早期肠内营养对先天性室间隔缺损修补术后病儿预后的影响
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摘要
目的:探讨早期肠内营养(EEN)对先天性室间隔缺损体外修补术后病儿预后的影响。方法:选取在我院行体外循环下先天性室间隔缺损修补术的36例病儿为研究对象,随机分为观察组和对照组,分别给予规范化EEN和常规营养支持。观察两组病儿的术后并发症发生率、喂养状况、胃肠功能、达到全肠内营养(TEN)的时间以及心脏监护室(CICU)滞留时间。结果:观察组和对照组术后并发症(包括呼吸机相关性肺炎、胸腔积液及心率失常)发生率分别为25.0%和11.8%,差异无统计学意义(P> 0.05);观察组病儿术后腹胀、呕吐、喂养不耐受及喂养中断的发生率明显低于对照组(P <0.05);观察组病儿术后胃黏膜pH值高于对照组,而术后24 h和48 h血糖、胃泌素、胃动素均低于对照组,差异均具有统计学意义(P <0.05);与对照组相比,观察组病儿术后达到TEN的时间(68.3±14.7)h,及CICU滞留时间(42.3±10.2)h缩短(P <0.05)。结论:先天性室间隔缺损修补术后给予EEN可以改善病儿糖代谢紊乱,促进术后胃肠功能的恢复,缩短CICU滞留时间,改善病儿预后。
Objective: To assess the effects of early enteral nutrition on the outcome in infants with congenital ventricular septal defect repair. Methods: Thirty-six infants with ventricular septal defects(VSD) repair under cardiopulmonary bypass in our hospital was randomly divided into observation group and control group. Observation group was fed with early enteral nutrition, and control group was given routine nutrition. The incidence of postoperative complications, feeding status, gastrointestinal function, time to achieve total gastrointestinal nutrition, and Cardiac Intensive Care Unit(CICU) retention time were observed. Results: The incidence of postoperative complications(including ventilator-associated pneumonia, pleural effusion and arrhythmia)in the observation group and the control group were 25% and 11.8%, respectively. The difference between two groups was not statistically significant(P > 0.05).The incidence of abdominal distension, vomiting, feeding intolerance and feeding interruption in the observation group was significantly lower than that in the control group(all P < 0.05). The pH value of gastric mucosa in the observation group was higher than that in the control group(P < 0.05). And the observation group has a lower level of blood glucose,gastrin and motilin at 24 and 48 hours after operation compared with the control group(P < 0.05). The time to achieve total gastrointestinal nutrition [(68.3 ± 14.7)h,P <0.05] and the retention time of CICU [(42.3 ± 10.2)h,P <0.05] in the observation group were significantly shorter compared with the control group. Conclusion: Early eternal nutrition can reduce glucose metabolism disorder, improve the recovery of gastrointestinal function, shorten the retention time of CICU, and improve the outcome of pediatric patients undergoing VSD repair surgery.
Objective: To assess the effects of early enteral nutrition on the outcome in infants with congenital ventricular septal defect repair. Methods: Thirty-six infants with ventricular septal defects(VSD) repair under cardiopulmonary bypass in our hospital was randomly divided into observation group and control group. Observation group was fed with early enteral nutrition, and control group was given routine nutrition. The incidence of postoperative complications, feeding status, gastrointestinal function, time to achieve total gastrointestinal nutrition, and Cardiac Intensive Care Unit(CICU) retention time were observed. Results: The incidence of postoperative complications(including ventilator-associated pneumonia, pleural effusion and arrhythmia)in the observation group and the control group were 25% and 11.8%, respectively. The difference between two groups was not statistically significant(P > 0.05).The incidence of abdominal distension, vomiting, feeding intolerance and feeding interruption in the observation group was significantly lower than that in the control group(all P < 0.05). The pH value of gastric mucosa in the observation group was higher than that in the control group(P < 0.05). And the observation group has a lower level of blood glucose,gastrin and motilin at 24 and 48 hours after operation compared with the control group(P < 0.05). The time to achieve total gastrointestinal nutrition [(68.3 ± 14.7)h,P <0.05] and the retention time of CICU [(42.3 ± 10.2)h,P <0.05] in the observation group were significantly shorter compared with the control group. Conclusion: Early eternal nutrition can reduce glucose metabolism disorder, improve the recovery of gastrointestinal function, shorten the retention time of CICU, and improve the outcome of pediatric patients undergoing VSD repair surgery.
