肠外营养延长非手术性钝性胰腺损伤患儿的住院时间：倾向评分加权分析。
Parenteral nutrition prolongs hospital stay in children with nonoperative blunt pancreatic injury: A propensity score weighted analysis.
机构信息
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA; Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
出版信息
J Pediatr Surg. 2020 Jul;55(7):1249-1254. doi: 10.1016/j.jpedsurg.2019.06.015. Epub 2019 Jun 28.
BACKGROUND
Blunt pancreatic injury is frequently managed nonoperatively in children. Nutritional support practices - either enteral or parenteral - are heterogeneous and lack evidence-based guidelines. We hypothesized that use of parenteral nutrition (PN) in children with nonoperatively managed blunt pancreatic injury would 1) be associated with longer hospital stay and more frequent complications, and 2) differ in frequency by trauma center type.
METHODS
We conducted a retrospective cohort study using the National Trauma Data Bank (2007-2016). Children (≤18 years) with blunt pancreatic injury were included. Patients were excluded for duodenal injury, mortality <4 days from admission, or laparotomy. We compared children that received versus those that did not receive PN. Logistic regression was used to model patient characteristics, injury severity, and trauma center type as predictors for propensity to receive PN. Treatment groups were balanced using the inverse probability of treatment weights. Outcomes included hospital length of stay, intensive care unit days, incidence of complications and mortality.
RESULTS
554 children with blunt pancreatic injury were analyzed. PN use declined in adult centers from 2012 to 2016, but remained relatively stable in pediatric centers. Propensity-weighted analysis demonstrated longer median length of stay in patients receiving PN (14 versus 4 days, rate ratio 2.19 [95% CI: 1.97, 2.43]). Children receiving PN also had longer ICU stay (rate ratio 1.73 [95% CI: 1.30, 2.30]). There was no significant difference in incidence of complications or mortality.
CONCLUSIONS
Use of PN in children with blunt pancreatic injury that are managed nonoperatively differs between adult and pediatric trauma centers, and is associated with longer hospital stay. Early enteral feeding should be attempted first, with PN reserved for children with prolonged intolerance to enteral feeds.
LEVEL OF EVIDENCE
III, Retrospective cohort.
背景
儿童钝性胰腺损伤常采用非手术治疗。营养支持方式（肠内或肠外）存在差异，且缺乏循证指南。我们假设，在非手术治疗的儿童钝性胰腺损伤患者中，使用肠外营养（PN）会：1）与更长的住院时间和更频繁的并发症相关；2）根据创伤中心类型的不同而有所不同。
方法
我们使用国家创伤数据库（2007-2016 年）进行了一项回顾性队列研究。纳入了患有钝性胰腺损伤的儿童患者。排除了十二指肠损伤、入院后 4 天内死亡或剖腹手术的患者。我们比较了接受 PN 治疗和未接受 PN 治疗的患者。使用逻辑回归模型，将患者特征、损伤严重程度和创伤中心类型作为接受 PN 治疗的倾向性预测因素。使用逆概率治疗权重对治疗组进行平衡。主要结局包括住院时间、重症监护病房天数、并发症发生率和死亡率。
结果
共分析了 554 例患有钝性胰腺损伤的儿童患者。成人中心 PN 的使用率从 2012 年到 2016 年有所下降，但在儿科中心仍相对稳定。倾向性加权分析显示，接受 PN 治疗的患者的中位住院时间更长（14 天 vs. 4 天，比率比 2.19 [95%置信区间：1.97，2.43]）。接受 PN 治疗的患儿 ICU 住院时间也更长（比率比 1.73 [95%置信区间：1.30，2.30]）。并发症发生率和死亡率无显著差异。
结论
在接受非手术治疗的儿童钝性胰腺损伤患者中，成人和儿科创伤中心之间 PN 的使用存在差异，并且与住院时间延长有关。应首先尝试早期肠内喂养，对于对肠内喂养耐受时间延长的患儿应保留 PN。
证据等级
III，回顾性队列研究。
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