经鼻留置空肠营养管肠内营养支持对新生儿高位肠梗阻手术治疗效果的影响  

Effect of transnasal indwelling jejunal nutrition tube in the treatment of high intestinal obstruction operation for the newborns

作　　者：牛会忠[1] 刘锋[1] 张鹏举[1] 耿建磊[1] 任慧[1] Niu Huizhong;Liu Feng;Zhang Pengju;Geng Jianlei;Ren Hui(Department of General Surgery,Children’s Hospital of Hebei Province,Shijiazhuang 050032,China)

机构地区：[1]河北省儿童医院普外科,石家庄050032

出　　处：《中华普通外科学文献（电子版）》2021年第6期437-441,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：河北省医学科学研究课题项目(20190794)。

摘　　要：目的术后不同营养方式对新生儿高位肠梗阻手术治疗效果的影响不一,本研究探讨经鼻留置空肠营养管肠内营养支持的治疗优势。方法前瞻性随机选择2016年2月至2018年2月河北省儿童医院收治的60例高位肠梗阻新生患儿,均行高位肠梗阻手术,按照信封法进行分组:对照组30例,给予肠外营养支持;研究组30例,给予经鼻置入空肠营养管肠内营养支持。观察两组患儿术后1、7、15 d、1个月血常规及血生化指标变化,肠功能恢复情况,术后并发症发生情况;比较两组患儿治疗前后体质量变化、住院时间及住院费用的差异性。随访3个月,记录两组患儿生长发育情况。结果①两组患儿术前血红蛋白水平差异无统计学意义;与术前比较,两组术后1、7、15 d、1个月血红蛋白水平均降低(P<0.05);组间比较,研究组术后1、7 d血红蛋白水平均高于对照组(P<0.05)。②两组术后白蛋白、总蛋白水平组间差异均无统计学意义;与术前比较,两组术后1、7、15 d、1个月白蛋白、总蛋白水平均降低(P<0.05)。③治疗期间,研究组达到全肠内营养时间、喂养达到40 ml/3 h时间、初次排便时间均短于对照组(P<0.05)。④研究组呕吐、腹胀等术后并发症发生率(6.67%)显著低于对照组(26.67%)(χ^(2)=4.320,P=0.038)。⑤治疗前,两组患儿体质量差异无统计学意义。出院时,研究组体质量较对照组高(P<0.05),住院时间较对照组短(P<0.05),住院费用较对照组少(P<0.05)。随访3个月,两组患儿体质量、身高均符合我国7岁以下儿童生长发育参照标准,差异无统计学意义。结论经鼻留置空肠营养管肠内营养支持可有效巩固新生儿高位肠梗阻手术治疗效果,术后并发症较少,有益于新生儿肠道功能恢复,临床价值高。Objective Different nutritional methods have different effects on the newborns with high intestinal obstruction operation.This study is to explore the advantages of enteral nutrition support with transnasal indwelling jejunal nutrition tube(TIJNT).Methods Sixty newborns with high intestinal obstruction treated in Children’s Hospital of Hebei Province from February 2016 to February 2018 were prospectively and randomly selected.All patients underwent high intestinal obstruction surgery and were divided into two groups according to envelope method,with 30 cases in each group:the control group were given parenteral nutrition support;the study group were given TIJNT.The changes of blood biochemical indexes(1 day,7 days,15 days and 1 month after operation),the recovery of intestinal function,the occurrence of postoperative complications,the changes of body mass,hospitalization time and costs between the two groups were compared.The growth and development of the two groups at 3 months after operation were recorded.Results①There was no significant difference in preoperative hemoglobin between the two groups.Compared with preoperation,the hemoglobin levels of the two groups decreased 1 day,7 days,15 days and 1 month after operation(P<0.05).The hemoglobin levels in the study group were higher than those in the control group at 1 day and 7 days after operation(P<0.05).②There were no significant differences in postoperative albumin and total protein between the two groups.Compared with preoperation,the levels of albumin and total protein in the two groups decreased 1 day,7 days,15 days and 1 month after operation(P<0.05).③During the treatment period,the time to achieve total enteral nutrition,feeding up to 40 ml/3 h and the first defecation time in the study group were shorter than those in the control group(P<0.05).④The incidence of postoperative complications such as vomiting and abdominal distension in the study group(6.67%)was significantly lower than 26.67%in the control group(χ^(2)=4.320,P=0.038).⑤Before t

关 键 词：肠梗阻 婴儿 新生 肠道营养 外科手术 经鼻留置 

分 类 号：R726.5[医药卫生—儿科]