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| Application of enteral nutrition tolerance management program in early enteral nutrition for children with severe sepsis |
| ZHANG Xianmin ZHANG Gang▲ |
| Department of Pediatrics, the First People′s Hospital in Yibin, Sichuan Province, Yibin 644000, China |
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Abstract Objective To explore the effect of enteral nutrition (EN) tolerance management on early EN tolerance in children with severe sepsis. Methods Ninety-six children with severe sepsis in pediatric intensive care unit (PICU) of the First People′s Hospital in Yibin from March 2015 to September 2017 were selected as the subjects. According to the order of admission time, the children were divided into the observation group and the control group, 48 cases in each group. Children of the two groups were given EN within 24-48 h after admission to PICU. The control group was given routine observation and treatment, and the observation group was evaluated by self-designed EN tolerance evaluation and management program. The tolerability during EN, nutrition index at PICU and 1 weeks after admission [serum total protein (TP), albumin (ALB), prealbumin (PA), fibronectin (FN), transferrin (TF), hemoglobin (Hb) and body mass index (BMI)], stay PICU time, hospitalization expenses and 28 d fatality rate were compared between two groups. Results The number of intolerance cases in the observation group during EN was lower than that in the control group (P < 0.05); the tolerance rate of EN in the observation group was higher than that in the control group (P < 0.05); the serum levels of TP, ALB, PA, TF and Hb in the observation group 1 week after EN were higher than those in the control group (P < 0.05); the PICU stay time, hospitalization expenses and 28 d fatality rate of the observation group were lower than those of the control group (P < 0.05). Conclusion Assessment and management of severe sepsis in children receiving EN support therapy using EN tolerance assessment management program can effectively improve EN tolerance, improve nutritional indicators and prognosis of children with severe sepsis.
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[1] 彭红艳，祝益民，张新萍.降钙素原联合心脏相关标志物评估脓毒症患儿病情意义[J].临床儿科杂志，2015，33（1）：23-27.
[2] 姜建渝，王玲.小儿脓毒症血流感染致各种并发症的诊治分析[J].中国小儿急救医学，2016，23（1）：62-63.
[3] 张铭涛，苗耐英，张翔，等.小剂量糖皮质激素对小儿脓毒症血清sTREM-1、PCT、CD64的影响[J].中国医药导报，2017，14（17）：61-64.
[4] 薛梅.重度烧伤患者早期肠内免疫营养对机体免疫功能的影响及护理[J].中国医药导报，2012，9（20）：139-143.
[5] Skillman HE，Mehta NM. Nutrition therapy in the critically ill child [J]. Curr Opin Crit Care，2012，18（2）：192-198.
[6] 方伯梁，钱素云.PICU脓毒症及严重脓毒症患儿肠内营养摄入能量及蛋白质充分性及其与预后的关系[J].首都医科大学学报，2016，37（2）：125-129.
[7] Dellinger RP，Levy MM，Rhodes A，et al. Surviving sepsis campaign：international guidelines for management of severe sepsis and septic shock，2012 [J].Intensive Care Med，2013，39（2）：165-228.
[8] Mehta NM，Bechard LJ，Cahill N，et al. Nutritional practices and their relationship to clinical outcomes in critically ill children-an international multicenter cohort study [J]. Crit Care Med，2012，40（7）：2204-2211.
[9] Bechard LJ，Parrott JS，Mehta NM. Systematic review of the influence of energy and protein intake on protein balance in critically ill children [J]. J Pediatr，2012，161（2）：333-339.
[10] Prieto MB，Cid JL. Malnutrition in the critically ill child：the importance of enteral nutrition [J]. Int J Environ Res Public Health，2011，8（11）：4353-4366.
[11] 严正，黄英姿，吕国忠，等.严重烧伤患者肠内营养不耐受的影响因素及与预后的相关性[J].广东医学，2016， 37（4）：567-569.
[12] 陈建丽，黄莉，徐艳霞，等.儿童重症医学科脓毒症发病及死亡相关危险因素临床分析[J].贵州医药，2013，37（3）：201-205．
[13] 葛世伟，刘云，何先弟，等.危重症病人肠内营养耐受性评估方法的研究进展[J].护理学杂志，2013，27（7）：2057-2059.
[14] 叶向红，彭南海，江方正，等.重症急性胰腺炎合并腹腔高压患者早期肠内营养耐受性的管理[J].中华护理杂志，2016，51（12）：1439-1442.
[15] 朱丽，高纯，冯永东，等.肠内营养耐受性评估表对胃癌术后患者早期肠内营养耐受性的影响[J].现代临床护理，2015，14（7）：18-22.
[16] Bejarano N，Navarro S，Rebasa P，et al. Intm-abdominal pressure as a prognostic factor for tolerance of enteml nutrition in critical patients [J].J Parenteml Enteral Nutrition，2013，37（3）：352-360．
[17] Kyle UG，Jaimon N，Coss-Bu JA. Nutrition support in critically ill children：underdelivery of energy and protein compared with current recommendations [J]. J Acad Nutr Diet，2012，112（12）：1987-1992.
[18] Schetz M，Casaer MP，Van den Berghe G. Does artificial nutrition improve outcome of critical illness? [J]. Crit Care Med，2013，17（1）：302-309．
[19] Rice TW，Mogan S，Hays MA，et al. Randomized trial of initial tmphic Versus full-energy enteml nutrition in mechanically ventilated patients with acute re8piratory failure [J]. Crit Care Med，2011，39（5）：967-974．
[20] 常海霞，张丽波，张中馥.脓毒症患儿外周血CD4+CD25＋Treg细胞含量与全身炎症反应程度的相关性研究[J].海南医学院学报，2017，32（12）：1672-1674.
[21] 朱潮涌，李洁，毛明锋，等.脓毒症性急性肾损伤患者CD4+ T淋巴细胞内三磷酸腺苷水平变化及其与肾功能转归的关系[J].中国全科医学，2016，19（8）：894-897. |
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