胃肠道畸形患儿围手术期肠内肠外联合营养疗效分析

发布时间：2018-04-16 13:28

本文选题：早期肠内营养 + 肠外营养　；参考：《山东大学》2017年硕士论文

【摘要】：目的:探讨胃肠道畸形患儿围手术期不同的营养支持治疗方案,即术后早期肠内营养治疗与常规营养支持治疗方案,为胃肠道畸形患儿提供更优的临床营养治疗。资料与方法:选择2011-2014年来淄博市妇幼保健院普外科胃肠道畸形需要手术患儿115例,其中男性87例,女性28例,月龄1天-1月,术前相关血液检验指标无重大异常,术前行辅助检查考虑胃肠道畸形。所有患儿均外科手术治疗。围手术期营养支持分为两组:A组(常规治疗组):术后给予全肠外营养支持,能量为基础消耗(BEE)的1.2倍,5天后可经鼻胃管或经口进食肠内营养,并逐渐增加肠内营养量和减少肠外营养量,直至过渡为经口全肠内喂养。B组(早期加入肠内营养组EEN组):术后尽早(鼻胃管内无大量墨绿色胃液)开始经鼻胃管或营养管滴入肠内营养,开始时为少量温糖水,观察患儿无明显不适症状,可采用微量泵24h内持续均匀泵入温糖水,并逐渐改为泵入母乳或水解配方奶1ml/kg · h,可按1ml/kg · d递增,至经口全肠内营养。其它营养支持部分与A组相同,两组并分别根据需要给予抗生素等药物。分析两组患儿围手术期不同方案的营养支持,对患儿术后恢复情况、术后并发症、实验室指标及2年出院随访结果的影响,有无统计学差异。结果:两组患儿术前一般资料、手术时间无统计学差异,P0.05;术后初次排气时间、住院费用、住院时间、出院时体重增加情况,都有统计学差异,P0.05;喂养不耐受情况(呕吐、腹胀)等有统计学差异,切口炎性反应、胆汁淤积、坏死性肠炎等并发症情况较对照组明显减少,P0.05,有统计学差异;两组患儿肺炎的发生率两组无统计学差异,P0.05;两组患儿术后7d实验室检验结果,EEN组患儿的白蛋白、炎症指标、胆红素值都有统计学差异;术后随访2年,两组患儿随访3-24个月时所测生长发育指标体重、身高比较差异均无统计学差异,P0.05,均达到我国2010年九省市7岁以下儿童生长参照标准。结论:胃肠道畸形患儿围手术期,早期肠内营养支持治疗的实施方案可靠,尽早开始给予肠内营养,可改善患儿术后的营养状况,促进患儿术后的恢复,降低围手术期相关并发症的发生率,缩短患儿住院日期,降低患儿的费用。对胃肠道畸形患儿的以后生长发育的影响,两者无明显差异。
[Abstract]:Objective: to explore the different nutritional support treatment schemes in perioperative period for children with gastrointestinal malformation, that is, early postoperative enteral nutrition therapy and routine nutritional support therapy, so as to provide better clinical nutrition treatment for children with gastrointestinal malformation.Materials and methods: 115 children (87 males and 28 females) with Gastrointestinal malformation in general surgery department of Zibo Maternal and Child Health Hospital from 2011 to 2014 were selected. The age of one month to one month was one month to one month. There was no significant abnormality in blood test before operation.Preoperative adjuvant examination was performed to consider gastrointestinal malformation.All the children were treated surgically.Perioperative nutritional support was divided into two groups: group A (routine treatment group: total parenteral nutrition support after operation, energy based consumption of bee 1.2 times), after 5 days of feeding enteral nutrition through nasogastric tube or through mouth.And gradually increased the amount of enteral nutrition and reduced the amount of parenteral nutrition,Until the transition to oral total enteral feeding. Group B (early enteral nutrition group EEN group: early postoperative (no large amount of dark green gastric juice in the nasogastric tube) began to drip enteral nutrition through the nasogastric tube or nutrition tube, starting with a small amount of warm sugar water,It was observed that there were no obvious symptoms of discomfort in the children, and the warm sugar water could be pumped into the warm sugar water continuously and evenly within 24 hours by micropump, and then the 1ml/kg hs of breast milk or hydrolyzed formula milk could be gradually pumped into the breast milk or the hydrolyzed formula milk.Other nutritional support was the same as group A, and the two groups were given antibiotics and other drugs as needed.To analyze the effect of nutritional support in perioperative period on postoperative recovery, postoperative complications, laboratory indexes and 2 year follow-up results in the two groups, and whether there were statistical differences between the two groups.Results: there was no significant difference in the operation time between the two groups before operation (P 0.05), the first time of exhaust, the cost of hospitalization, the time of hospitalization, and the weight gain at discharge were all significantly different between the two groups (P 0.05).There were statistical differences in abdominal distension and other complications, such as incision inflammatory reaction, cholestasis, necrotizing enteritis and so on, which were significantly lower than those in the control group (P 0.05).There was no significant difference in the incidence of pneumonia between the two groups (P 0.05). There were significant differences in albumin, inflammatory indexes, bilirubin in EEN group 7 days after operation.There was no significant difference in body weight and height between the two groups during 3-24 months follow-up, which reached the growth standard of children under 7 years of age in nine provinces and cities in 2010.Conclusion: during the perioperative period of gastrointestinal malformation, the early enteral nutrition support therapy is reliable, and it can improve the nutritional status and promote the recovery of children with gastrointestinal malformation as early as possible.Reduce the incidence of perioperative complications, shorten the length of hospitalization, reduce the cost of children.There was no significant difference in the growth and development of children with gastrointestinal malformation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5

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