
腹型过敏性紫癜儿童肠内营养治疗方案的选择
Selection of enteral nutrition regimens for children with abdominal Henoch-Schönlein purpura
目的 探讨腹型过敏性紫癜患儿合理有效的肠内营养方案。方法 回顾性分析我院2013年8月至2018年8月间腹型过敏性紫癜住院患儿的临床资料;根据腹痛缓解后开始肠内营养时间不同分为 < 24 h组(n=68)、24 h~组(n=64)、48~72 h组(n=60),根据引入肠内营养种类不同分为氨基酸配方组(n=53)、乳蛋白深度水解配方组(n=67)和普通食物组(n=72);比较不同组别患儿临床症状反复发生率及家属满意度。在回顾性研究基础上,招募了166例腹型过敏性紫癜患儿进行前瞻性研究;所有患儿在腹痛缓解后均采用乳蛋白深度水解配方奶喂养,根据腹痛缓解后喂养时间不同分为 < 24 h组(n=52)、24 h~组(n=59)、48~72 h组(n=55);比较三组患儿腹痛、皮疹、便血症状反复发生率及静脉营养使用率、静脉激素使用率、出院时体重降低发生率。结果 回顾性研究结果显示,腹痛缓解后24~ < 48 h开始肠内营养及引入乳蛋白深度水解配方奶行肠内营养,患儿不仅临床症状反复发生率低,且其家属满意度最高(P < 0.0167)。前瞻性研究结果显示,腹痛缓解后24~ < 48 h开始引入乳蛋白深度水解配方奶行肠内营养患儿皮疹、腹痛反复发生率低,静脉营养使用率及患儿出院时体重下降发生率低(P < 0.05)。结论 腹型过敏性紫癜患儿在腹痛缓解后24~ < 48 h引入乳蛋白深度水解配方奶喂养是合理有效的,值得临床广泛应用。
Objective To explore the reasonable and effective enteral nutrition regimen for children with abdominal Henoch-Schönlein purpura (HSP). Methods A retrospective analysis was performed on the medical data of children with abdominal HSP who were hospitalized from August 2013 to August 2018. According to the starting time of enteral nutrition after abdominal pain relief, the children were divided into three groups: < 24 hours (n=68), 24-48 hours (n=64), and 48-72 hours (n=60). According to the type of enteral nutrition, they were divided into another three groups:amino acid-based formula (n=53), extensively hydrolyzed lactoprotein formula (n=67), and normal diet (n=72). The recurrence rate of clinical symptoms and degree of satisfaction among family members were compared between groups. Based on the retrospective analysis, 166 children with abdominal HSP were enrolled in a prospective study. They were given extensively hydrolyzed lactoprotein formula after abdominal pain relief. According to the feeding time after abdominal pain relief, they were divided into three groups: < 24 hours (n=52), 24-48 hours (n=59), and 48-72 hours (n=55). The three groups were compared in terms of the recurrence rates of abdominal pain, rash, and hematochezia, the rate of use of parenteral nutrition and intravenous steroids, and the incidence rate of weight loss at discharge. Results The retrospective analysis showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had a lower recurrence rate of clinical symptoms and the highest degree of satisfaction among their family members (P < 0.0167). The prospective study showed that the children who were given extensively hydrolyzed lactoprotein formula for enteral nutrition at 24-48 hours after abdominal pain relief had lower recurrence rates of rash and abdominal pain, a lower rate of use of parenteral nutrition, and a lower incidence rate of weight loss at discharge (P < 0.05). Conclusions It is reasonable and effective to start the feeding with extensively hydrolyzed lactoprotein formula at 24-48 hours after abdominal pain relief in children with abdominal HSP.
腹型过敏性紫癜 / 肠内营养 / 乳蛋白深度水解配方粉 / 满意度 / 儿童
Abdominal Henoch-Schönlein purpura / Enteral nutrition / Extensively hydrolyzed lactoprotein formula / Degree of satisfaction / Child
[1] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 8版. 北京:人民卫生出版社, 2015:773-775.
