3例消化道高流量瘘患儿行消化液回输联合接力式营养支持的护理

doi:10.3761/j.issn.0254-1769.2021.12.013

摘要/Abstract

摘要：

总结3例消化道高流量瘘患儿行胃液、胆汁、肠液回输联合接力式营养支持的护理经验。护理要点包括：营养风险筛查与评估、实施接力式营养支持治疗、进行肠内营养联合消化液回输、造瘘口的管理以及做好患儿及其家长的人文关怀等。3例患儿经过精心的治疗与护理,体重平稳增长,营养状况逐步改善,均顺利康复出院。

关键词: 高流量瘘, 接力式营养支持, 消化液回输, 儿科护理学

Abstract:

To summarize the clinical nursing experience of 3 children with high flow fistula of digestive tract who underwent gastric fluid,bile fluid and intestinal fluid reinfusion combined with relay-type nutritional support. The key points of nursing include：nutritional risk screening and assessment,implementation of relay nutritional support treatment,enteral nutrition combined with digestive fluid reinfusion,fistula management and humanistic care for children and their parents. After careful treatment and nursing care,the weight of the 3 children increased steadily and their nutritional status improved gradually. All of them recovered and were discharged from hospital smoothly.

Key words: High Flow Fistula, Relay Nutrition Support, Digestive Fluid Reinfusion, Pediatric Nursing

杨颖, 盛玉, 卞兰峥, 卢燕, 章文娴. 3例消化道高流量瘘患儿行消化液回输联合接力式营养支持的护理[J]. 中华护理杂志, 2021, 56(12): 1838-1842.

YANG Ying, SHENG Yu, BIAN Lanzheng, LU Yan, ZHANG Wenxian. Application of relayed parenteral and enteral nutrition support assisted by digestive fluid reinfusion in the nursing care of 3 children with high flow fistula[J]. Chinese Journal of Nursing, 2021, 56(12): 1838-1842.

