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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (2): 145-149.

• 论著 • 上一篇    下一篇

新生儿体外膜氧合救治下肠内营养和肠外营养11例病例系列报告

钱甜1,2，张蓉1，闫钢风3，陆国平3，陈超1，曹云1   

  1. 复旦大学附属儿科医院 上海，201102；1 新生儿重症监护室；2 临床营养科；3 儿科重症医学科
  • 收稿日期:2020-01-19 修回日期:2020-04-22 出版日期:2020-04-25 发布日期:2020-04-25
  • 通讯作者: 曹云

Enteral and parenteral nutrtion support for 11 neonates with extracorporeal membrane oxygenation: A case series report

QIAN Tian1,2, ZHANG Rong1, YAN Gang-feng3, LU Guo-ping3, CHEN Chao1, CAO Yun1   

  1. Chidren's Hospital of Fudan University, Shanghai 201102, China; 1 Neonatal Intensive Care Unit, 2 Department of Clinical Nutrition, 3 Department of Pediatric Critical Care Medicine
  • Received:2020-01-19 Revised:2020-04-22 Online:2020-04-25 Published:2020-04-25
  • Contact: CAO Yun

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摘要： 目的 观察危重症新生儿接受体外膜氧合（ECMO）救治技术下肠内营养（EN）和肠外营养（PN）的耐受性和安全性。方法 回顾性收集复旦大学附属儿科医院2015年8月10日至2020年3月31日收入PICU接受ECMO治疗的新生儿，排除经心外科讨论为复杂性、难治性先天性心脏病（不论是否行手术治疗）的新生儿，所有患儿均接受了静脉-动脉ECMO治疗，同时采用PN联合EN支持治疗。采集人口学资料（胎龄、出生体重、性别等），PN和EN支持开始时间、每天PN和EN用量及维持时间以及相关并发症，营养相关实验室检查（生化检查和电解质等），加EN时应用的血管活性药物剂量和种类、呼吸支持时间和预后。结果 11例危重新生儿进行了ECMO辅助治疗，均接受PN支持,9例接受EN支持,无NEC发生，8例存活者中7例出院体重均＞P10(WHO标准)。ECMO期间均合并血小板减少和低磷血症，6例发生胆汁淤积，合并低钙血症10例、低镁血症5例。ECMO联合间歇连续性肾脏替代治疗（CRRT）较不联合CRRT直接胆红素（μmol·L-1）更高，差异有统计学意义［70.0（32.4-182.4） vs 13.7（11.2~-15.7），P =0.015］。结论 接受ECMO辅助的危重新生儿EN联合PN治疗安全、可行，但需临床严密观察和监测相关实验室指标。

Abstract: Objective To observe the tolerance and safety of enteral nutrition (EN) and parenteral nutrition (PN) in neonates with critical illness supported with extracorporeal membrane oxygenation (ECMO). Methods Neonates admitted to Pediatric Intensive Care Unit (PICU) in Children's Hospital of Fudan University and receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) combined with EN and PN were retrospectively collected from August 10, 2015 to March 31, 2020. The newborns with complex and refractory congenital heart disease were excluded. Demographic data (gestational age, birth weight, sex, etc. ), nutrition-related laboratory data (biochemical and electrolytes tests), the initial time and daily doses of PN and EN, the vasoactive agents at the beginning of EN, the ventilation time，the morbidity and the prognosis were reviewed for each patient during hospitalization. Results A total of 11 neonates underwent ECMO. All of them were supported with PN, and 9 of them received EN. There was no necrotizing enterocolitis (NEC). Among 8 survivors, 7 patients' weight was >P10 at discharge according to the standard of World Health Organization. During the period of ECMO, all patients had experienced thrombocytopenia and hypophosphatemia, and cholestasis, hypocalcemia and hypomagnesemia were found in 6, 10 and 5 cases respectively. There was a statistically significant difference in serum concentration of direct bilirubin between ECMO with CRRT group and ECMO without CRRT group ［70.0(32.4,182.4) μmol·L-1 vs 13.7(11.2, 15.7) μmol·L-1，P =0.015］. Conclusion It is safe and feasible to treat critically ill neonates supported by ECMO with enteral and parenteral nutrition, but it is necessary to closely observe clinical situations and monitor laboratory indexes.