Suita S, Yamanouchi T
Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Nihon Geka Gakkai Zasshi. 1998 Mar;99(3):164-70.
The prognosis of pediatric surgical patients is significantly improved by perioperative nutritional support. However, the morbidity and mortality rates from intestinal failure, including short gut syndrome and allied disorders of Hirschsprung's disease, remain high. Recent advance in nutrition support focus on the management of intestinal failure. A central venous catheter is commonly used for long-term total parenteral nutrition (TPN) in intestinal failure, although the incidence of catheter-related complications is still high. A nutrition support team approach might reduce such complications, with the exception of deep vein thrombosis, which is another serious problem in intestinal failure after long-term TPN on which more research is needed. A other serious complication in long-term TPN is liver dysfunction. It is postulated that bacterial translocation plays an important role in TPN-associated liver damage, although so far without evidence. Both cyclic TPN and enteral feeding are known to be effective in preventing liver damage. Since we are now familiar with methods of nutritional support little attention is paid to complications. Therefore nutritional management should be reevaluated from this standpoint.
围手术期营养支持显著改善了小儿外科患者的预后。然而，包括短肠综合征和先天性巨结肠相关疾病在内的肠衰竭的发病率和死亡率仍然很高。营养支持的最新进展集中在肠衰竭的管理上。中心静脉导管常用于肠衰竭患者的长期全胃肠外营养（TPN），尽管导管相关并发症的发生率仍然很高。营养支持团队的方法可能会减少此类并发症，但深静脉血栓形成除外，深静脉血栓形成是长期TPN后肠衰竭中的另一个严重问题，对此还需要更多的研究。长期TPN的另一个严重并发症是肝功能障碍。据推测，细菌易位在TPN相关的肝损伤中起重要作用，尽管目前尚无证据。已知循环TPN和肠内喂养在预防肝损伤方面均有效。由于我们现在熟悉营养支持方法，因此很少关注并发症。因此，应从这一角度重新评估营养管理。
