经鼻留置空肠营养管在新生儿高位消化道畸形矫治中的应用

A new transnasal approach of the placement of jejunal feeding tube intraoperatively for upper digestive tract malformation newborn

目的评估经鼻留置空肠营养管肠内营养在新生儿消化道畸形矫治中的意义。方法回顾性分析2010年1月至2013年6月南京医科大学附属南京儿童医院新生儿外科收治的104例新生儿十二指肠、空肠先天性梗阻病例的治疗过程，根据是否经鼻留置空肠营养管肠内营养将患儿分为两组，即术中经鼻放置肠营养管组（置管组，n=54），术中未放置肠营养管组（对照组，n=50）；比较两组患儿胎龄、出生体重、手术年龄、麻醉时间、手术时间、术后肠功能恢复时间（术后经口喂养达40mL/3h的时间）及并发症等方面的差异。结果术前两组患儿在胎龄、出生体重、手术年龄方面比较，差异无统计学意义。置管组麻醉时间、手术时间分别是（131．9±13．5）月，（114．1±13．2）个月，与对照组的（128．7±12．6）月、（110．5±15．3）个月相比，差异无统计学意义。置管组术后经口喂养达40mL/3h所需的时间为（17．7±5．1）d，较对照组（21．4±7．4）d显著缩短（P〈0．05）。术后并发症比较，置管组无肠穿孔、肠扭转、堵管等置管并发症，无粘连性肠梗阻，发生胆汁淤积l例；对照组术后发生功能性肠梗阻3例，粘连性肠梗阻4例，胆汁淤积6例，发生率较置管组显著增加。结论术中经鼻放置肠营养管用于高位消化道畸形新生儿术后肠内营养，方法简单，无创伤，并发症少，有助于提高喂养耐受性，为新生儿消化道手术后早期肠内营养提供了一条安全、有效的途径。

Objetive To accomplish early enteral feeding in upper digestive tract malformation newhorn,a new transnasal approach to the placement of postpylorie enteral nutrition tubes intraoperatively was evaluated. Methods Retrospective review the clinical data of 104 newborn cases about duodenal,jejunal congenital obstruction treated in Neonatal Surgery Department of Nanjing Children＇ s Hospital from January 2010 to June 2013. According to whether transnasal approach to the placement of postpyloric enteral nutrition tubes intraoperatively, patients were divided into two groups ： indwelling tube group （ n = 54 ） , control group （ n = 50 ）. The gestational age, birth weight, age at surgery, time of anesthesia, time of operation, time for intestinal function recovery （ the time of oral feeding of 40 mL/3 h postoperative ） , and complications were evaluated. Results There were no significant differences in gestational age, birth weight and age at surgery between the two groups. The time of anesthesia （ 131.9 ± 13.5 m） vs （ 128.7 ± 12.6 m） and operation time （ 114. 1± 13.2 m） vs （ 110.5 ± 15.3 m） of two groups showed no statistical difference （ P 〉 0.05 ） ; However the time of oral feeding up to 40 mL/3 h postoperative （17.7±5.1 d） in indwelling tube group was significantly shorter than that in control group （ （21.4 ± 7.4d） ,P 〈 0. 05 ）. There were no tube plugging complications such as intestinal perforation,intestinal volvulus, no adhesive intestinal obstruction occurred, only one case of cholestasis in indwellingtube group. In contrast, with four cases of function of intestinal obstruction postoperation, three cases of adhesive intestinal obstruction and 6 cases of cholestasis in the control group, occurrence rate was significantly increased than indwelling tube group. Conclusion It is simple, with no trauma and little complications, and can improve the feeding tolerance to place jejunal feeding tube transnasal in upper digestive tract malformation neonate intraoperatively. It provides a safe, effective approach for early cnteral nutrition after gastrointestinal operation in newborns.