肠外营养在新生儿短肠综合征治疗中的作用

目的　探讨肠外营养对新生儿短肠综合征 (SBS)患儿治疗的作用。方法　回顾总结1988～ 2 0 0 1年在我院PN支持治疗的 9例新生儿短肠综合征 ,观察PN开始时对患儿生长的影响及PN相关并发症。结果　 9例长期随访中 8例存活 ,1例放弃治疗后死亡。4例出现并发症 ,严重低钙1例 ,血尿、右肾结石 1例 ,胆汁淤积 1例 ,贫血 1例 ,经治疗后痊愈。PN开始迟的 2例 ,第 1个月体重下降明显。PN开始早的 7例 ,3例伴CMV感染者生后 3个月内体重增加较非感染组缓慢 ,两组比较有显著性差异 (t=5 .78,P =0 .0 0 2 )。结论　SBS患儿应早期营养支持。SBS患儿伴CMV感染将严重影响体重增加。SBS患儿PN治疗期间并发症出现率较高 ,应予高度重视。     

肠内营养治疗短肠综合征

肠内营养治疗短肠综合征伍烽综述金先庆审校自６０年代末期开始应用胃肠外营养（ｐａｒｅｎｔｅｒａｌｎｕｔｒｉｔｉｏｎ，ＰＮ）以来，短肠综合征（ｓｈｏｒｔｂｏｗｅｌｓｙｎ－ｄｒｏｍｅ，ＳＢＳ）患者的存活率和生存质量已得到明显的改善。在儿童，ＰＮ使残留小肠长...     

婴幼儿短肠综合征的院内营养支持疗效观察

目的探讨肠内肠外营养支持对短肠综合征(SBS)患儿的治疗作用。方法回顾性分析2013年11月至2015年1月在本院进行营养治疗的7例短肠综合征患儿临床资料,观察营养支持对患儿体重增长和血清白蛋白、血红蛋白、尿素氮、胆红素等生化指标的影响。结果 7例患儿中,体重增长满意2例,体重变化不明显4例,体重下降明显1例。营养支持前后患儿生化指标无明显变化。结论及时有效的营养支持,可减少短肠综合征患儿的体重丢失,维持营养相关生化指标的合理水平,改善疾病预后。     

短肠综合征的营养策略

短肠综合征是儿童肠衰竭的主要原因,由于手术切除、先天性缺陷或与疾病相关的吸收丧失引起,在常规正常饮食下无法维持蛋白质-能量、体液、电解质以及微量营养素的平衡,需要专门的营养治疗,治疗的目标是促进肠道适应以达到肠道自主,同时保持健康的生长和发育。营养治疗策略是异质的和复杂的,须量身定制。对肠外、肠内和口服营养的类型和持续时间尚无循证建议。提倡阶段化营养管理,肠外营养对于短肠综合征的婴儿和儿童的生存至关重要,谨慎的营养策略对于减少肠外营养持续时间以及降低肠外营养相关并发症发生的风险至关重要,鉴于肠道适应的需要,早期开始最低限度的喂养、根据肠道耐受性逐渐增加肠内营养的量、经口腔喂养以及多样化平衡饮食是必要的。母乳和混合饮食是不错的选择。     

新生儿短肠综合征的远期疗效,手术评价与选择

目的：了解新生儿短肠综合征（ＮＳＢＳ）的远期疗效以及评价各种术式，方法：手术治疗的９例与非手术治疗的５例共１４例ＮＳＢＳ，５种术式，小肠肠袢再循环术（１例）小肠肠袢倒置术（２例）小肠瓣膜成形术（２例）小肠新粘膜再生术（３例）结肠间置术（１例），结果：经过５年以上的随访，手术组９例中８例存活，非手术组５例仅１例存活。小肠新粘膜再生术与结肠间置术的远期疗效最好，小肠肠袢再循环术与小肠肠袢倒置术３例中２     

新生儿短肠综合征远期营养评价和智力发育评估

目的评价新生儿期短肠综合征患儿远期营养状况和智力发育状况。方法2005年11月-2006年3月间对我院1988年1月1日2003年12月31日15年间收治的9例出生后28d内诊断为短肠综合征，并且已脱离静脉营养至少2年的患儿进行随访。随访内容包括人体测量、血液生化指标和智商测定。结果9例患儿中，1例3岁时车祸意外死亡，其余8例得到患儿本人及家长同意随访。8例患儿中，7例年龄、身高、体重正常，1例患儿肥胖，患儿体脂含量为11．1％～24．9%，血液生化指标如血红蛋白、白蛋白、免疫球蛋白均正常，1例患儿前白蛋白（Pre-ALB）低于正常（0．14g／L），1例平均红细胞体积（MCV）高于正常（103．3f1），1例MCV低于正常（78．3f1）。7例患儿智力发育均处于正常水平，但3例患儿存在智商分离现象，1例患儿学校成绩处于班级下游。结论短肠综合征患儿脱离静脉营养后的远期营养状况基本正常，但仍然存在问题，全面随访应坚持到静脉营养停用后的整个生长发育时期。智力发育值得重视，应纳入随访内容。     

