加速康复外科联合经鼻留置空肠营养管在先天性肠旋转不良治疗中的应用  

Application of enhanced recovery after surgeryplus transnasal placement of jejunal feeding tube for intestinal malrotation in neonates

作　　者：路长贵[1] 陈焕[1] 耿其明[1] 李红星[1] 谢华[1] 徐小群[1] 唐维兵[1] Lu Changgui;Chen Huan;Geng Qiming;Li Hongxing;Xie Hua;Xu Xiaoqun;Tang Weibing(Department of Neonatal Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008, China)

机构地区：[1]南京医科大学附属儿童医院新生儿外科,210008

出　　处：《中华小儿外科杂志》2019年第9期790-796,共7页Chinese Journal of Pediatric Surgery

基　　金：南京市科技发展计划(201723006).

摘　　要：目的评估加速康复外科(enhanced recovery after surgery,ERAS)联合经鼻留置空肠营养管应用于先天性肠旋转不良治疗的安全性和有效性。方法以2015年1月至2018年3月间南京医科大学附属儿童医院收治的51例年龄为1~28 d的先天性肠旋转不良新生儿为研究对象。患儿在明确诊断后,根据家长意愿分为两组,其中31例患儿采用加速康复外科处理模式同时术中经鼻留置空肠营养管(ERAS组),20例采用传统围手术期处理模式(对照组)。比较两组患儿术前住院时间、手术时间、术中出血量、术后首次排便时间、术后初次肠内营养时间、术后完全肠内营养时间、术后应激指标和并发症发生率等情况。结果ERAS组和对照组术前住院时间[(1.78±0.33)d比(2.28±0.74)d]、手术时间[(139.16±7.03)min比(74.30±5.92)min]、术后首次排便时间[(1.80±0.33)d比(2.25±0.54)d]、初次肠内营养时间[(1.32±0.31)d比(4.42±0.82)d]、完全肠内营养时间[(7.55±0.66)d比(8.40±0.75)d],术后24 h应激反应指标C反应蛋白[(9.29±1.81)mg/L比(20.45±4.31)mg/L]、白细胞介素6[(2.76±0.21)pg/L比(7.10±1.02)pg/L]及皮质醇水平[(86.75±32.77)nmol/L比(156.75±35.59)nmol/L]比较,差异均有统计学意义(P均<0.05);但两组术中出血量[(18.77±3.57)ml比(18.90±3.48)ml]比较,差异无统计学意义。术后主要并发症方面,随访6个月,两组均无肠扭转复发及粘性肠梗阻发生患儿;对照组有2例出现切口感染,ERAS组无。ERAS组和对照组呼吸道感染率分别为9.6%(3/31)和15.0%(3/20),腹泻发生率分别为6.4%(2/31)和10.0%(2/20),组间比较,差异均无统计学意义(P>0.05)。术后随访6个月,ERAS组及对照组均无再入院患儿。结论ERAS处理模式联合经鼻留置空肠营养管应用于新生儿肠旋转不良治疗是安全可行的,可减少患儿应激损伤,促进患儿早期恢复。Objective To evaluate the safety and efficacy of enchanced recovery plus transnasal placement of jejunal feeding tube for intestinal malrotation in neonates. Methods A prospective study was conducted for assessing the safety and efficacy of enhanced recovery after surgery (ERAS) plus transnasal placement of jejunal feeding tube for intestinal malrotation. A total of 51 surgical neonates aged from 1 day to 28 days with intestinal malrotation from January 2015 to March 2018 were recruited and divided into ERAS group (ERAS plus transnasal placement of jejunal feeding tube, n=31) and control group (n=20) according to the parental willingness on admission. The parameters of intraoperative blood loss, operative duration, preoperative hospital stay, time to initial defecation, time to initial enteral nutrition, time to total enteral nutrition time, postoperative stress and complications were compared. Postoperative recovery was tracked for 6 months. Results Significant inter-group differences existed in preoperative hospital stay [(1.78±0.33) vs.(2.28±0.74) days], operative duration [(139.16±7.03) vs.(74.30±5.92)min], time to first defecation [(1.80±0.33)vs.(2.25±0.54)days], time to initial enteral nutrition [(1.32±0.31) vs.(4.42±0.82) days] and time to total enteral nutriton [(7.55±0.66) vs.(8.40±0.75) days](all P<0.05). There were also inter-group statistical differences (P<0.05) in stress parameters at 24h post-operation including c-reactive protein (CRP)[(9.29±1.81) vs.(20.45±4.31) mg/L], interleukin-6 [(2.76±0.21) vs.(7.10±1.02) pg/L] and cortisol [(86.75±32.77) vs.(156.75±35.59) nmol/L]. However, the difference of intraoperative blood loss was not statistically significant between two groups [(18.77±3.57) vs.(18.90±3.48) ml]. As for postoperative complications, there was no recurrence of volvulus in neither groups and no incision infection in ERAS group. However, two incision infections occurred in control group. The inter-group rates of respiratory tract infection and diarrhea were not statistic

关 键 词：肠道营养 空肠 肠旋转不良 加速康复外科 

分 类 号：R726.5[医药卫生—儿科]