Fang B L, Qian S Y, Jia X L, Li Z, Liu J
Pediatric Intensive Care Unit, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2016 Sep;54(9):665-8. doi: 10.3760/cma.j.issn.0578-1310.2016.09.007.
To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU).
Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013. Clinical prognosis was compared between children with and without EN interruptions by t, rank-sum and χ(2) tests.
Totally 60 consecutive children were included, 42 males, median age 9.67 (5.36, 37.0) months; 50 children suffered from EN interruptions, while 10 children did not. Median time to EN initiation was 2.59 (1.53, 3.67) h; EN was interrupted in 83% (50/60) of children, for a total of 108 times and 696 h, the most common reasons were fibrobronchoscopy and radiologic procedures, 27 and 29 times respectively. Children spent 0.04 (0.02, 0.08) of their total observation period without EN nutrition due to EN interruptions, and was not correlated with pediatric critically ill score (r=0.12, P=0.38). Children with EN interruptions suffered from longer PICU duration ((12±7) vs. (7±4) d, t=2.18, P=0.03), but there was no significant difference in the 28(th) hospital day's mortality between these two groups (6 cases vs. 1 case, χ(2)=0.00, P=1.00).
EN is frequently interrupted due to procedures needed fasting, EN intolerance and other reasons in children with sepsis. EN interruptions may have something to do with prolonged PICU length of stay, but the relationship needs to be examined in future studies.
分析儿科重症监护病房(PICU)中脓毒症患儿肠内营养(EN)的中断情况及其与预后的关系。
对2012年11月至2013年4月入住我院PICU的脓毒症患儿每日的EN摄入量及EN中断原因进行前瞻性观察和记录。采用t检验、秩和检验及χ²检验比较有EN中断和无EN中断患儿的临床预后。
共纳入60例连续患儿,男42例,中位年龄9.67(5.36,37.0)个月;50例患儿发生EN中断,10例未发生。EN开始的中位时间为2.59(1.53,3.67)小时;83%(50/60)的患儿EN被中断,共中断108次,累计696小时,最常见的原因是纤维支气管镜检查和放射学检查,分别为27次和29次。因EN中断,患儿在总观察期内有0.04(0.02,0.08)的时间未接受EN营养,且与儿科危重病评分无相关性(r = 0.12,P = 0.38)。发生EN中断的患儿PICU住院时间更长((12±7)天 vs.(7±4)天,t = 2.18,P = 0.03),但两组在第28个住院日的死亡率无显著差异(6例 vs. 1例,χ² = 0.00,P = 1.00)。
脓毒症患儿常因需要禁食的操作、EN不耐受等原因导致EN中断。EN中断可能与PICU住院时间延长有关,但这种关系有待未来研究进一步探讨。