短肠综合征儿童导管相关性血流感染的单中心回顾性研究

目的评估儿童短肠综合征(SBS)导管相关血流感染(CRBSI)的发生率和危险因素。方法回顾性分析2015年8月至2019年12月收治的19例SBS患儿的临床资料,评估CRBSI的发生率和相关危险因素。结果在19例SBS患儿中,共置管57次,总置管日为1 907天,其中6例患儿共发生11次CRBSI,发生率为5.8次/1000导管日。SBS患儿CRBSI的常见表现为发热(6/11,54.5%)、嗜睡(5/11,45.4%)、体质量不增(7/11,63.6%)和肠造瘘量增加(7/11,63.6%)。与未发生CRBSI组相比,CRBSI组SBS患儿的回盲瓣缺失以及肠外营养持续时间≥120天的比例更高,差异均有统计学意义(P0.05)。SBS患儿发生CRBSI时的血培养共获得11次阳性结果,最常见的病原微生物为肺炎克雷伯杆菌(6/11,54.55%)。结论 CRBSI发生可能与回盲瓣缺失和肠外营养持续时间长有关。     

Management of short bowel syndrome in infancy

Short bowel syndrome (SBS) is a reduction in functioning bowel length which is most often a result of surgical resection. Risk factors in the neonatal period include necrotising enterocolitis, small bowel atresia and gastroschisis. With increasing survival of preterm infants there is an increase in incidence. Management is dependent on the use of parenteral nutrition to maintain fluid and electrolyte homeostasis and promote growth and development with the longer term aim being to promote intestinal adaptation to achieve partial or complete enteral autonomy. In this review we discuss the incidence, aetiology, pathophysiology, medical and surgical treatments and outcome.     

Surgical treatment of the short bowel syndrome

Long-term survival after massive intestinal resection is now possible with parenteral nutritional support. The expense, morbidity, and inconvenience of this therapy, however, has led to continued interest in alternatives for the treatment of the short bowel syndrome. The goals of surgical therapy in the short bowel syndrome are to increase the area of absorption, slow intestinal transit, and reduce gastric hyperacidity. Selected patients with dilated bowel segments benefit from intestinal tapering or lengthening. Growing neomucosa to increase surface area is not yet clinically efficacious. The results of transplantation remain unsatisfactory despite recent advances in immunosuppression. Antiperistaltic segments, colon interposition, and intestinal valves may benefit patients with sufficient absorptive area but rapid intestinal transit. Recirculating loops are associated with prohibitive morbidity and mortality. Intestinal pacing is currently being investigated. Surgical treatment of the short bowel syndrome is not sufficiently safe and effective to recommend its routine use. Operations should be performed only on selected patients to achieve specific goals. Adjunct procedures should not be carried out at the initial intestinal resection. Most important is continued emphasis on the prevention of intestinal resection and conservation of the intestine when massive resection is necessary.     

The rationale for the use of parenteral omega-3 lipids in children with short bowel syndrome and liver disease

Parenteral nutrition associated liver disease (PNALD) is the major source of morbidity and mortality in children with short bowel syndrome (SBS). There is emerging evidence that omega-6 fatty acids (omega6FA) within the parenteral solution play a major role in PNALD and their effects may be reversed or ameliorated by substitution with omega-3 fatty acids (omega3FA). This paper reviews the mechanisms whereby omega3FAs may influence PNALD by improving bile flow, inhibiting steatosis, and having immunomodulatory effects. The early clinical experience with omega3FAs in SBS and PNALD is briefly reviewed and the implications of such, and future directions are considered.     

Nutritional aspects of the short bowel syndrome

Adequate oral nutrition in patients with short bowel syndrome after operation is limited by the amount of intestine left after resection. The remnant small intestine has an important capacity to compensate for the loss of mucosal tissue and develops intestinal hyperplasia when stimulated by a variety of luminal and extraluminal factors such as nutrients, pancreatic biliary secretions, growth factors and hormones. In order to provide appropriate stimuli for the intestinal adaptation after resection, oral feeding is necessary as early as possible after operation. Among nutrients fat, especially LCT and free fatty acids, are the most stimulating nutrients besides proteins and carbohydrates. They increase pancreatic biliary secretions and the excretion of growth promoting hormones such as enteroglucagon. Because of gastric acid hypersecretion the administration of H2 receptor blocking agents (cimetidine) is recommended in these patients. As oral caloric intake is not sufficient in most patients with short bowel syndrome after operation total parenteral nutrition (TPN) or home-TPN has to be installed for longer periods to supplement the appropriate nutritional needs. Both early oral feeding together with TPN or home-TPN have increased considerably the survival rate of children with short bowel syndrome.     

