早期微泵肠内营养输注对新生儿食管闭锁临床预后的研究

Early enteral nutrition infusion micropump supports for neonate esophageal atresia

目的探讨早期微泵肠内营养输注法在新生儿食管闭锁治疗中的必要性及对预后的影响。方法回顾性分析1999年4月至2012年4月收治的新生儿Ⅲ型食管闭锁112例的临床资料。112例均采用食道一期吻合术。其中，1999—2006年的50例为常规治疗组，2006—2012年的62例为早期微泵肠内营养组。两组病例胎龄、人院体重无明显差异，围手术期均常规行肠外营养。早期微泵肠内营养组术后3d微泵微量输注法给予深度水解奶和益生菌，并逐步增量过渡为经口全喂养。常规治疗组术后7d开始经鼻一胃管喂养，逐步增量并过渡至经口全喂养。结果早期微泵肠内营养组治愈59例，死亡3例，病死率为4．8％，存活儿体重增加52例，不变5例，平均体重增加（0．11±0．06）k。常规治疗组治愈47例，死亡3例，病死率为6％，存活儿体重均下降，平均体重降低（0．05±0．04）kg。两组呼吸机辅助时间、住院天数、首次排便时间、人／出院体重变化经t检验及卡方检验，差异有统计学意义（P〈O．05）；病死率和吻合口瘘发生率差异没有统计学意义（P〉O．05）。结论新生儿食管闭锁术后早期微泵肠内营养输注法可有效改善患儿的营养风险，缩短住院时间和减少经济花费，而病死率和吻合口瘘发生率无明显变化。

Objective To evaluate the effects of early enteral nutrition infusion micropump supports during peri-operation in the treatment of neonate esophageal atresia. Methods Retrospective analyses were performed for 112 cases of newborn esophageal atresia between April 1999 and April 2012. Fifty patients between 1999-2006 received conventional therapy while 62 patients after 2006 had early enteral nutrition infusion micropump supports during peri-operation. The gestational age and admission weight had no significant intergroup difference. Early enteral nutrition infusion micropump support group received enteral nutrition after 3 days while control group had enterai nutrition after 7 days. Both groups are received basic supports during peri-operation. Results In early enteral nutrition infusion micropump support group, 59 cases were cured and 3 died with a mortality rate of 4. 8%. For cured children, their average weight increased （0. 11 ± 0. 06） kg, 52 cases gained weight and 5 cases had no change in weight; in control group, 47 cases were cured and 3 died with a mortality rate of 6~. For cured cases, their average weight decreased （0. 05 ± 0. 04） kg. Significant intergroup differences existed in ventilator time, days of hospitalization and weight change （P〈0. 05）. But mortality rate and anastomotic leak showed no intergroup difference （P〉0. 05）. Conclusions Early enteral nutrition infusion micropump supports can significantly reduce the nutrition risks of neonate esophageal atresia, shorter in-hospital stays, reduce economic costs and improve prognosis.