[2] 刘雅婷, 卢思广. IgA血管炎免疫学发病机制的研究进展[J]. 中国当代儿科杂志, 2017, 19(7):837-841.
[3] Trnka P. Henoch-Schönlein purpura in children[J]. J Paediatr Child Health, 2013, 49(12):995-1003.
[4] 中华医学会儿科学分会免疫学组, 《中华儿科杂志》编辑委员会. 儿童过敏性紫癜循证诊治建议[J]. 中华儿科杂志, 2013, 51(7):502-507.
[5] 张碧丽, 王文红, 范树颖. 儿童过敏性紫癜575例分析[J]. 中华儿科杂志, 2001, 39(11):646-649.
[6] 王业军, 张秋业, 徐静. 食物过敏原试验对过敏性紫癜病因分析和治疗意义[J]. 齐鲁医学杂志, 2007, 22(2):95-97.
[7] 姜敏, 盖建芳, 张丽芬, 等. 降低新生儿经外周穿刺中心静脉置管术导管相关血流感染的分析与防范[J]. 中国药物与临床, 2020, 20(6):1050-1052.
[8] 王芳芳, 谢庆芝. 儿童过敏性紫癜与幽门螺杆菌感染类型的相关性分析[J]. 现代医药卫生, 2018, 34(21):3358-3360.
[9] 朱建建, 易著文, 黄进华, 等. 儿童过敏性紫癜118例临床分析[J]. 临床皮肤科杂志, 2014, 43(6):336-339.
[10] 黄雷, 刘爱民, 戴宇文, 等. 儿童过敏性紫癜760例临床分析[J]. 中华皮肤科杂志, 2015, 48(1):11-14.
[11] 易利纯, 石绍南, 游洁玉, 等. 要素饮食治疗儿童过敏性紫癜疗效观察[J]. 当代护士(上旬刊), 2016(10):95-96.
[12] Rigante D. Clinical overview of vasculitic syndromes in the pediatric age[J]. Eur Rev Med Pharmacol Sci, 2006, 10(6):337-345.
[13] 齐海花, 何磊, 黄占强, 等. 不同分型过敏性紫癜患者外周血Th1/Th2型细胞因子的相关性研究[J]. 河北医学, 2019, 25(6):996-998.
[14] 刘玲, 魏岚, 赵学良. 抗幽门螺杆菌治疗儿童腹型过敏性紫癜临床观察[J]. 吉林医学, 2012, 33(7):1395-1396.
[15] 朱洁瑾, 李晴宇, 江砚, 等. 肠外营养致严重肝功能损伤1例[J]. 中国医院药学杂志, 2018, 38(10):1127-1129.
[16] 张雨萌, 谢庆芝, 刘永蛟, 等. 饮食疗法联合益生菌对过敏性紫癜患儿肠黏膜屏障的影响研究[J]. 国际医药卫生导报, 2020, 26(10):1354-1356.
[17] 王文秀, 高慧. 37例过敏性紫癜患儿的饮食限制护理[J]. 世界最新医学信息文摘, 2016, 16(15):181.
[18] 王莉, 薛晚利, 毛华, 等. 深度水解蛋白奶粉对过敏性紫癜儿童营养状况的应用研究[J]. 中国儿童保健杂志, 2016, 24(7):732-735.
[19] 杨美英, 房夏玲. 舒适护理在小儿过敏性紫癜中的应用观察[J]. 陕西医学杂志, 2016, 45(5):641.
[20] 苗豫珠, 杨晓云, 惠安丽, 等. 儿童过敏性紫癜的饮食控制[J]. 中华护理杂志, 2001, 36(7):505-506.
[21] 陈淑杰. 小儿过敏性紫癜的护理体会[J]. 中国实用医药, 2011, 6(29):220-221.
[22] 冷冬明, 张冬梅, 刘冬俊, 等. 深度水解蛋白奶对早产儿早期喂养不耐受的效果[J]. 中国药物经济学, 2020, 15(3):49-51.
[23] 苏华泽. 婴儿牛奶蛋白过敏性肠炎临床分析[J]. 深圳中西医结合杂志, 2018, 28(3):132-133.