摘要
目的探讨早产低体重十二指肠梗阻患者术后早期肠内营养的可行性和必要性。方法回顾性分析2012年1月至2019年6月徐州市儿童医院新生儿外科73例早产低出生体重十二指肠梗阻新生儿的诊治过程,根据是否留置空肠营养管将患者分为两组,观察组(n=37)为留置空肠营养管,对照组(n=36)为未留置空肠营养管,比较两组在胎龄、出生体质量、手术年龄、手术时间、术后呼吸机使用时间、住院时间、术后两组患者开始进食的时间、喂养不耐受并再次禁食、术后肠外营养(postoperative parenteral nutrition,PPN)时间和出院时体质量增加量、术后1周复查前白蛋白以及术后并发症等方面的差异。结果两组患者在胎龄、出生体质量、手术年龄、手术时间、喂养不耐受并再次禁食、术后呼吸机使用时间、术后并发症(术后放弃治疗、吻合口瘘、吻合口狭窄、粘连性肠梗阻、再次手术)以及胆汁淤积性黄疸(直接胆红素>2 mg/dL)等方面比较,差异无统计学意义(P>0.05)。观察组的住院时间、术后开始进食时间、PPN时间分别为(16.4±3.4)d、(3.86±1.0)d和(12.9±2.3)d,对照组分别为(19.0±4.1)d、(6.0±1.3)d和(16.3±2.9)d,差异有统计学意义(P<0.05);观察组在出院时体质量增加量、术后1周前白蛋分别为(0.51±0.24)kg和(95.30±19.38)mg/L,对照组分别为(0.31±0.22)kg和(82.86±14.98)mg/L,差异有统计学意义(P<0.05)。结论早产低出生体重十二指肠梗阻患者术后的早期肠内营养有助于早产低出生体重患者肠道功能恢复,减少静脉营养的使用时间,缩短住院时间,改善患者的营养状况,为今后追赶性生长奠定了良好的基础,同时并未增加术后并发症发生率。
Objective To explore the feasibility and necessity of early postoperative enteral nutrition in premature and low-birth-weight children with duodenal obstruction.Methods From January 2012 and June 2019,retrospective analysis was performed for clinical data of 73 premature and low-birth-weight neonates with duodenal obstruction.According to whether or not jejunal nutrient tube was used,they were divided into two groups of jejunal nutrition tube(treatment,n=37)and no jejunum nutrition tube(control,n=36).Differences in gestational age,birth weight,operative age,operative duration,period of postoperative ventilator,hospitalization stay,time of resuming eating,feeding intolerance&re-fasting,postoperative parenteral nutrition time,weight gain at discharge and prealbumin were detected at Week 1 post-operation and postoperative complications compared between two groups.Results No significant inter-group difference existed in gestational age,birth weight,operative age,operative duration,feeding intolerance&re-fasting,period of postoperative ventilator and postoperative complications(giving up treatment,anastomotic leakage/stenosis,adhesive ileus&reoperation),etc.(P>0.05).And no significant inter-group differences existed in gestational age,birth weight,operative age,operative duration,feeding intolerance&re-fasting after feeding,period of postoperative ventilator,postoperative complications(giving up treatment,anastomotic leakage/stenosis,adhesive ileus&reoperation)and cholestatic jaundice(direct bilirubin>2 mg/dl).Statistical differences were significant(P>0.05).Hospitalization stay,time of resuming eating and time of postoperative parenteral nutrition(PPN)in observation group[(16.4±3.4),(3.86±1.0),(12.9±2.3)days]were shorter than those in control group[(19.0±4.1),(6.0±1.3),(16.3±2.9)days],and the differences was statistically significant(P=0.004,0.000,0.000);weight gain at discharge and prealbumin were detected at Week 1 post-operation[(0.51±0.24)kg,(95.30±19.38)mg/l]in observation group were higher than those in control group[(0.31±0.22)k g,(82.86±14.98)mg/l].And the differences were statistically significant(P=0.000,0.003).Conclusion Early postoperative enteral nutrition in preterm low-birth-weight children with duodenal obstruction may facilitate the recovery of intestinal function,reduce the use time of intravenous nutrition,shorten hospitalization stay,improve nutritional status and lay a solid foundation for later catch-up growth while postoperative complications are not heightened.
作者
张宁
刘丰丽
马同胜
曾战东
黄广锋
袁海彬
Zhang Ning;Liu Fengli;Ma Tongsheng;Zeng ZhanDong;Huang GuangFeng;Yuan HaiBin(Department of neonatal surgery,Xuzhou Children's Hospital,Xuzhou 221009,China)
出处
《临床小儿外科杂志》
CAS
2020年第12期1118-1122,1129,共6页
Journal of Clinical Pediatric Surgery
