Sánchez César, López-Herce Jesús, Mencía Santiago, Urbano Javier, Carrillo Angel, María Bellón José
Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Br J Nutr. 2009 Jul;102(2):191-4. doi: 10.1017/S0007114508159049.
The objective of the present study was to analyse whether there is a relationship between the clinical severity at the time of starting transpyloric enteral nutrition (TEN) and the onset of digestive tract complications in critically ill children. Between May 2005 and December 2007, we performed a prospective, observational study with the participation of 209 critically ill children aged between 3 d and 17 years and who received TEN. The characteristics of the nutrition and its tolerance were compared with the paediatric risk of mortality (PRISM), the paediatric index of mortality (PIM) and the paediatric logistic organ dysfunction index (PELOD) at the time of starting the nutrition. Higher PRISM and PELOD scores correlated with a later time of starting enteral nutrition, a longer time to reach the maximum daily energy delivery and a longer duration of the TEN. However, the severity scores did not correlate with the maximum energy delivery achieved. Abdominal distension or excessive gastric residues were observed in 4.7 % of the patients and diarrhoea in 4.3 %. The ability of the severity scores to predict diarrhoea was of 0.67 for PRISM, 0.63 for PELOD and 0.60 for PIM-2.The severity scores were not able to predict other digestive tract complications. Higher scores of clinical severity at the time of starting enteral nutrition correlate with a later initiation of the nutrition, a longer time to reach the maximum energy delivery and a longer duration of TEN. However, their ability to predict digestive tract complications is low.
本研究的目的是分析危重症儿童开始经幽门肠内营养（TEN）时的临床严重程度与消化道并发症的发生之间是否存在关联。在2005年5月至2007年12月期间，我们进行了一项前瞻性观察研究，共有209名年龄在3天至17岁之间且接受TEN的危重症儿童参与。将营养的特征及其耐受性与开始营养时的儿科死亡风险（PRISM）、儿科死亡率指数（PIM）和儿科逻辑器官功能障碍指数（PELOD）进行比较。较高的PRISM和PELOD评分与开始肠内营养的时间较晚、达到最大每日能量供给的时间较长以及TEN的持续时间较长相关。然而，严重程度评分与所达到的最大能量供给并无关联。4.7%的患者出现腹胀或胃残余物过多，4.3%的患者出现腹泻。PRISM预测腹泻的能力为0.67，PELOD为0.63，PIM-2为0.60。严重程度评分无法预测其他消化道并发症。开始肠内营养时较高的临床严重程度评分与营养开始时间较晚、达到最大能量供给的时间较长以及TEN的持续时间较长相关。然而，它们预测消化道并发症的能力较低。
