Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves 4 rue Adolphe Leray CS54435, 35044 RENNES Cedex, France.
Nutrients. 2020 May 11;12(5):1376. doi: 10.3390/nu12051376.
Some temporary double enterostomies (DES) or entero-atmospheric fistulas (EAF) have high output and are responsible for Type 2 intestinal failure. Intravenous supplementations (IVS) for parenteral nutrition and hydration compensate for intestinal losses. Chyme reinfusion (CR) artificially restores continuity pending surgical closure. CR treats intestinal failure and is recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) when possible. The objective of this study was to show changes in nutritional status, intestinal function, liver tests, IVS needs during CR, and the feasibility of continuing it at home. A retrospective study of 306 admitted patients treated with CR from 2000 to 2018 was conducted. CR was permanent such that a peristaltic pump sucked the upstream chyme and reinfused it immediately in a tube inserted into the downstream intestine. Weight, plasma albumin, daily volumes of intestinal and fecal losses, intestinal nitrogen, and lipid absorption coefficients, plasma citrulline, liver tests, and calculated indices were compared before and during CR in patients who had both measurements. The patients included 185 males and 121 females and were 63 ± 15 years old. There were 37 (12%), 269 (88%) patients with EAF and DES, respectively. The proximal small bowel length from the duodeno-jejunal angle was 108 ± 67 cm ( = 232), and the length of distal small intestine was 117 ± 72 cm ( = 253). The median CR start was 5 d (quartile 25-75%, 2-10) after admission and continued for 64 d (45-95), including 81 patients at home for 47 d (28-74). Oral feeding was exclusive 171(56%), with enteral supplement 122 (42%), or with IVS 23 (7%). Before CR, 211 (69%) patients had IVS for nutrition (77%) or for hydration (23%). IVS were stopped in 188 (89%) 2 d (0-7) after the beginning of CR and continued in 23 (11%) with lower volumes. Nutritional status improved with respect to weight gain (+3.5 ± 8.4%) and albumin (+5.4 ± 5.8 g/L). Intestinal failure was cured in the majority of cases as evidenced by the decrease in intestinal losses by 2096 ± 959 mL/d, the increase in absorption of nitrogen 32 ± 20%, of lipids 43 ± 30%, and the improvement of citrulline 13.1 ± 8.1 µmol/L. The citrulline increase was correlated with the length of the distal intestine. The number of patients with at least one liver test >2N decreased from 84-40%. In cases of Type 2 intestinal failure related to DES or FAE with an accessible and functional distal small bowel segment, CR restored intestinal functions, reduced the need of IVS by 89% and helped improve nutritional status and liver tests. There were no vital complications or infectious diarrhea described to date. CR can become the first-line treatment for intestinal failure related to double enterostomy and high output fistulas.
一些临时双肠造口术（DES）或肠-大气瘘（EAF）具有高输出量，是导致 2 型肠道衰竭的原因。肠外营养和补液的静脉补充（IVS）可补偿肠道损失。通过回肠输注（CR）在手术关闭前人为恢复连续性。CR 可治疗肠道衰竭，并且被欧洲临床营养与代谢学会（ESPEN）和美国肠外与肠内营养学会（ASPEN）推荐，只要可能。本研究的目的是展示 CR 期间的营养状况、肠道功能、肝功能检查、IVS 需求的变化，以及在家中继续进行 CR 的可行性。对 2000 年至 2018 年期间接受 CR 治疗的 306 例住院患者进行了回顾性研究。CR 是永久性的，通过蠕动泵抽吸上游肠液，并立即通过插入下游肠道的管将其再注入。比较了有两次测量值的患者在 CR 前后的体重、血浆白蛋白、每日肠道和粪便损失量、肠道氮和脂质吸收系数、血浆瓜氨酸、肝功能检查和计算指数。患者包括 185 名男性和 121 名女性，年龄为 63 ± 15 岁。有 37（12%）例和 269（88%）例分别为 EAF 和 DES 患者。十二指肠空肠角处的近端小肠长度为 108 ± 67 cm（= 232），远端小肠长度为 117 ± 72 cm（= 253）。中位 CR 起始时间为入院后 5 天（四分位距 25-75%，2-10），持续 64 天（45-95），其中 81 例患者在家中进行 47 天（28-74）。171 例（56%）患者完全口服喂养，122 例（42%）患者经肠内补充，23 例（7%）患者经 IVS 补充。在 CR 前，211 例（69%）患者接受 IVS 营养（77%）或补液（23%）。188 例（89%）患者在 CR 开始后 2 天（0-7）停止 IVS，23 例（11%）患者继续使用较低剂量的 IVS。营养状况改善，体重增加（+3.5 ± 8.4%）和白蛋白增加（+5.4 ± 5.8 g/L）。大多数情况下，肠道衰竭得到治愈，表现为肠道损失减少 2096 ± 959 mL/d，氮吸收增加 32 ± 20%，脂质吸收增加 43 ± 30%，瓜氨酸增加 13.1 ± 8.1 µmol/L。瓜氨酸的增加与远端小肠的长度相关。至少有一项肝功能检查 >2N 的患者数量从 84 例减少至 40 例。对于 DES 或 FAE 导致的 2 型肠道衰竭，只要有可及且功能正常的远端小肠段，CR 即可恢复肠道功能，将 IVS 的需求量减少 89%，有助于改善营养状况和肝功能检查。迄今为止，尚无危及生命的并发症或感染性腹泻的描述。CR 可以成为与双肠造口术和高输出瘘相关的肠道衰竭的一线治疗方法。
