手术及术后喂养时机对先天性肥厚性幽门狭窄患儿营养状况的影响

Effect of the operative and postoperative feeding time on the nutritional status of children with congenital hypertrophic pyloric stenosis

目的总结先天性肥厚性幽门狭窄患儿围术期营养支持策略。方法回顾性分析本院2005年1月～2012年12月收治的100例先天性肥厚性幽门狭窄患儿行幽门环肌切开手术治疗的临床资料，按入院至手术时间长短将患儿分为早手术组（入院至手术时间〈48h）、晚手术组（入院至手术时间≥48h）；按手术后首次进食时间分为早喂养组（术后首次进食时间〈24h），晚喂养组（术后首次进食时间≥24h），分别比较各组治疗效果。结果各组Ln生时间、入院体重、呕吐至人院时间差异无统计学意义（P〉0.05）。早手术组和早喂养组的总住院时间、达全量喂养时间、肠外营养维持时间、术后治疗时间短于晚手术组和晚喂养组，组问差异有统计学意义（P〈0.01）；早手术组和早喂养组体重增长速度分别高于晚手术组和晚喂养组，组间差异有统计学意义（P〈0.01）。结论先天性肥厚性幽门狭窄患儿围术期早期营养支持对保证手术成功具有重要意义。

Objective To summarize the perioperative nutritional support strategy for congenital hypertrophic pyloric stenosis. Methods 100 cases of children with congenital hypertrophic pyloric stenosis who underwent circular muscle resection in our hospital from January 2005 to December 2012 were retrospectively analyzed. According to the duration from the admission to surgery, they were divided into early surgery group（duration 〈 48 h）, and late surgery group（duration ≥ 24 h）. According to the first feeding time, they were divided into early feeding group（duration 〈 24 h）, and late feeding group （duration ≥24 h）. The therapeutic effects were compared between each group. Results The time of birth, weight on admission, and vomiting of early surgery group were not significantly different from the late surgery group （P〉0.05）. In early surgery group and early feeding group, the total length of hospital stay, time to full amount feeding, maintaining the parenteral nutrition time were all shorter than the late surgery group and late feeding group; the growth rates of body weight was higher than the late surgery group and late feeding group with significant differences （P〈 0.01）. Conclusion The early perioperative nutritional support has great significance to ensure the success of surgery for children with congenital hypertrophic pyloric stenosis.