加速康复理念联合早期肠液回输在新生儿小肠造瘘术后的临床应用  

Clinical application of enhanced recovery after surgery combined with intestinal fluid reflux in enterostomy in newborn

作　　者：刘文跃[1] 吴晓霞[1] 张晖 孙雪[1] 赵宝红[1] 靳园园[1] 任红霞[1] Liu Wenyue;Wu Xiaoxia;Zhang Hui;Sun Xue;Zhao Baohong;Jin Yuanyuan;Ren Hongxia(Department of Neonatal Surgery,Shanxi Provincial Children's Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院新生儿外科,太原030013

出　　处：《中华新生儿科杂志（中英文）》2024年第3期145-149,共5页Chinese Journal of Neonatology

基　　金：山西省儿童医院院内课题项目(2023002,202055)。

摘　　要：目的探讨加速康复理念联合早期肠液回输技术在新生儿肠梗阻中高位小肠造瘘术后的应用价值。方法本研究为前瞻性病例对照研究,选择2018年12月至2022年12月山西省儿童医院新生儿外科因肠梗阻行中高位小肠造瘘的新生儿为研究对象,术后随机分为加速康复组与传统治疗组。加速康复组术后应用加速康复理念联合早期肠液回输,传统治疗组术后采用常规胃肠减压、不常规镇痛及根据排便量实施肠液回输等传统措施,比较两组患儿术后肠外营养时间、导管留置时间、每日体重增长、住院时间、相关并发症指标及30 d内再入院率。结果共纳入42例患儿,加速康复组22例,传统治疗组20例。加速康复组术后肠外营养时间[(22.6±9.4)d比(30.7±11.3)d]、导管留置时间[(5.9±0.8)d比(9.9±2.1)d]、术后住院时间[(26.8±9.8)d比(33.8±11.5)d]均短于传统治疗组,差异有统计学意义(P<0.05);两组术后每日体重增长比较差异无统计学意义(P>0.05);加速康复组术后胃肠黏膜出血发生率低于传统治疗组(13.6%比45.0%),差异有统计学意义(P<0.05);两组喂养不耐受、肠外营养相关性胆汁淤积、中心静脉导管相关血流感染、肠液回输相关并发症发生率、提前关闭造瘘率以及30 d内再入院率比较,差异均无统计学意义(P>0.05)。结论加速康复理念联合早期肠液回输在新生儿肠梗阻中高位小肠造瘘术后的应用安全可行,能缩短肠外营养使用时间、置管时间和住院时间,加速患儿术后康复。Objective To study the clinical value of enhanced recovery after surgery(ERAS)strategy combined with early intestinal fluid reinfusion among neonates receiving jejunostomy due to intestinal obstruction.Methods From December 2018 to December 2022,neonates with intestinal obstruction receiving jejunostomy in the Department of Neonatal Surgery of our hospital were prospectively enrolled.They were randomly assigned into ERAS group and traditional treatment(TT)group after surgery.The ERAS group was treated with ERAS strategy plus early intestinal fluid reinfusion.The TT group was treated with conventional gastrointestinal decompression,analgesia as needed and enteric fluid reinfusion according to the amount of defecation.The postoperative parenteral nutrition(PN)duration(Tpn),central venous catheter(CVC)duration(Tcvc),daily weight gain,duration of postoperative hospital stay(Thos),complications and readmission rate within 30 days were compared between the two groups.Results A total of 22 cases were included in the ERAS group and 20 cases were in the TT group.Tpn[(22.6±9.4)d vs.(30.7±11.3)d],Tcvc[(5.9±0.8)d vs.(9.9±2.1)d]and Thos[(26.8±9.8)d vs.(33.8±11.5)d]in the ERAS group were significantly shorter than the TT group(P<0.05).No significant difference existed in daily weight gain between the two groups(P>0.05).The incidence of postoperative gastrointestinal mucosal bleeding in the ERAS group was significantly lower than the TT group(13.6%vs.45.0%)(P<0.05).No significant differences existed in the following items between the two groups:feeding intolerance,PN-associated cholestasis,CVC-related bloodstream infection,intestinal fluid reinfusion-related complications,premature closure of fistula and readmission rate within 30 days(all P>0.05).Conclusions The application of ERAS strategy plus early intestinal fluid reinfusion in neonates with enterostomy is safe and feasible,which can reduce the postoperative durations of PN,CVC and hospital stay and accelerate the recovery.

关 键 词：加速康复 肠液回输 肠造瘘 新生儿 

分 类 号：R722.1[医药卫生—儿科]