新生儿高位消化道畸形术后早期肠内营养的可行性

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.

Feasibility of early enteral nutrition after surgical treatment of upper digestive tract malformation in newborns

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.