Objective: To evaluate the effectiveness of enteral nutrition in children with accidental upper gastrointestinal injury. Methods: The medical records of 128 patients with mechanical or chemical gastrointestinal mucosal injury, who were hospitalized in Department of Gastroenterology, Children's Hospital of Zhejiang University School of Medicine from January 1, 2011 to December 30, 2017, were collected. All cases were treated with enteral nutrition. The clinical features and etiologies were retrospectively analyzed. Weight-for-age Z score and lab findings including white blood cells, C-reactive protein, neutrophils, albumin, prealbumin, urea nitrogen and hemoglobin before and after treatment were extracted. The clinical characteristics, the duration of enteral nutrition and gastrointestinal mucosal healing between different etiologies were further analyzed. Normal distribution variables and categorized variables were compared with t test and χ(2) test respectively, and abnormal distribution data was compared with Wilcoxon test. Results: Among all the cases, 77 were males and 51 were females. The average age was (29±22) months. The mean duration of hospitalization and enteral nutrition were (11±7)d and (27±20)d respectively. Vomiting was the most common clinical presentation (72 cases, 56.3%). In 79 cases the problems were caused by mechanical injury, among which coins were most commonly seen. The rest 49 cases were caused by chemical injury. However, the duration of hospitalization ((13±8) d vs. (10±6)d, t=-3.089, P=0.002) and enteral nutrition ((39±22) vs. (19±14) d, t=-5.365, P=0.000) were longer in children with chemical injury than those with mechanical injury. A total of 112 cases got complete blood count and C-reactive protein both before and after enteral nutrition. Inflammatory markers, including leukocytes ((7.7±2.7) ×10(9)/L vs. (13.7±5.0) ×10(9)/L, t=12.244, P <0.05), neutrophils ((3.4±1.9)×10(9)/L vs. (9.4±4.6) ×10(9)/L, t=13.655, P<0.05), and C-reactive proteins (5.0(3.0,7.8) vs. 13.5(6.0,40.5) mg/L, Z=7.776, P <0.05) were significantly decreased. The nutritional markers, including the weight-for-age z score (-0.1 ± 1.0 vs. 0.0 ± 1.0, t=-2.622, P=0.010) and the prealbumin (0.1 ± 0.1 vs. 0.2 ± 0.0 g/L, t=-3.671, P=0.001) were significantly increased. Fifty-five (82.1%) children in mechanical injury group recovered in 4 weeks, while 27 (79.4%) children in chemical injury group recovered in 7 weeks. Conclusion: Enteral nutrition can provide adequate nutritional requirements for children with upper gastrointestinal injury, and may help to decrease imflammation and improve mucosal healing.
目的： 研究肠内营养对儿童误吞后上消化道损伤的治疗有效性。 方法： 回顾性收集2011年1月1日至2017年12月30日因机械性或化学性消化道黏膜损伤在浙江大学医学院附属儿童医院消化科住院的128例患儿的临床资料，所有患儿均行肠内营养治疗，分析其临床特点、消化道黏膜损伤病因、肠内营养治疗前后炎症指标（包括血白细胞、超敏C反应蛋白、中性粒细胞）及营养指标（包括白蛋白、前白蛋白、年龄别体重Z评分、尿素氮、血红蛋白）的变化情况；分析不同损伤因素患儿的临床特征、肠内营养治疗时间、消化道黏膜愈合时间。组间比较采用t检验、Wilcoxon秩和检验或χ(2)检验。 结果： （1）一般资料：男女比例为77/51，平均年龄（29±22）月龄，平均住院时间（11±7）d，平均肠内营养治疗时间（27±20）d。呕吐（72例，56.3%）为最常见的临床表现。（2）消化道损伤病因：机械性损伤79例，化学性损伤49例；化学性损伤患儿住院时间[（13±8）比（10±6）d，t=-3.089, P=0.002]及肠内营养时间[(39±22）比（19±14）d，t=-5.365, P=0.000]明显长于机械性损伤组，差异均有统计学意义。（3）肠内营养治疗前后炎症指标变化情况：肠内营养治疗后血白细胞[（7.7±2.7）×10(9)比（13.7±5.0）×10(9)/L]，中性粒细胞[（3.4±1.9）×10(9)比（9.4±4.6）×10(9)/L]，超敏C反应蛋白[5.0（3.0，7.8）比13.5（6.0，40.5）mg/L]均较治疗前下降，差异有统计学意义（t=12.244、13.655，Z=7.776，P均<0.05）。（4）肠内营养治疗前后营养指标变化情况：年龄别体重Z评分由治疗前的-0.1±1.0增加至治疗后的0.0±1.0(t=-2.622, P=0.010)；前白蛋白由治疗前的（0.1±0.1)g/L增加至治疗后的（0.2±0.0）g/L(t=-3.671, P=0.001)。（5）消化道黏膜愈合情况：机械性损伤组55例（82.1%）患儿在第4周黏膜完全愈合，而化学性损伤组27例（79.4%）患儿则在第7周黏膜完全愈合。 结论： 肠内营养治疗可保证营养需求，对炎症缓解及黏膜恢复可能起到一定作用。.
Keywords: Child; Enteral nutrition; Foreign bodies; Gastrointestinal tract.