Детская хирургия. Журнал им. Ю.Ф. Исакова. 2023; 27: 34-40
Нутритивная поддержка пациентов с травмой поджелудочной железы в педиатрическом отделении реанимации и интенсивной терапии
https://doi.org/10.55308/1560-9510-2023-27-1-34-40Аннотация
Введение. Травма поджелудочной железы является преобладающей причиной развития острого панкреатита у детей. Консервативная тактика ведения пациентов в своей основе имеет нутритивную поддержку, исключающую железу из процесса пищеварения.
Цель исследования – поиск оптимального алгоритма нутритивной поддержки пациентов с травмой поджелудочной железы в педиатрическом отделении реанимации и интенсивной терапии.
Материал и методы. Проанализированы протоколы нутритивной поддержки 20 детей с травмой поджелудочной железы.
Результаты. Показано, что при травме поджелудочной железы предпочтение следует отдавать энтеральному питанию через интестинальный зонд, при необходимости дополняя его парентеральным питанием. Программу нутритивной поддержки следует разрабатывать с опорой на объективные методы оценки потребности пациента в белке и энергии.
Заключение. Энтеральное питание в кишку показано всем пациентам с травмой поджелудочной железы с первых суток их пребывания в стационаре.
Список литературы
1. Mekitarian Filho E., Carvalho W.B., Silva F.D. Pancreatite aguda em pediatria: revisão sistemática da literatura. Jornal de Pediatria. 2012; 88(22): 101–14.
2. Sutherland I. et al. Pancreatic trauma in children. Pediatric surgery international. 2010; 26(12): 1201–6.
3. Potoka D.A., Saladino R.A. Blunt abdominal trauma in the pediatric patient. Clinical Pediatric Emergency Medicine. 2005; 6(1): 23–31.
4. Chang Y.J., Chao H.C., Kong M.S., Hsia S.H., Lai M.W., Yan D.C. Acute pancreatitis in children. Acta Paediatrica. 2011; 100(5): 740–4.
5. Ермолов А.С., Хубутия М.Ш., Абакумов М.М. Абдоминальная травма: Руководство для врачей. М.: Издательский дом Видар; 2010.
6. Shilyansky J. et al. Nonoperative management of pancreatic injuries in children. Journal of pediatric surgery. 1998; 33(2): 343–9.
7. Moore E.E. et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. The Journal of trauma. 1990; 30(11): 1427–9.
8. Mihatsch W.A. et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clinical Nutrition. 2018; 37(6): 2303–5.
9. Jochum F. et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electrolytes. Clinical Nutrition. 2018; 37(6): 2344–53.
10. Raynard B. Place de la calorimétrie indirecte et des formules estimant la dépense énergétique des malades de réanimation. Nutrition clinique et métabolisme. 2009; 23(4): 192–7.
11. Oshima T. et al. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clinical nutrition. 2017; 36(3): 651– 62.
12. Weir J.B.V. New methods for calculating metabolic rate with special reference to protein metabolism. The Journal of physiology. 1949; 109(1–2): 1–9.
13. Holdy K.E. Monitoring energy metabolism with indirect calorimetry: instruments, interpretation, and clinical application. Nutrition in Clinical Practice. 2004; 19(5): 447–54.
14. Sion-Sarid R., Cohen J., Houri Z., Singer P. Indirect calorimetry: a guide for optimizing nutritional support in the critically ill child. Nutrition. 2013; 29(9): 1094–9.
15. Глебова Е.С., Иванова-Давыдова Е.В., Амчеславский В.Г. Непрямая калориметрия как объективный метод оценки энергетических потребностей пациентов в критических состояниях. Детская хирургия. 2019; 23(6): 329–34.
16. Шестопалов А.Е., Пасько В.Г., Стец В.В., Половников С.Г., Панова Н.Г. Нутритивная поддержка у пострадавших с тяжёлой сочетанной травмой. Медицинский алфавит. 2011;4(18): 35–40.
17. Jundt Herman, Nicole. Pancréatite aiguë chez l’enfant: la nutrition entérale par sonde nasojéjunale. Diss. University of Geneva, 2005.
18. Kudsk K.A. et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Annals of surgery. 1992; 215(5): 503–11.
19. Vieira J.P. et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cirurgica Brasileira. 2010; 25: 449–54.
20. Marik P.E. What is the best way to feed patients with pancreatitis? Current opinion in critical care. 2009; 15(2): 131–8.