Long-term nutritional assessment in children with short bowel syndrome

目的 比较不同剩余小肠长度的短肠综合征患儿长期随访营养状况.方法 对我院已脱离肠外营养2年以上的短肠综合征的14例患儿进行随访.随访内容包括人体测量(身高、体重)和血液生化指标测定(血常规;肝功能;血铜、锌、铁、钙、磷、镁;维生素A、维生素E、β-胡萝卜素、维生素B12),并根据剩余小肠长度≤60 cm和＞60 cm分两组进行比较.结果 1例患儿存在轻度营养不良,1例患儿存在重度营养不良,1例患儿超重.≤60 cm和＞60 cm组比较,年龄别身高百分比29.65±19.22、53.31±36.15和Z-评分-0.73±0.90、0.48±2.00、年龄别体重百分比44.39±31.41、47.43±29.42和Z-评分-0.57±1.90、-0.30±0.63以及BMI百分比49.20±39.82、43.71±19.43和Z-评分-0.22±2.11、-0.20±0.57均无统计学意义.剩余小肠≤60 cm组患儿的维生素A、维生素E水平为(46.87±20.07) μg/dl和(4.89±4.57)王g/L均低于剩余小肠＞60 cm组的(152.27±75.98) μg/dl和(11.68±5.97)μg/L,两组比较差异有统计学意义.Hb、MCV、MCH、MCHC、前白蛋白、白蛋白、血铜、锌、铁、钙、磷、镁、β-胡萝卜素、维生素B12水平无差异.结论 短肠综合征患儿脱离肠外营养大于2年的远期营养状况基本正常,剩余小肠长度不同对脱离肠外营养2年后患儿的体格发育情况无明显影响,但是剩余小肠过短脂溶性维生素A、E吸收仍存在问题,需坚持全面随访.     

Clinical problem-solving: Short bowel syndrome in an infant

The present case report describes the clinical problems encountered over a five-month period in an infant born with jejunal atresia, extensive midgut volvulus and a microcolon. After an initial surgical resection, the patient had no remaining ileum and his ileocecal valve was also removed. The patient had 35 cm of jejunum, which was successfully lengthened to 60 cm using enteral nutrition and two bowel-lengthening procedures (serial transverse enteropathy procedures). Bouts of cholestatic liver disease, sepsis and small bowel bacterial overgrowth were vigorously treated. The patient was discharged at 5.5 months of age and is now 40 months of age. He is at the 50th percentile for both height and weight, and is developing normally. The outcome for infants with short bowel syndrome has improved significantly in the past few years due to intestinal rehabilitation programs, which integrate nutritional, surgical and pharmacological approaches tailored to individual needs.     

Immunonutritional effects during synbiotics therapy in pediatric patients with short bowel syndrome

The aim of this study was to evaluate the effects of synbiotic therapy in patients with short bowel syndrome (SBS). Four pediatric patients with SBS, who were receiving synbiotics therapy including Bifidobacterium breve, Lactobacillus casei and galactooligosaccharides, were enrolled in this study. We evaluated changes in immunonutritional parameters before and after receiving synbiotics therapy. Four normal, healthy, age-matched children were enrolled as controls. Fecal samples from patients and controls were collected and analyzed for fecal bacterial flora and organic acid (OA) contents. Levels of short chain fatty acids (SCFA) such as butyrate, propionate, and acetate increased in one patient, and SCFA/total OA levels increased in three patients. Serum lymphocyte counts and concentrations of pre-albumin increased after beginning synbiotics therapy, reaching a statistically significant level at the ninth month compared to the pre-treatment level. There was an increasing trend in height and weight gain velocity during the study compared with the pre-treatment period. The patients’ fecal bacterial flora improved as a result of synbiotics therapy. Synbiotics therapy may be very effective at improving the intestinal flora and systemic immunonutritional status of patients with SBS.     

Surgical therapy for short bowel syndrome

Patients with short bowel syndrome (SBS) suffer tremendous morbidity secondary to prolonged hospitalization and chronic parenteral nutrition (TPN). Overall, the majority of infants will adapt and ultimately become independent of TPN, but this process may require many months or years. Reasons for continued TPN dependency include bowel dysmotility, bacterial overgrowth, insufficient adaptation, or very short bowel length. It is this subpopulation of patients who may benefit from surgical procedures that optimize intestinal adaptation and increase the mucosal absorptive surface area. The goal of this review article is to summarize the process of intestinal adaptation and then to outline the surgical principles and techniques available to surgeons who treat this complicated group of patients.