先天性心脏病术后两种胃肠道营养支持方法的比较

Comparison between two different ways in enteral nutritional support after congenital cardiac operation

目的探讨先天性心脏病（先心病）术后胃肠道营养的最佳方法。方法选取复杂先心病术后病例加例，分为A、B两组，每组各20例，于术后24h开始通过鼻胃管进行胃肠道营养，连续进行6d；A组采用24h持续微量泵输注实施肠道营养，B组采用常规间断喂养，分别于术前及术后第1天、第4天和第7天测定血中白蛋白、前白蛋白和纤维连接蛋白的含量。结果A、B两组病例术后第1天的白蛋白和前白蛋白水平较术前明显下降（P〈0．01），此低水平状态持续至术后第7天（P〈0．05）；B组病例的纤维连接蛋白在术后前4d皆低于术前（P〈0．05），于术后第7天恢复至术前水平；A组病例术后第1天的纤维连接蛋白水平低于术前（P〈0．05），于术后第4天即恢复至术前水平（P〈0．05）；A组病例的肠道并发症发生率低于B组。结论先心病术后通过鼻饲持续进行肠道营养，其效果优于间断肠道喂养。纤维连接蛋白是较敏感的营养学指标。

Objective To find an optimal method in enteral nutritional support after congenital cardiac operation. Methods Forty children received complex congenital cardiac operation were recruited and were divided into two groups. The enteral nutrition support began in 24 h after operation with a nasal-gastric tube, went on for 6 d. In group A the feeding was used in a 24 h contiuous style with a pump, while the intermittent feeding was practiced in group B. Blood sample prepared for measurement of albumin, pre-albumin and fibronectin was obtained at following time：pre-operation;the first, the fourth, and the seventh day after operation. Results The albumin level in two groups decreased significantly in the first post-operation day （ P 〈 0. 01 ） and persisted until the seventh day （ P 〈 0.05 ） ; the pre-albumin level also decreased after operation until the end of this experimentation （ P 〈 0.05 ）. In group B, the fibronectin level decreased in the first three days after operation （P 〈 0. 05 ）, and recovered to the pre-operative level until the seventh day;the fibronectin level in group A decreased in the first day after operation （ P 〈 0. 05 ）, but resumed to the pre-operative de gree irt the fourth day after operation. The gastric-intestinal syndrome was less seen in group A. Conclusion The continuous feeding is a better method than the intermittent one in enteral nutritional support after congenital cardiac ooeration. The fibronectin is a sensitive index in the monitoring of the nutrition status.