中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2014年
1期
23-27
,共5页
吕小逢%徐小群%耿其明%张杰%蒋维维%李薇%陈焕%路长贵%李波
呂小逢%徐小群%耿其明%張傑%蔣維維%李薇%陳煥%路長貴%李波
려소봉%서소군%경기명%장걸%장유유%리미%진환%로장귀%리파
消化道畸形%早期肠内营养%新生儿
消化道畸形%早期腸內營養%新生兒
소화도기형%조기장내영양%신생인
Digestive tract malformation%Early enteral nutrition%New born
目的 评估新生儿高位消化道畸形手术矫治后实施早期肠内营养的可行性和安全性.方法 分析2010年1月至2013年1月南京医科大学附属南京儿童医院新生儿外科收治的85例十二指肠、空肠先天性梗阻新生儿术前、术中和术后诊疗过程的临床资料,根据术后是否开展早期肠内营养将患儿分为两组,术中经鼻放置肠营养管、术后开展早期肠内营养组[早期肠内营养组(EEN组),n =37],术中未放置肠营养管、待胃肠功能恢复开展经口喂养组(对照组,n=48)；比较两组患儿胎龄、出生体质量、手术年龄和时间、住院时间、全静脉营养持续时间、肠功能恢复时间(术后经口喂养时间、术后经口喂养达40 ml/3 h的时间)、住院费用、并发症、营养指标、生长发育等方面的差异.结果 术前两组胎龄、出生体质量、手术年龄、疾病分布、营养指标相比差异无统计学意义；EEN组手术时间(110.5±14.9) min、术后经口喂养时间(11.7±4.2)d与对照组(110.0±15.3) min、(12.3±2.9)d相比差异均无统计学意义(t值分别为0.871、0.508,均P＞0.05)；EEN组术后初次排便时间、经口喂养达40 ml/3 h的时间、全静脉营养持续时间、住院时间分别是(50.1±16.6)h、(17.9±6.0)d、(14.5±5.5)d,(19.4±6.2)d,均比对照组(60.4±21.3)h、(21.3±7.5)d、(17.8±7.5)d, (23.1 ±8.3)d显著缩短,且住院费用(20 022.7±4 615.1)元与对照组(23 036.4 ±5 877.7)元比较显著减少(t值分别为2.885、2.238、2.281、2.266、2.567,均P＜0.05)；EEN组无肠穿孔、肠扭转、堵管等置管并发症发生,无粘连性肠梗阻发生,无呕吐、胆汁淤积发生；对照组术后功能性肠梗阻3例、粘连性肠梗阻3例,呕吐、胆汁淤积发生率比EEN组显著增加(P＜0.05).术后平均随访时间为1.8年(6个月～3年),两组生长发育指标相比差异无统计学意义.结论 先天性十二指肠、空肠畸形新生儿经鼻肠营养管实施早期肠内营养,方法简单,无创伤,并发症少,静脉营养应用时间短,有助于新生儿肠功能恢复,提高喂养耐受性,安全可行.
目的 評估新生兒高位消化道畸形手術矯治後實施早期腸內營養的可行性和安全性.方法 分析2010年1月至2013年1月南京醫科大學附屬南京兒童醫院新生兒外科收治的85例十二指腸、空腸先天性梗阻新生兒術前、術中和術後診療過程的臨床資料,根據術後是否開展早期腸內營養將患兒分為兩組,術中經鼻放置腸營養管、術後開展早期腸內營養組[早期腸內營養組(EEN組),n =37],術中未放置腸營養管、待胃腸功能恢複開展經口餵養組(對照組,n=48)；比較兩組患兒胎齡、齣生體質量、手術年齡和時間、住院時間、全靜脈營養持續時間、腸功能恢複時間(術後經口餵養時間、術後經口餵養達40 ml/3 h的時間)、住院費用、併髮癥、營養指標、生長髮育等方麵的差異.結果 術前兩組胎齡、齣生體質量、手術年齡、疾病分佈、營養指標相比差異無統計學意義；EEN組手術時間(110.5±14.9) min、術後經口餵養時間(11.7±4.2)d與對照組(110.0±15.3) min、(12.3±2.9)d相比差異均無統計學意義(t值分彆為0.871、0.508,均P＞0.05)；EEN組術後初次排便時間、經口餵養達40 ml/3 h的時間、全靜脈營養持續時間、住院時間分彆是(50.1±16.6)h、(17.9±6.0)d、(14.5±5.5)d,(19.4±6.2)d,均比對照組(60.4±21.3)h、(21.3±7.5)d、(17.8±7.5)d, (23.1 ±8.3)d顯著縮短,且住院費用(20 022.7±4 615.1)元與對照組(23 036.4 ±5 877.7)元比較顯著減少(t值分彆為2.885、2.238、2.281、2.266、2.567,均P＜0.05)；EEN組無腸穿孔、腸扭轉、堵管等置管併髮癥髮生,無粘連性腸梗阻髮生,無嘔吐、膽汁淤積髮生；對照組術後功能性腸梗阻3例、粘連性腸梗阻3例,嘔吐、膽汁淤積髮生率比EEN組顯著增加(P＜0.05).術後平均隨訪時間為1.8年(6箇月～3年),兩組生長髮育指標相比差異無統計學意義.結論 先天性十二指腸、空腸畸形新生兒經鼻腸營養管實施早期腸內營養,方法簡單,無創傷,併髮癥少,靜脈營養應用時間短,有助于新生兒腸功能恢複,提高餵養耐受性,安全可行.
