摘要
目的研究新生儿十二指肠梗阻术后早期喂养对术后康复的作用。方法选取2017年8月至2018年7月在深圳市儿童医院确诊为新生儿十二指肠梗阻并行手术治疗的40例患儿。按照信封随机法将患儿分成2组:早期喂养组19例,对照组21例。早期喂养组在术后24 h后开始经胃管注入喂养。第二个24 h:使用5%葡萄糖水10~20 ml·kg-1·d-1,分8次喂养。第三个24 h:使用深度水解蛋白配方奶粉10~20 ml·kg-1·d-1,分8次喂养。第四个24 h:根据患儿胃肠耐受情况逐渐增加喂养奶量,增加喂养奶量的速度为10~20 ml·kg-1·d-1。直至达到生理需要量120 ml·kg-1·d-1,在增加奶量时可逐步改为经口喂养。喂养热卡不足的部分,以肠外营养补充。对照组为按照传统术后管理方法,术后常规禁食、胃肠减压、全静脉营养支持(目标热卡334.72 kJ·kg-1·d-1,氨基酸2.5~3 g·kg-1·d-1,热氮比100~200∶1)。待胃肠减压引流液减少至10 ml·kg-1·d-1且颜色转为无色或淡黄绿色后,开始经口喂养深度水解蛋白配方奶粉,若消化道耐受良好,逐渐增加奶量直至全量喂养,即120 ml·kg-1·d-1。比较两组患儿术后住院时间、第一次排便情况、体重变化、住院费用以及一些术后喂养并发症情况,用SPSS 19.0软件进行数据分析。结果术后住院时间:早期喂养组(12.80±5.13)d,对照组(19.50±6.60)d(P<0.001)。术后第一次排便时间:早期喂养组(45.50±26.41)h,对照组(96.00±52.58)h(P<0.001)。手术前后体重变化(体重变化=术后体重-术前体重):早期喂养组(0.28±0.20)kg,对照组(0.27±0.32)kg(P=0.878)。术后并发症情况:早期喂养组发生并发症2例,均为呕吐;对照组发生并发症5例,其中乳糜漏1例、呕吐3例、鞘膜腔感染1例(P>0.05)。结论对于新生儿十二指肠梗阻患儿术后予以早期喂养可以明显缩短术后住院和胃肠道功能恢复的时间,且并不增加手术相关并发症的发生率,可以达到促进康复的目�
Objective To explore the effect of postoperative early feeding upon recovery in neonates with congenital duodenal obstruction. Methods From August 2017 to July 2018, 40 neonates of congenital duodenal obstruction who underwent operation were divided randomly into early feeding group (n=19) and control group(n=21). Neonates in early feeding group were fed via a tube as of the second 24 h post-operatively. The second 24 h, 5% glucose solution(10-20 ml/kg/day) was fed eight times daily;the third 24 h, deep hydrolyzed protein milk, 10-20 ml/kg/day, was fed eight times daily;the fourth 24 h, deep hydrolyzed protein milk, increment of 10-20 ml/kg/day up to total enteral nutrition (120 ml/kg/day). Parenteral nutrition supplemented the rest of energy needs. Neonates in control group were treated initially by total parenteral nutrition. Upon a recovery of gastrointestinal function, feeding was increased progressively till total enteral nutrition. Two groups were compared with regards to postoperative hospital stays, initial postoperative defecation, weight change and complications. SPSS 19 was employed for data analysis. Results The postoperative hospital stay was (12.8±5.13) days in early feeding group and (19.5±6.60) days in control group (P<0.001);initial postoperative defecation (45.5±26.41) hours in early feeding group and (96.0±52.58) hours in control group (P<0.001);weight change (90.28±0.199) kg in early feeding group and (0.27±0.320) kg in control group (P=0.878). No significant inter-group difference existed in rate of complications. Conclusions In neonates with congenital duodenal obstruction, postoperative early feeding can shorten the postoperative hospital stay and accelerate the recovery of gastrointestinal function. However, it does not increase the rate of postoperative complications.
作者
徐皓中
肖东
王秀良
张翅
任锋
崔雄俭
Xu Haozhong;Xiao Dong;Wang Xiuliang;Zhang Chi;Ren Feng;Cui Xiongjian(Department I of General Surgery, Municipal Children's Hospital, Shenzhen 518026, China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第10期911-915,共5页
Chinese Journal of Pediatric Surgery
