Gao Zhongmin,Kong Lin.Special segmental enteral nutrition therapy for a child with labiate intestinal fistula,severe malnutrition and depression: one case report[J].Journal of Clinical Pediatric Surgery,2020,19(05):455-460.[doi:10.3969/j.issn.1671-6353.2020.05.016]
1例小肠唇状瘘、重度营养不良伴抑郁患儿的特殊分段肠内营养治疗
- Title:
- Special segmental enteral nutrition therapy for a child with labiate intestinal fistula,severe malnutrition and depression: one case report
- 分类号:
- R720.5;R574.5
- 摘要:
- 目的 介绍1例车祸伤后小肠唇状瘘、重度营养不良伴抑郁患儿围手术期的临床营养专科管理方案。方法 关瘘术前采用局部双腔套管负压引流，联合静脉使用生长激素及生长抑素，满足其经口进食欲望（限量半流质饮食），收集食物残渣后由瘘口排除，并通过远端空肠营养置管间歇输注个性化肠内营养液，实现分段肠内营养支持。关瘘术后逐渐恢复普通饮食。治疗期间利用儿童抑郁量表（children’s depression inventory，CDI）评估患儿的情绪及行为，积极辅以肠外营养支持，并持续监测患儿消化道情况、体重和营养相关生化指标，阶段性调整营养方案。结果 患儿抑郁量表得分从31分降至14分，心理状态逐渐稳定，配合度逐渐提高，实现体重平稳增长，达到手术要求并顺利关瘘，行关瘘术后营养状况进一步改善，顺利出院。结论 根据患儿心理特点和车祸伤后新的胃肠解剖结构，制定个性化的肠内肠外营养方案，可以保证患儿治疗依从性和治疗效果。
- Abstract:
- Objective To summarize a case of clinical nutrition specialist management program for a child with labiate intestinal fistula,severe malnutrition and depression after traffic accident injury.Methods Before fistula operation,double suction drainage and intravenous doses of somatotropin and somatostatin were performed.According to the psychological characteristics of post-traumatic depression,the preoperative appetite for food (limited semi-liquid diet) was satisfied.Food residues were collected and removed from fistula while individualized enteral nutrition solution was intermittently infused through distal jejunal nutrition catheter for segmental enteral nutrition support.After fistula closure,normal diet gradually resumed.During treatment period,parenteral nutrition support was actively supplemented and digestive tract,body weight and nutrition-related biochemical parameters were continuously monitored.And nutrition program was adjusted periodically.Results As his depression inventory score dropped from 31 to 14,his psychological state gradually stablized,the degree of cooperation gradually improved,body weight gained steadily and then fistula was closed smoothly.Nutritional status further improved after fistula closure and he was discharged smoothly.Conclusion According to the psychological characteristics of and new gastrointestinal anatomical structure after injury,individualized enteral and parenteral nutrition programs may ensure the compliance and efficacy at the same time.
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备注/Memo
收稿日期:2019-08-15。
通讯作者:孔粼,Email:179424871@qq.com