21. Tiengou L.E. et al. Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study. Journal of Parenteral and Enteral Nutrition. 2006; 30(1): 1–5.
22. Hegazi R. et al. Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis.Journal of Parenteral and Enteral Nutrition. 2011; 35(1): 91–6.
23. Piciucchi M. et al. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World Journal of Gastroenterology: WJG. 2010; 16(29): 3692–6.
24. Sánchez C., López-Herce J., Carrillo A., Mencía S., Vigil D. Early transpyloric enteral nutrition in critically ill children. Nutrition. 2007; 23(1): 16–22.
25. Ефремов С.М., Талабан В.О., Артемьева В.В., Дерягин М.Н., Ломиворотов В.В. Теория и практика определения энергетических потребностей пациентов отделений реанимации и интенсивной терапии. Вестник анестезиологии и реаниматологии. 2016; 13(4): 61–7.
26. Лекманов А.У., Ерпулева Ю.В. Использование метода непрямой калориметрии в отделении интенсивной терапии у детей. Вестник анестезиологии и реаниматологии. 2011; 8(3): 3–7.
27. Basile-Filho A. et al. Gasto energético em pacientes sépticos: correlação entre a calorimetria indireta e as equações preditivas derivadas a partir de dados hemodinâmicos. Rev Bras Ter Intensiva. 2003; 15(3): 101–7.
28. Colognesi L.M.S.M. et al. Pancreatite: uma revisão literária do disponível acerca de sua incidência, etiologia, manifestação clínica, diagnóstico, tratamento da patologia ou suas formas de apresentação. Brazilian Journal of Health Review. 2020; 3(4): 7550–7.
29. De Almeida Coelho L.C., Nunes C.P. Pancreatite aguda: uma revisao. Revista de Medicina de Família e Saúde Mental. 2019; 1(2): 36–49. (in Portuguese)
30. Kaushik N., Pietraszewski M., Holst J. J., O’Keefe S. J. Enteral feeding without pancreatic stimulation. Pancreas. 2005; 31(4): 353–9.
31. Bernardoni L., Frulloni L., Benini L., Gabbrielli A. Aggiornamento delle linee guida della pancreatite acuta. Giorn. Ital. End. Dig. 2014; 37: 25–30.
Russian Journal of Pediatric Surgery. 2023; 27: 34-40
Nutrition therapy in children with pancreatic trauma in pediatric Intensive Care Unit
https://doi.org/10.55308/1560-9510-2023-27-1-34-40Abstract
Introduction. Pancreatic injury is a leading cause of acute pancreatitis in children. The prescribed conservative therapy (nutrition therapy) excludes the pancreas from the process of digestion.
Purpose. The aim of the study was to find an optimal algorithm of nutrition therapy for patients with pancreatic injury in a pediatric intensive care unit.
Material and methods. Nutrition therapy protocols applied in 20 children with pancreatic injury were analyzed.
Results. In pancreatic injury, the enteral feeding via an intestinal tube seems to be the most preferable nutrition strategy; in case of necessity, it can be combined with parenteral nutrition. The nutrition therapy program should be designed using objective techniques for assessing energy and protein needs.
Conclusion. All patients with pancreatic injury should receive the enteral feeding via an intestinal tube since the first day of their stay in the hospital.
References
1. Mekitarian Filho E., Carvalho W.B., Silva F.D. Pancreatite aguda em pediatria: revisão sistemática da literatura. Jornal de Pediatria. 2012; 88(22): 101–14.
2. Sutherland I. et al. Pancreatic trauma in children. Pediatric surgery international. 2010; 26(12): 1201–6.
3. Potoka D.A., Saladino R.A. Blunt abdominal trauma in the pediatric patient. Clinical Pediatric Emergency Medicine. 2005; 6(1): 23–31.
4. Chang Y.J., Chao H.C., Kong M.S., Hsia S.H., Lai M.W., Yan D.C. Acute pancreatitis in children. Acta Paediatrica. 2011; 100(5): 740–4.
5. Ermolov A.S., Khubutiya M.Sh., Abakumov M.M. Abdominal'naya travma: Rukovodstvo dlya vrachei. M.: Izdatel'skii dom Vidar; 2010.
6. Shilyansky J. et al. Nonoperative management of pancreatic injuries in children. Journal of pediatric surgery. 1998; 33(2): 343–9.
