CAJ | 학술논문

目的探讨小肠营养管在新生儿高位肠梗阻治疗中的价值.方法 5例新生儿(其中男3例,女2例；早产儿1例,足月儿4例；十二指肠膜状闭锁2例,环状胰腺1例,近段小肠闭锁2例；合并旋转不良1例),行十二指肠隔膜切除、小肠盲端切除及肠吻合手术,合并旋转不良一并解决.术中在吻合完成前,由麻醉师经鼻置入日本CREATE MEDIC CO.,LTD生产的6Fr小肠ED导管[注册号:国食药监械(进)字2007第2661620号],术后24 h拍腹平片,喂糖水；48 h用静脉推注泵从营养管泵入配方奶,奶量据病情渐加至正常.初始3～4 d使用静脉营养,术后1周不拔管经口喂养,辅以管内泵奶,停止补液.10～22 d拔营养管出院.结果 5例全部达到经管喂养目的,减少静脉营养的使用时间和避免造瘘手术.无1例脱管,无黄疸加重,肝肾功能正常.刚开始1例有奶瓣堵管,0.9％氯化钠液冲洗后恢复通畅,之后每次注奶后温开水冲洗管道1次.1例经口足量喂奶出现呕吐,上消化道造影未见吻合口狭窄和瘘,无肠梗阻,拔管喂养症状消失出院.1例腹泻,改无乳糖营养液同时给予复合乳酸菌制剂口服,症状消失.5例最短住院10 d,最长住院22 d,平均住院16 d.术后3～5d体重恢复到出生体重,出院时体重均有增加,平均增长5.5g/(kg·d).结论小肠营养管对新生儿高位肠梗阻术后营养的维持有重要价值.
목적 탐토소장영양관재신생인고위장경조치료중적개치.방법 5례신생인(기중남3례,녀2례；조산인1례,족월인4례；십이지장막상폐쇄2례,배상이선1례,근단소장폐쇄2례；합병선전불량1례),행십이지장격막절제、소장맹단절제급장문합수술,합병선전불량일병해결.술중재문합완성전,유마취사경비치입일본CREATE MEDIC CO.,LTD생산적6Fr소장ED도관[주책호:국식약감계(진)자2007제2661620호],술후24 h박복평편,위당수；48 h용정맥추주빙종영양관빙입배방내,내량거병정점가지정상.초시3～4 d사용정맥영양,술후1주불발관경구위양,보이관내빙내,정지보액.10～22 d발영양관출원.결과 5례전부체도경관위양목적,감소정맥영양적사용시간화피면조루수술.무1례탈관,무황달가중,간신공능정상.강개시1례유내판도관,0.9％록화납액충세후회복통창,지후매차주내후온개수충세관도1차.1례경구족량위내출현구토,상소화도조영미견문합구협착화루,무장경조,발관위양증상소실출원.1례복사,개무유당영양액동시급여복합유산균제제구복,증상소실.5례최단주원10 d,최장주원22 d,평균주원16 d.술후3～5d체중회복도출생체중,출원시체중균유증가,평균증장5.5g/(kg·d).결론 소장영양관대신생인고위장경조술후영양적유지유중요개치.
Objective To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Method Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum,1 had annular pancreas,and 2 had proximal small intestine atresia; 1 infant had malrotation ). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed,which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery,the anesthetist inserted via nose a 6Fr small intestinal ED tube,made by CREATE MEDIC CO LTD of Japan [ Registration number: the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620 ].Twenty-four hours after surgery,abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later,formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feediug tube.The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation,the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion.Ten to 22 days after operation, the tube was removed and the infant patients were discharged.Result All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal.At the very beginning,the tube was occasionally blocked by milk vale in one infant and after 0.9％ sodium chloride solution flushing patency restored.After that,the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula,or intestinal obstruction.After pulling out the tube,the symptoms disappeared and then the patient was discharged.One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration,the symptom disappeared.In the 5 cases,the shortest hospital stay was 10 days and the longest was 22 days,the average stay was 16 days.Three to 5 days after operation the weight restored to birth weight,the weight had increased,when discharged,to an average of 5.5 g(kg · d).Conclusion The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.