of them for mechanical problems. Our study shows that HPN still can be a valid alternative to small intestinal transplantation in patients affected by intestinal failure and that only patients with PN-related liver disease must be considered early candidates for combined liver-small bowel transplant.
当肠道功能衰竭导致无法通过肠内途径提供充足营养时，肠外营养（PN）就成为维持充足营养的唯一途径；然而，长期的肠外营养会导致严重并发症。此外，因这种营养方式而长期住院对患儿及其家庭可能不利。在过去20年里，家庭肠外营养（HPN）项目得以发展。我们研究的目的是回顾性评估一组接受家庭肠外营养的儿科病例中并发症的种类和发生频率。我们有61例接受家庭肠外营养的患者。该项目的总时长为27740天（总计76年，平均每位患者1.2年）。我们共观察到58例并发症；平均每位患者每年0.79例，其中中心静脉导管相关并发症最为常见（机械性并发症占52%；感染性并发症占26%）。我们的代谢并发症发生率很低（3%），与肠外营养相关的肝脏并发症发生率也较低（19%）。所描述的并发症均未导致死亡。我们一半的患者已能够停止该项目。我们的脓毒症发作发生率较低（每位患者每年0.20例），低于同期住院接受肠外营养的患者（每位患者每年0.38例）。我们不得不更换20根导管，其中18根是由于机械问题。我们的研究表明，对于患有肠道衰竭的患者，家庭肠外营养仍是小肠移植的有效替代方案，只有患有与肠外营养相关肝病的患者才应被视为肝小肠联合移植的早期候选者。
