Hanekamp M N, Spoel M, Sharman-Koendjbiharie M, Hop W C, Hopman W P, Jansen J B, Tibboel D
Department Of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands.
J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):175-9. doi: 10.1097/00005176-200502000-00017.
The objective of this study was to gain insight into the hormonal responses to enteral nutrition in critically ill newborns requiring venoarterial extracorporeal membrane oxygenation (ECMO) by analyzing plasma gut hormone levels of gastrin, cholecystokinin and peptide-YY in relation to enteral nutrition.
In 24 consecutive neonates treated with venoarterial ECMO intestinal hormone secretions were determined by radioimmunoassay at 2-day intervals. Twelve received parenteral nutrition only. In 12 enteral nutrition was introduced later. The findings in these patients were compared with those of 16 measurements in eight non-ECMO treated age-matched controls. Mixed model analysis of variance was used for statistical analysis.
Concentrations of gastrin, cholecystokinin and peptide-YY were significantly higher in ECMO patients receiving enteral nutrition compared with ECMO patients who received parenteral nutrition (62, 3.8 and 59.4 pmol/L versus 46, 3.1 and 34.7 pmol/L, respectively). Overall, plasma hormone levels did not differ from those in age-matched controls.
Intestinal hormone levels showed normal responses after introduction of enteral feeding, comparable with those in age-matched controls without ECMO. These results do not provide an argument for withholding enteral nutrition even in the most severely ill neonates on venoarterial ECMO.
本研究的目的是通过分析胃泌素、胆囊收缩素和肽YY的血浆肠道激素水平与肠内营养的关系，深入了解需要静脉-动脉体外膜肺氧合（ECMO）的危重新生儿对肠内营养的激素反应。
对24例接受静脉-动脉ECMO治疗的连续新生儿，每隔2天通过放射免疫分析法测定肠道激素分泌情况。12例仅接受肠外营养。12例随后引入肠内营养。将这些患者的结果与8例年龄匹配的非ECMO治疗对照的16次测量结果进行比较。采用混合模型方差分析进行统计分析。
与接受肠外营养的ECMO患者相比，接受肠内营养的ECMO患者胃泌素、胆囊收缩素和肽YY的浓度显著更高（分别为62、3.8和59.4 pmol/L，而46、3.1和34.7 pmol/L）。总体而言，血浆激素水平与年龄匹配的对照无差异。
引入肠内喂养后，肠道激素水平显示出正常反应，与未接受ECMO的年龄匹配对照相当。这些结果即使对于接受静脉-动脉ECMO的最重病新生儿也不能作为拒绝肠内营养的依据。
