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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (6): 414-419.DOI: 10.3969/j.issn.1673-5501.2022.06.002

• 论著 • 上一篇    下一篇

消化道大出血儿童禁食时间及进食种类对再出血和住院时间影响的回顾性队列研究

付丽琴1,2,汪志凌1,白辉科2,李秋平2,万朝敏1   

  1.  1 四川大学华西第二医院儿科，国家卫生健康委员会时间生物学重点实验室（四川大学） 成都，610041；2 成都市第二人民医院儿科 成都，610017
  • 收稿日期:2022-05-30 修回日期:2022-06-12 出版日期:2022-12-25 发布日期:2022-12-25
  • 通讯作者: 万朝敏

Effects of fasting time and different diet on rebleeding and hospital stay in children with massive gastrointestinal hemorrhage: A retrospective cohort study

FU Liqin1,2 , WANG Zhiling1, BAI Huike2, LI Qiuping2, WAN Chaomin1    

  1. 1 Department of Pediatrics, West China Second Hospital, Sichuan University, Key Laboratory of chronobiology, National Health Commission, Chengdu 610041, China; 2 Department of Pediatrics, Chengdu Second People's Hospital, Chengdu 610017, China
  • Received:2022-05-30 Revised:2022-06-12 Online:2022-12-25 Published:2022-12-25
  • Contact: WAN Chaomin

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摘要： 背景：消化道出血后的禁食时间一直是个有争议的问题，消化道出血儿童的禁食时间及饮食管理，国内外鲜见报道。 目的：：探讨消化道大出血儿童是否需要早期严格禁食及开放饮食时进食种类的合理选择。 设计：：回顾性队列研究。 方法：收集 2011年10月至 2021年10月在四川大学华西第二医院住院的消化道大出血患儿的临床资料，按禁食时间分为<24 h组、~48 h组、~72 h组和＞72 h组，按开放饮食时食物种类分为碳水化合物饮食组、蛋白质饮食组和混合饮食组。分别比较禁食时间组及不同进食种类组在人口学特征、临床特征、实验室检查和临床结局方面的差异，对组间差异有统计学意义的变量行多因素回归分析。 主要结局指标：消化道再出血、住院时间。 结果：266例消化道大出血患儿纳入本研究，男175例（65.8%），女91例，年龄6.0(2.4，10.9)岁。以禁食时间<24 h为参照，多因素Logistic回归分析的结果显示，禁食时间与再出血、院内感染发生风险差异无统计学意义（P>0.05）。多重线性回归分析结果显示，禁食时间＞72 h的患儿ln转换后住院时间（lnLOS）增加0.192 (95%CI: 0.047~0.337, P=0.010)d，即禁食时间＞72 h的患儿住院时间延长。以碳水化合物饮食组为参照，多因素Logistic回归分析结果显示，进食种类与再出血、进食后不良反应发生风险差异无统计学意义（P>0.05），多重线性回归分析结果显示，碳水化合物饮食组及蛋白质饮食组的患儿lnLOS差异无统计学意义（P>0.05），而混合饮食组的患儿lnLOS缩短0.176(95%CI：-0.318~-0.034, P=0.015)d，即进食碳水化合物+蛋白质混合食物的患儿住院时间缩短。 结论：消化道大出血患儿禁食<24 h不会增加再出血、院内感染等不良结局的风险，且24 h内早期进食住院时间更短；消化道大出血后开放饮食，碳水化合物+蛋白质混合的食物更有利于缩短住院时间，且不增加再出血率及进食后不良反应发生率，可作为初始食物选择。

关键词: 消化道大出血, 儿童, 禁食时间, 进食, 再出血, 院内感染

Abstract: Background: The fasting time after gastrointestinal bleeding has always been a controversial area. It is rarely to be reported for children with gastrointestinal bleeding about fasting time and diet management at home and abroad. Objective: To explore whether children with massive gastrointestinal bleeding need early strict fasting and preliminarily explore the reasonable choice of food when starting feeding. Design: Retrospective cohort study. Methods: The clinical data of children with massive gastrointestinal bleeding hospitalized in West China Second Hospital of Sichuan University from October 2011 to October 2021 were collected. Patients were divided into four groups according to fasting time: less than 24 hours group, 24 to 48 hours group, 48 to 72 hours group and greater than 72 hours group. Meanwhile, patients were divided into three groups according to different diet when starting feeding: carbohydrate diet group, protein diet group and mixed diet group. The research analysed the different variables in demographic characteristics, clinical features, laboratory examinations and clinical outcomes in fasting time group and different diet group, respectively. The variables with statistically significant differences among groups were analyzed by multivariate regression analysis. Main outcome measures: Rebleeding and hospital stay. Results: A total of 266 patients with massive gastrointestinal hemorrhage were selected into this study, including 175 males（65.8%）and 91 females（34.2%）with the median age of 6.0(2.4, 10.9) years. As less than 24 hours group as the reference, the multivariate logistic regression analysis showed that fasting time was disassociated with rebleeding and nosocomial infection and there was no statistically significant difference(P>0.05). Multiple linear regression analysis showed that patients with fasting time greater than 72 hours had prolonged length of hospital stay(lnLOS) (0.192, 95%CI: 0.047 to 0.337, P=0.010). As carbohydrate diet group as the reference, multivariate logistic regression analysis showed that the type of diet was disassociated with rebleeding and adverse reactions after feeding and there was no statistically significant difference(P>0.05). Multiple linear regression analysis revealed that there were no statistically significant differences in lnLOS between carbohydrate diet group and protein diet group(P>0.05), while hospital stays of mixed diet group was shorter than other two groups (-0.176, 95%CI: -0.318 to -0.034, P=0.015). Conclusion: Fasting time for less than 24 hours in children with massive gastrointestinal bleeding will not increase the risk of adverse outcomes such as rebleeding and nosocomial infection, and early feeding within 24 hours tend to have shorter hospital stays. When patients began to take food after massive gastrointestinal bleeding, carbohydrate + protein mixed food which can be used as the initial diet choice, was more conducive to shorten the hospital stay and may not increase the rebleeding rate and the incidence of the adverse reaction after feeding.

Key words: Gastrointestinal hemorrhage, Children, Fasting time, Diet, Rebleeding, Nosocomial infection