목적 평고신생인고위소화도기형수술교치후실시조기장내영양적가행성화안전성.방법 분석2010년1월지2013년1월남경의과대학부속남경인동의원신생인외과수치적85례십이지장、공장선천성경조신생인술전、술중화술후진료과정적림상자료,근거술후시부개전조기장내영양장환인분위량조,술중경비방치장영양관、술후개전조기장내영양조[조기장내영양조(EEN조),n =37],술중미방치장영양관、대위장공능회복개전경구위양조(대조조,n=48)；비교량조환인태령、출생체질량、수술년령화시간、주원시간、전정맥영양지속시간、장공능회복시간(술후경구위양시간、술후경구위양체40 ml/3 h적시간)、주원비용、병발증、영양지표、생장발육등방면적차이.결과 술전량조태령、출생체질량、수술년령、질병분포、영양지표상비차이무통계학의의；EEN조수술시간(110.5±14.9) min、술후경구위양시간(11.7±4.2)d여대조조(110.0±15.3) min、(12.3±2.9)d상비차이균무통계학의의(t치분별위0.871、0.508,균P＞0.05)；EEN조술후초차배편시간、경구위양체40 ml/3 h적시간、전정맥영양지속시간、주원시간분별시(50.1±16.6)h、(17.9±6.0)d、(14.5±5.5)d,(19.4±6.2)d,균비대조조(60.4±21.3)h、(21.3±7.5)d、(17.8±7.5)d, (23.1 ±8.3)d현저축단,차주원비용(20 022.7±4 615.1)원여대조조(23 036.4 ±5 877.7)원비교현저감소(t치분별위2.885、2.238、2.281、2.266、2.567,균P＜0.05)；EEN조무장천공、장뉴전、도관등치관병발증발생,무점련성장경조발생,무구토、담즙어적발생；대조조술후공능성장경조3례、점련성장경조3례,구토、담즙어적발생솔비EEN조현저증가(P＜0.05).술후평균수방시간위1.8년(6개월～3년),량조생장발육지표상비차이무통계학의의.결론 선천성십이지장、공장기형신생인경비장영양관실시조기장내영양,방법간단,무창상,병발증소,정맥영양응용시간단,유조우신생인장공능회복,제고위양내수성,안전가행.
Objective To assess the feasibility and safety of early enteral nutrition (EEN) after surgical treatment of upper digestive tract malformation in newborns.Methods The clinical data of 85 newborns with with duodenal or jejunal congenital intestinal obstruction who were treated in our hospital from January 2010 to January 2013 were retrospectively analyzed.These 85 cases were divided into two groups according to the application (or not) of the EEN:the EEN group (n =37),in which the patients were intraoperatively placed with nasal intestinal feeding tube and received postoperative early enteral nutrition; the control group (n =48),in which the patients were not intraopratively placed with enteral nutrition tube and underwent oral feeding after the recovery of gastrointestinal function.The potential difference of two groups in fetal age,birth weight,age and time of operation,length of hospital stay,days of total parenteral nutrition,intestinal function recovery time (the time of postoperative oral feeding and postoperative oral feeding of 40 ml/3 h),cost,complications,and growth/development were compared.Results The gestational age,birth weight,age,disease distribution,and nutrition-related indicators showed no significant difference between the two groups (all P ＞0.05).The operation time [(110.5 ± 14.9) min vs (110.0 ± 15.3) min] and postoperative oral feeding time [(11.7 ±4.2) days vs (12.3 ±2.9) days] was not significantly different.However,the first defecation time after operation [(50.1±16.6) hours vs (60.4±21.3) hours],oral feeding time 40 ml/3 h [(17.9±6.0)days vs (21.3 ± 7.5) days],total parenteral nutrition duration [(14.5 ± 5.5) days vs (17.8 ± 7.5) days],length of hospital stay [(19.4 ±6.2) days vs (23.1 ± 8.3) days],and hospitalization expenses [(20 022.7 ±4 615.1)yuan vs (23 036.4 ± 5 877.7) yuan] in EEN group were significantly shorter than those in control group (all P ＜ 0.05).There were no catheter-related complications such as intestinal perforation,intestinal volvulus,and plugging and no adhesive ileus,vomiting,or cholestasis in EEN group; in contrast,three cases of functional intestinal obstruction and three cases of adhesive ileus were reported in the control group.Also,the incidences of vomiting and cholestasis significantly increased in the control group.Follow-up (mean:1.8 years; range:6 months-3years) showed that the growth and development indicators were not significantly different between these two groups.Conclusions EEN through nasal intestinal feeding tube after surgical treatment of congenital duodenal or jejunal deformity in newborns is simple and with few complications and short application time.It helps to promote the neonatal intestinal function recovery and improves feeding tolerance.