7. Moore E.E. et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. The Journal of trauma. 1990; 30(11): 1427–9.
8. Mihatsch W.A. et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clinical Nutrition. 2018; 37(6): 2303–5.
9. Jochum F. et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electrolytes. Clinical Nutrition. 2018; 37(6): 2344–53.
10. Raynard B. Place de la calorimétrie indirecte et des formules estimant la dépense énergétique des malades de réanimation. Nutrition clinique et métabolisme. 2009; 23(4): 192–7.
11. Oshima T. et al. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clinical nutrition. 2017; 36(3): 651– 62.
12. Weir J.B.V. New methods for calculating metabolic rate with special reference to protein metabolism. The Journal of physiology. 1949; 109(1–2): 1–9.
13. Holdy K.E. Monitoring energy metabolism with indirect calorimetry: instruments, interpretation, and clinical application. Nutrition in Clinical Practice. 2004; 19(5): 447–54.
14. Sion-Sarid R., Cohen J., Houri Z., Singer P. Indirect calorimetry: a guide for optimizing nutritional support in the critically ill child. Nutrition. 2013; 29(9): 1094–9.
15. Glebova E.S., Ivanova-Davydova E.V., Amcheslavskii V.G. Nepryamaya kalorimetriya kak ob\"ektivnyi metod otsenki energeticheskikh potrebnostei patsientov v kriticheskikh sostoyaniyakh. Detskaya khirurgiya. 2019; 23(6): 329–34.
16. Shestopalov A.E., Pas'ko V.G., Stets V.V., Polovnikov S.G., Panova N.G. Nutritivnaya podderzhka u postradavshikh s tyazheloi sochetannoi travmoi. Meditsinskii alfavit. 2011;4(18): 35–40.
17. Jundt Herman, Nicole. Pancréatite aiguë chez l’enfant: la nutrition entérale par sonde nasojéjunale. Diss. University of Geneva, 2005.
18. Kudsk K.A. et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Annals of surgery. 1992; 215(5): 503–11.
19. Vieira J.P. et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cirurgica Brasileira. 2010; 25: 449–54.
20. Marik P.E. What is the best way to feed patients with pancreatitis? Current opinion in critical care. 2009; 15(2): 131–8.
21. Tiengou L.E. et al. Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study. Journal of Parenteral and Enteral Nutrition. 2006; 30(1): 1–5.
22. Hegazi R. et al. Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis.Journal of Parenteral and Enteral Nutrition. 2011; 35(1): 91–6.
23. Piciucchi M. et al. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World Journal of Gastroenterology: WJG. 2010; 16(29): 3692–6.
24. Sánchez C., López-Herce J., Carrillo A., Mencía S., Vigil D. Early transpyloric enteral nutrition in critically ill children. Nutrition. 2007; 23(1): 16–22.
25. Efremov S.M., Talaban V.O., Artem'eva V.V., Deryagin M.N., Lomivorotov V.V. Teoriya i praktika opredeleniya energeticheskikh potrebnostei patsientov otdelenii reanimatsii i intensivnoi terapii. Vestnik anesteziologii i reanimatologii. 2016; 13(4): 61–7.
26. Lekmanov A.U., Erpuleva Yu.V. Ispol'zovanie metoda nepryamoi kalorimetrii v otdelenii intensivnoi terapii u detei. Vestnik anesteziologii i reanimatologii. 2011; 8(3): 3–7.
27. Basile-Filho A. et al. Gasto energético em pacientes sépticos: correlação entre a calorimetria indireta e as equações preditivas derivadas a partir de dados hemodinâmicos. Rev Bras Ter Intensiva. 2003; 15(3): 101–7.
28. Colognesi L.M.S.M. et al. Pancreatite: uma revisão literária do disponível acerca de sua incidência, etiologia, manifestação clínica, diagnóstico, tratamento da patologia ou suas formas de apresentação. Brazilian Journal of Health Review. 2020; 3(4): 7550–7.
29. De Almeida Coelho L.C., Nunes C.P. Pancreatite aguda: uma revisao. Revista de Medicina de Família e Saúde Mental. 2019; 1(2): 36–49. (in Portuguese)
30. Kaushik N., Pietraszewski M., Holst J. J., O’Keefe S. J. Enteral feeding without pancreatic stimulation. Pancreas. 2005; 31(4): 353–9.
31. Bernardoni L., Frulloni L., Benini L., Gabbrielli A. Aggiornamento delle linee guida della pancreatite acuta. Giorn. Ital. End. Dig. 2014; 37: 25–30.
