Nutritional and Digestive Rehabilitation Unit, Clinique Saint-Yves, Rennes, France.
Nutritional and Digestive Rehabilitation Unit, Clinique Saint-Yves, Rennes, France.
Clin Nutr. 2020 Dec;39(12):3695-3702. doi: 10.1016/j.clnu.2020.03.030. Epub 2020 Apr 2.
BACKGROUND & AIMS: High output entero-cutaneous fistulas may lead to intestinal failure with parenteral nutrition (PN) as the gold standard treatment to prevent dehydration and malnutrition. However in case of entero-atmospheric fistula (EAF) with the distal limb of the fistula accessible, chyme reinfusion (CR), a technique that restores artificially digestive continuity can be performed until the surgical repair. Our aim was to study the efficacy of CR in EAF regarding nutritional status, intestinal function, PN weaning and liver tests.
Retrospective study of 37 patients admitted for EAF and treated by CR from 1993 to 2017. Delays were expressed in median (25%-75% quartiles) and other data on mean ± SD.
Location of EAF: jejunum (29), ileum (8). The length of the upstream intestine was estimated in 21 patients: 19 had a bowel length <150 cm of which 16 had less than 100 cm. During CR, mean digestive losses decreased from 1734 ± 578 to 443 ± 487 ml/24 h (p < 0.000001), nitrogen absorption increased from 45.3 ± 18.6 to 81.8 ± 12.9% of ingesta (p < 0.001). The percentage of patients with plasma citrulline <20 µmol/l decreased from 71 to 10%. PN was stopped in all patients within 3 (0-14) days after CR initiation, 2 patients required an intravenous hydration and 20 had an additional enteral support. The nutritional status improved: albumin (33.1 ± 5.1 g/L vs 28.4 ± 6.5, p < 0.001), NRI (decrease of the number of patients at risk of severe malnutrition from 22 to 10 (p < 0.001)). The number of patients who had one or several liver tests abnormalities (>2 N) decreased from 94 to 41% (p < 0.001).
When the efferent part of the small bowel is accessible, CR is a safe and inexpensive method that restores bowel function. In most cases, it makes it possible to stop PN and helps to improve the nutritional status until surgical reconstruction.
高输出性肠-皮肤瘘可能导致肠衰竭，肠外营养（PN）是预防脱水和营养不良的金标准治疗方法。然而，对于有远端瘘管可及的肠-大气瘘（EAF），可以进行肠液再输注（CR），这是一种恢复人工消化连续性的技术，直到进行手术修复。我们的目的是研究 EAF 中 CR 对营养状况、肠道功能、PN 撤机和肝功能试验的疗效。
对 1993 年至 2017 年间因 EAF 接受 CR 治疗的 37 例患者进行回顾性研究。延迟用中位数（25%-75%四分位数）表示，其他数据用均值±标准差表示。
EAF 位置：空肠（29），回肠（8）。21 例患者估计 EAF 上游肠管长度：19 例肠管长度<150cm，其中 16 例<100cm。在 CR 期间，平均消化损失从 1734±578ml/24h 降至 443±487ml/24h（p<0.000001），氮吸收从摄入的 45.3±18.6%增加到 81.8±12.9%（p<0.001）。血浆瓜氨酸<20μmol/l 的患者百分比从 71%降至 10%。所有患者在 CR 开始后 3（0-14）天内停止 PN，2 例患者需要静脉补液，20 例患者需要额外的肠内支持。营养状况改善：白蛋白（33.1±5.1g/L 比 28.4±6.5，p<0.001），NRI（从有严重营养不良风险的患者数量减少 22 例到 10 例（p<0.001））。有一项或多项肝功能试验异常（>2N）的患者数量从 94%降至 41%（p<0.001）。
当小肠的输出段可及时，CR 是一种安全且廉价的方法，可以恢复肠道功能。在大多数情况下，它可以停止 PN，并有助于改善营养状况，直到进行手术重建。
