López-Herce Jesús, Mencía Santiago, Sánchez César, Santiago Maria J, Bustinza Amaya, Vigil Dolores
Pediatric intensive care unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Nutr J. 2008 Jan 31;7:6. doi: 10.1186/1475-2891-7-6.
Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients.
A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN). The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN.
Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%). In only one patient was the death related to complications of the nutrition.
Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.
尚未对重症休克患儿的肠内营养耐受性进行研究。本研究的目的是分析重症休克患儿的肠内营养特征及其耐受性，并与非休克患者进行比较。
进行了一项前瞻性观察性研究，纳入接受幽门后肠内营养（PEN）的重症休克患儿。评估所使用的营养类型、持续时间、耐受性和胃肠道并发症。将65例接受PEN的休克患儿与461例接受PEN的非休克重症患儿进行比较。
65例年龄在21天至22岁之间的重症休克患儿接受了PEN。75.4%的休克患者仅接受PEN。PEN的平均持续时间为25.2天，最大热量摄入量为每天79.4千卡/千克。20例休克患者（30.7%）出现胃肠道并发症，10例（15.4%）腹胀和/或胃残余量过多，13例（20%）腹泻，1例坏死性小肠结肠炎，1例因幽门后管导致十二指肠穿孔。胃肠道并发症的发生率显著高于其他461例重症患儿（9.1%）。6例休克患者（9.2%）因胃肠道并发症而暂停PEN。休克并接受PEN的患者中有18例死亡（27.7%）。仅1例患者的死亡与营养并发症有关。
尽管大多数重症休克患儿能够耐受幽门后肠内营养，但该组患者的胃肠道并发症发生率高于其他重症患儿。
