腹腔镜下修补儿童食管裂孔疝术后早期肠内营养结合静脉营养的经验分析  

A clinical study of early enteral nutrition combined with parenteral nutrition in children after hiatus hernia surgery

作　　者：万敏 李明兄[1] 张晨[1] 蔡丽娜[1] 朱翠英 徐京[1] WAN Min;LI Mingxiong;ZHANG Chen;CAI Lina;ZHU Cuiying;XU Jing(Department of Cardiothoracic 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心胸外科,江苏南京210008

出　　处：《现代医学》2025年第2期264-270,共7页Modern Medical Journal

摘　　要：目的:探讨食管裂孔疝修补+抗返流术后早期肠内营养结合静脉营养对患儿术后恢复的影响。方法:回顾性分析2016年10月至2023年5月在南京医科大学附属儿童医院心胸外科行食管裂孔疝修补+抗返流术的患儿73例,依据营养支持方法的不同,设为早期联合营养组32例和全肠外营养组41例。比较两组术前1天和术后第7天的营养状况相关指标、肝功能相关指标、术后并发症及住院时间。结果:早期联合营养组的前白蛋白(PAB)、白蛋白(AB)、总蛋白(TP)大幅度降低,相比全肠外营养组,差异有统计学意义(P<0.05);术后第7天检测早期联合营养组的总胆红素(TB)、直接胆红素(DB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)降低,具有统计学意义(P<0.05);早期联合营养组的住院天数、并发感染率、胃排空延迟率及高血糖率均低于全肠外营养组(P<0.05)。早期联合营养组的腹胀腹痛、肠鸣音、胃肠反应等评分均低于全肠外营养组,胃肠道功能的恢复时间明显少于全肠外营养组(P<0.05)。结论:早期实施肠内联合静脉营养支持对改善儿童食管裂孔疝术后的肝功能、降低相关感染率、缩短胃排空延迟时间以及减少患儿住院天数有很大帮助。Objective:To investigate the effect of intravenous nutrition combined with early enteral nutrition on postoperative recovery of children with hiatal hernia repair and anti-reflux surgery.Methods:A retrospective analysis was performed on 73 children who underwent hiatal hernia repair+anti-reflux surgery at the Department of Cardiothoracic Surgery,Children s Hospital Affiliated to Nanjing Medical University from October 2016 to May 2023,these patients were divided into an early combined nutrition group of 32 cases and a total parenteral nutrition group of 41 cases.The study compared preoperative day 1 and postoperative day 7 nutritional status indicators,liver function indicators,postoperative complications,and hospital stay between the two groups.Results:The prealbumin(PAB)、albumin(AB)、total protein(TP)in the early combined nutrition group was significantly lower than that in the total parenteral nutrition group,and the difference was statistically significant(P<0.05).On postoperative day 7,the early combined nutrition group demonstrated significant reductions in total bilirubin(TB),direct bilirubin(DB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and lactate dehydrogenase(LDH)levels compared to preoperative baseline measurements,with all decreases reaching statistical significance(P<0.05).The hospitalization days,co-infection rate,delayed gastric emptying rate and hyperglycemia rate in the early combined nutrition group were lower than those in the total parenteral nutrition group(P<0.05).The gastrointestinal reaction score,abdominal distension pain score and bowel sound score in the early combined nutrition group were lower than those in the total parenteral nutrition group(P<0.05).The scores of abdominal distension and pain,bowel sounds and gastrointestinal reactions in the early combined nutrition group were all lower than those in the total parenteral nutrition group,and the recovery time of gastrointestinal function was significantly shorter than that in the total parenteral nutrition gr

关 键 词：食管裂孔疝 Nissen术 肠内营养 静脉营养 

分 类 号：R726.1[医药卫生—儿科]