Li Jiahua,Peng Yanfen,Lyu Junjian,et al.Effect of early enteral nutrition on enhanced recovery after surgery for severe jejunoileal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(09):813-817.[doi:10.3760/cma.j.cn101785-202305043-003]
早期肠内营养支持在难治型空回肠闭锁术后加速康复中的应用研究
- Title:
- Effect of early enteral nutrition on enhanced recovery after surgery for severe jejunoileal atresia
- Keywords:
- Intestinal Atresia; Enhanced Recovery After Surgery; Nutritional Support; Surgical Procedures; Operative; Child
- 摘要:
- 目的 评估术后早期肠内营养支持(enteral nutrition,EN)对难治型空回肠闭锁(jejunoileal atresia,JIA)肠吻合术后加速康复的作用。方法 回顾性分析广州市妇女儿童医疗中心2018年1月至2022年12月收治的92例诊断为难治型JIA患儿的临床资料,根据患儿术后开奶时间分为早期喂养组(39例)和常规喂养组(53例)。比较两组患儿一般资料、达全量喂养时间、住院时间、并发症发生率以及喂养不耐受发生率等情况。结果 早期喂养组和常规喂养组术后首次开奶时间分别为2.0(1.0,2.0)d和 7.0(5.0,13.0)d,差异有统计学意义(P<0.05)。早期喂养组和常规喂养组达全量喂养时间分别为20.0(10.0,34.0)d和21.0(15.0,33.0)d、术后住院时间分别为26.0(15.0,37.0)d和25.0(17.0,43.0)d,分别发生吻合口漏5例和4例、腹膜炎3例和5例、术后NEC 3例和3例、胃肠道出血2例和2例、胆汁淤积症7例和10例、非计划二次手术4例和7例,PN时间分别为18.0(12.0,32.0)d和19.0(13.0,34.0)d,30天内死亡例数分别为0例和1例,30天内再入院人数分别为1例和2例,差异均无统计学意义(P>0.05);分别发生腹胀28例和31例、反复呕吐分别为22例和24例、重复禁食分别为25例和30例、重复胃肠减压分别为23例和27例,差异无统计学意义(P>0.05)。结论 难治型JIA肠吻合术后早期EN是安全的,但在逆转肠道动力障碍所致肠梗阻方面无明显优势。
- Abstract:
- Objective To evaluate the effect of early enteral nutrition (EN) on enhanced recovery after surgery (ERAS) for severe jejunoileal atresia (JIA).Methods From January 2018 to December 2022,clinical data were retrospectively reviewed for 92 neonates of severe JIA.They were assigned into two groups of early feeding (n=39) and conventional feeding (n=53) based upon the time of initial postoperative feeding.General profiles,time to achieve full feeding,length of hospitalization,incidence of complications and feeding intolerance were compared between two groups.Results Time to initial postoperative feeding was significantly shorter in early feeding group than that in conventional feeding group[2.0(1.0,2.0) vs.7.0 (5.0,13.0) day](P<0.05).Time to achieve full feeding in two group was 20.0(10.0,34.0) and 21.0(15.0,33.0) day and postoperative length of stay 26.0(15.0,37.0) and 25.0 (17.0,43.0) day.Anastomotic leakage occurred (n=5 vs.n=4).There were peritonitis (n=5 vs.n=3),postoperative neonatal necrotizing enterocolitis (n=3 vs.n=3),gastrointestinal hemorrhage (n=2 vs.n=2) and cholestasis (n=7 vs.n=10).There were unplanned re-surgeries (n=4 vs.n=7) and duration of parenteral nutrition [18.0(12.0,32.0) vs.19.0(13.0,34.0) day].No death occurred in neither groups within 30 days,except for 1 case in early feeding group.The incidence of readmission within 30 days was (n=1 vs.n=2).There was no significant inter-group statistical difference (P>0.05).There were abdominal distension (n=5 vs.n=4),recurrent vomiting (n=22 vs.n=24),repeated fasting (n=25 vs.n=30) and repeated gastric decompression (n=23 vs.n=27).There were no statistically significant differences (P>0.05).Conclusion Early EN after intestinal anastomosis is safe for severe jejunoileal atresia.However,there is no clear advantage for reverse proximal hypomotility.
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备注/Memo
收稿日期:2023-5-26。
基金项目:广东省医学科学技术研究基金项目(A2020076);广州市科技创新发展专项资金项目(基础与应用基础研究项目)(202102080511)
通讯作者:何秋明,Email:qiuminghe@foxmail.com