引文
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[5]汪志明.肠内营养支持途径的建立与管理.肠外与肠内营养,2017, 24(2):68-71.
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[7]黑飞龙,王泽锋,崔勇丽,等.糖预处理对体外循环中胃肠激素和糖代谢的影响.中国体外循环杂志, 2010, 8(2):103-105.
[8] Constable PD. Acid-Base Assessment:When and How To Apply the Henderson-Hasselbalch Equation and Strong Ion Difference Theory. Vet Clin North Am Food Anim Pract, 2014, 30(2):295-316.
[9]程伟鹤,鲁梅珊,郭海凌,等.危重症患者早期肠内营养喂养不耐受的研究进展.中华护理杂志,2017,52(1):98-102.
[10]罗雯懿,何萍萍.先天性心脏病术后患儿住院期间营养现状的调查分析.中国实用护理杂志, 2013, 29(24):16-18.
[11]罗雯懿,何萍萍.先天性心脏病术后患儿早期肠内营养支持的研究进展.中华现代护理杂志, 2014, 20(15):1873-1875.
[12] Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest, 2006, 129(4):960-967.
[13] Gounaris A, Anacolitou F, Costalos C, et a1. Minimal enteral feeding,nasojejunal feeding and gastrin levels in premature infants. Acta Paediatr Scand,1990, 79(2):226-227.
[14]刘吉勇,姜军梅.胃肠激素与腹泻.山东医药, 2001, 41(14):55-56.
[15] Braramaki T, Konturek PC, Konturek SJ, et a1. Involvement of cyclooxygenase(cox)-2 products in acceleration of ulcer healing by gastrin and hepatocyte growth factor. J Physiol Pharmacol,2000, 51(4 Pt 1):751-773.
[2]罗文懿,何萍萍,唐珊珊.先心病术后机械通气患儿肠内营养支持流程对照研究.护理学杂志, 2015,30(12):31-33.
[3] Gaies MG, Gurney JG, Yen AH, et a1. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2):234-238.
[4]中华医学会小儿外科学分会心胸外科学组,中华医学会肠外肠内营养学分会儿科学组.先天性心脏病患儿营养支持专家共识.中华小儿外科杂志, 2016,37(1):3-8.
[5]汪志明.肠内营养支持途径的建立与管理.肠外与肠内营养,2017, 24(2):68-71.
[6]罗雯懿,何萍萍,韩萍,等.先天性心脏病患儿术后早期肠内营养支持流程的建立.护理管理杂志, 2015,15(3):186-188.
[7]黑飞龙,王泽锋,崔勇丽,等.糖预处理对体外循环中胃肠激素和糖代谢的影响.中国体外循环杂志, 2010, 8(2):103-105.
[8] Constable PD. Acid-Base Assessment:When and How To Apply the Henderson-Hasselbalch Equation and Strong Ion Difference Theory. Vet Clin North Am Food Anim Pract, 2014, 30(2):295-316.
[9]程伟鹤,鲁梅珊,郭海凌,等.危重症患者早期肠内营养喂养不耐受的研究进展.中华护理杂志,2017,52(1):98-102.
[10]罗雯懿,何萍萍.先天性心脏病术后患儿住院期间营养现状的调查分析.中国实用护理杂志, 2013, 29(24):16-18.
[11]罗雯懿,何萍萍.先天性心脏病术后患儿早期肠内营养支持的研究进展.中华现代护理杂志, 2014, 20(15):1873-1875.
[12] Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest, 2006, 129(4):960-967.
[13] Gounaris A, Anacolitou F, Costalos C, et a1. Minimal enteral feeding,nasojejunal feeding and gastrin levels in premature infants. Acta Paediatr Scand,1990, 79(2):226-227.
[14]刘吉勇,姜军梅.胃肠激素与腹泻.山东医药, 2001, 41(14):55-56.
[15] Braramaki T, Konturek PC, Konturek SJ, et a1. Involvement of cyclooxygenase(cox)-2 products in acceleration of ulcer healing by gastrin and hepatocyte growth factor. J Physiol Pharmacol,2000, 51(4 Pt 1):751-773.