目的 探讨序贯式营养治疗在先天性婴幼儿乳糜胸治疗中的应用效果，为规范化治疗提供依据。方法 回顾性采集 2017年1月至2019年12月在浙江大学医学院附属儿童医院呼吸科诊断为先天性乳糜胸患儿的临床资料，并总结序贯式营养治疗 方案及效果。结果 本研究共收集5例先天性乳糜胸患儿，确诊日龄为（75±17)d，男性2例、女性3例。5例均以咳嗽、气促为首发 表现，1例伴有呕吐、腹泻等消化道症状。4例为右侧胸腔积液，1例为双侧胸腔积液，胸腔积液量为（3.6±1.8)cm。5例患儿均接受 序贯式营养治疗（全肠外营养‑高中链甘油三酯肠内营养‑普通肠内营养）的保守治疗方法治愈，5例患儿均呈顺势增长，治疗前后 身高、体重分别为（61.9±2.2）cm和（67.0±2.0）cm（t=-23.3，P<0.001），（5.7±0.6）kg和（7.2±0.6）kg（t=-12.7，P<0.001）。治疗前后年 龄别身长Z评分（HAZ）、年龄别体重Z评分（WAZ）和身长别体重Z评分（WHZ）平均值分别为：1.45和1.48（t=-0.35，P=0.75）、0.004 和-0.39（t=-2.91，P=0.04）、-0.83和-0.59（t=-0.58；P=0.59），营养不良例数治疗前后分别为3例和1例。前白蛋白、白蛋白干预前 后分别为（0.12±0.04）g/L和（0.16±0.02）g/L（t=-4.67，P=0.01）、（41.6±3.4）g/L和（42.1±3.1）g/L（t=-0.75，P=0.49）。治疗后前白蛋白 水平显著增加，白蛋白无统计学差异。5例患儿出院后随访时间为（62±6）d，营养状况改善，乳糜胸均无复发。结论 先天性乳 糜胸患儿有较高的营养不良风险，长期的营养管理是保守治疗的重要部分。5例患儿经序贯式营养治疗后临床症状和营养状况 均得到改善。 关键词：先天性乳糜胸；序贯式营养治疗；乳糜胸

The effect of sequential nutrition support on 5 congenital chylothorax infants，1 Wang Wenqiao, 2 Wang Yuqi, 1 Long Qi, 1 Zhang Ting, 1 Chen Fei, 1 Chen Yuzhi, 1 Ma Ming 1 Department of Clinical Nutrition, the Children Hospital, Zhejiang University of Medicine/National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang, China; 2 Department of Respiratory Medicine, the Children Hospital, Zhejiang University of Medi‑ cine/National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang, China Abstract: Objective This research aims to explore the effect of sequential nutritional support on congenital chylothorax in infants, and to provide the basis for standardized treatment. Methods We collected five infants who were diagnosed with congenital chylothorax at Children′s Hospital of Medicine of Zhejiang University from January 2017 to December 2019, and retrospectively summarized clinical manifestation and analyzed the effect of the sequential nutritional support. Results A total of five infants with congenital chylothorax were recruited, including two males and three females. The average age of diagnosis was (75±17) days. All the 5 patients were characterized by cough and tachypnea, with 1 case accompanied by gastrointestinal symptoms (vomiting and diarrhea). The prenatal ultrasound detected pleural effusion in five patients, four of which presented with right pleural effusion, and the remaining one with bilateral pleural effusion. The average hydrothorax volume was (3.6±1.8) cm. All the five patients received sequential nutritional support (total parenteral nutrition to high MCT enteral nutrition) and recovered from conservative treatment. The height and weight of patients were both increased after treatment［ (61.9±2.2)cm vs (67.0±2.0)cm, t=23.3, P<0.001; (5.7±0.6)kg vs (7.2±0.6)kg, t=12.7, P<0.001, respectively］. The average values of length for age Z score（HAZ）、weight for age Z score（WAZ）、weight for length Z score（WHZ）before and after treatment were 1.45 and 1.48 (t=0.35, P=0.75), 0.004 and -0.39 (t=2.91, P=0.04), -0.83 and -0.59 (t=-0.58, P=0.59), and the incidence of malnutrition was 60% and 20%, respectively. The level of prealbumin in patients increased significantly after treatment［ (0.12±0.04) g/L vs (0.16± 0.02)g/L, t=-4.67, P=0.01］; while the change of albumin level had no statistical significance［(41.6±3.4)g/L vs (42.1±3.1)g/L, t= -0.75, P=0.49］. Through follow⁃up of two months, all the patients had no relapse of pleural effusion. Conclusion Patients with congenital chylothorax have high malnutrition risk. Nutritional support is an essential part of conservative treatment in patients with congenital chylothorax. The clinical symptoms and nutritional status of five cases were all improved after receiving sequential nutritional support. Key Words: Congenital chylothorax；Sequential nutrition treatment；Pleural effusion