体外膜肺氧合支持下儿科患者肠内营养的特点及其影响因素OA

Objective To explore the characteristics and influencing factors of enteral nutrition(EN)in critically ill children undergoing extracorporeal membrane oxygenation(ECMO).Methods Forty-eight children who received ECMO treatment and EN in the department of pediatric intensive care unit(PICU)of Henan Provincial People's Hospital were selected,and 50 critically ill children who were admitted to the PICU but did not receive ECMO-assisted treatment were also selected as the research subjects.The basic conditions of the children were observed,and the relevant indicators and complications of EN during the ECMO support were dynamically monitored.The levels of gastrin(GAS),motilin(MTL),and ghrelin in the children were detected,and the intake of EN was measured.The univariate correlation analysis method was employed to analyze the correlation between the 1-day and 2-day pediatric critical illness score(PCIS),vasoactive-inotropic score(VIS)as well as the calories provided by EN.Multiple linear regression analysis was used to explore the influencing factors of the calories provided by EN.Results Among the 48 ECMO children,those 0-1 year old,>1-5 years old and>5-14 years old accounted for 20.8%(10 cases),33.3%(16 cases)and 45.8%(22 cases)respectively.68.8%(33 cases)of the ECMO children started EN within 24 hours of ECMO initiation.The most common gastrointestinal complication during ECMO operation was gastric retention(60.4%),and no intestinal necrosis or severe bleeding was found.Within 7 days of ECMO initiation and weaning,the overall calories provided by EN in ECMO group children showed a gradually increasing trend,but the increase was relatively small after 3 days of ECMO initiation and continued to rise after weaning.Among the different age groups,the calories provided by EN in children 0-1 year old were the highest at 7 days of ECMO initiation,which was(112.4±44.0)kJ·kg-1·d-1.After weaning,the calories provided by EN in children 0-1 year old and>1-5 years old groups were significantly increased.During this period,the levels of gastrointestinal hormones in ECMO children generally showed a trend of first decreasing and then increasing.Compared with 2 days of ECMO initiation,the levels of GAS(ng/L:62.43±7.50 vs.66.86±7.70),MTL(ng/L:113.49±20.30 vs.128.10±20.90)and ghrelin(ng/L:198.51±22.20 vs.212.20±20.60)were significantly decreased at 5 days of ECMO initiation(all P<0.05),and then increased after 2 to 5 days of weaning(P<0.05).Univariate correlation analysis showed that at 1 day of ECMO initiation,PCIS score(r=0.574,P<0.001)and VIS score(r=-0.018,P=0.030)were significantly correlated with the calories provided by EN.At 2 days of ECMO initiation,only PCIS score was correlated with the calories provided by EN(r=1.045,P<0.001).Multivariate linear regression analysis showed that PCIS score was an independent risk factor affecting the calories provided by EN at 1 day and 2 days of ECMO initiation(both P<0.05).Compared with non-ECMO group children,the calories provided by EN in ECMO group children at 5 days of ECMO initiation were significantly lower(kJ·kg-1·d-1:57.3±42.0 vs.143.9±90.0,P<0.05),but there were no statistically significant differences in the levels of gastrointestinal hormones.Conclusions Early EN is safe and tolerable for children on ECMO.The calories provided by EN increase slowly after ECMO initiation,and significantly lower than those in non-ECMO children.The implementation of EN in ECMO children is closely related to the severity of their disease and the use of vasoactive drugs.