参考文献 21

[1]	郑涛, 解好好, 吴秀文, 等. 全国多中心肠外瘘诊治情况调查及预后风险因素分析[J]. 中华胃肠外科杂志, 2019, 22(11):1041-1050.
	Zheng T, Xie HH, Wu XW, et al. Investigation of treatment and analysis of prognostic risk on enterocutaneous fistula in China:a multicenter prospective study[J]. Chin J Gastrointest Surg, 2019, 22(11):1041-1050.
[2]	Sharma K, Mogensen KM, Robinson MK. Pathophysiology of critical illness and role of nutrition[J]. Nutr Clin Pract, 2019, 34(1):12-22. DOI URL
[3]	施倩倩, 王新, 侍玲, 等. 1例切口全层哆裂合并肠造口皮肤黏膜分离患儿的护理[J]. 中华护理杂志, 2021, 56(5):751-755.
	Shi QQ, Wang X, Shi L, et al. Nursing care of a child with incision full-thickness fissure combined with enterostomy skin and mucosal separation[J]. Chin J Nurs, 2021, 56(5):751-755.
[4]	余彦平, 薛跃进, 王士祺. 消化液回输治疗小肠中断病人的疗效分析[J]. 肠外与肠内营养, 2018, 25(6):359-361.
	Yu YP, Xue YJ, Wang SQ. Effect of digestive juice reinfusion in patients with small intestine interruption[J]. Parenter Enter Nutr, 2018, 25(6):359-361.
[5]	付裕, 张钰琪, 李蒙娜. 肠梗阻患儿肠内营养联合消化液回输的护理[J]. 中华护理杂志, 2019, 54(5):736-738.
	Fu Y, Zhang YQ, Li MN. Nursing care of one pediatric patient with intestinal obstruction treated by enteral nutrition combined with digestive fluid reinfusion[J]. Chin J Nurs, 2019, 54(5):736-738.
[6]	Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition[J]. Clin Nutr, 2017, 36(1):49-64. DOI PMID
[7]	Hulst JM, Zwart H, Hop WC, et al. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children[J]. Clin Nutr, 2010, 29(1):106-111. DOI URL
[8]	汤庆娅, 王莹, 蔡威, 等. 中国儿科肠内肠外营养支持临床应用指南[J]. 中华儿科杂志, 2010, 48(6):436-441.
	Tang QY, Wang Y, Cai W, et al. Guidelines for pediatric clinical application of enteral and parenteral nutritional support in China[J]. Chin J Pediatr, 2010, 48(6):436-441.
[9]	高中敏, 孔粼. 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[J]. 临床小儿外科杂志, 2020, 19(5):455-460.
	Gao ZM, Kong L. Special segmental enteral nutrition therapy for a child with labiate intestinal fistula,severe malnutrition and depression:one case report[J]. J Clin Pediatr Surg, 2020, 19(5):455-460.
[10]	罗娟, 马云丽, 赵允召, 等. 回肠造口术后切口裂开合并肠空气瘘患儿的护理[J]. 中华护理杂志, 2019, 54(5):727-729.
	Luo J, Ma YL, Zhao YZ, et al. Nursing care of an infant complicated with disruption of wound and enteroatmospheric fistula after terminal ileum double-barrelled enterostomy[J]. Chin J Nurs, 2019, 54(5):727-729.
[11]	Tume LN, Valla FV, Joosten K, et al. Nutritional support for children during critical illness:European Society of Pediatric and Neonatal Intensive Care(ESPNIC) metabolism,endocrine and nutrition section position statement and clinical recommendations[J]. Intensive Care Med, 2020, 46(3):411-425. DOI URL
[12]	高恒妙, 钱素云. 危重症儿童肠内营养时应关注的重点问题[J]. 肠外与肠内营养, 2020, 27(6):321-324.
	Gao HM, Qian SY. Key issues that should be paid attention to enteral nutrition in critically ill children[J]. Parenter Enter Nutr, 2020, 27(6):321-324.
[13]	米元元, 黄培培, 董江, 等. 危重症患者肠内营养不耐受预防及管理的最佳证据总结[J]. 中华护理杂志, 2019, 54(12):1868-1876.
	Mi YY, Huang PP, Dong J, et al. Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients[J]. Chin J Nurs, 2019, 54(12):1868-1876.
[14]	Lee ZY, Ibrahim NA, Mohd-Yusof BN. Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit[J]. Nutrition, 2018, 53:26-33. DOI URL
[15]	叶向红, 宫雪梅, 王慧君. 减少护理操作中喂养中断提高早期肠内营养达标率[J]. 肠外与肠内营养, 2019, 26(1):6-7.
	Ye XH, Gong XM, Wang HJ. Reduce feeding interruption in nursing operation and improve early enteral nutrition compliance rate[J]. Parenter Enter Nutr, 2019, 26(1):6-7.
[16]	普拉文·S.戈代, 尼雷斯·M.梅塔. 儿科重症营养治疗[M]. 钱素云译. 北京: 科学出版社, 2017.
	Godet PS, Mehta NM. Pediatric critical nutrition treatment[M]. Qian SY translated. Beijing: Science Press, 2017.
[17]	方伯梁, 钱素云, 贾鑫磊, 等. 儿科重症监护病房内脓毒症患儿肠内营养中断现状[J]. 中华儿科杂志, 2016, 54(9):665-668.
	Fang BL, Qian SY, Jia XL, et al. Current situation of enteral nutrition interruptions in sepsis children in pediatric intensive care unit[J]. Chin J Pediatr, 2016, 54(9):665-668.
[18]	Niu DG, Yang F, Tian WL, et al. Method for establishing continuous reinfusion of succus entericus in complex high-output fistula[J]. Surg Laparosc Endosc Percutaneous Tech, 2020, 30(3):227-232.
[19]	叶向红, 张君芳, 刘炜, 等. 1例十二指肠瘘患者早期肠内营养耐受性的评估及管理[J]. 中华护理杂志, 2016, 51(9):1148-1150.
	Ye XH, Zhang JF, Liu W, et al. Enteral nutrition nursing mana-gement of one patient with duodenal fistula:a case report[J]. Chin J Nurs, 2016, 51(9):1148-1150.
[20]	顾晓英, 李培. 1例肠系膜上动脉压迫综合征患者行肠内营养治疗的护理[J]. 中华护理杂志, 2016, 51(8):1023-1024.
	Gu XY, Li P. Nursing experience of one patient with superior mesenteric artery compression syndrome treated with enteral nutrition[J]. Chin J Nurs, 2016, 51(8):1023-1024.
[21]	刘碧红, 郑燕, 张雯雯, 等. 1例儿童Prader-Willi综合征伴代谢综合征并发急性胰腺炎患者的护理[J]. 中华护理杂志, 2018, 53(S1):103-105.
	Liu BH, Zheng Y, Zhang WW, et al. Nursing care of 1 child Prader-Willi syndrome with metabolic syndrome complicated with acute pancreatitis[J]. Chin J Nurs, 2018, 53(S1):103-105.