早期肠内营养支持对先天性心脏病术后患儿营养状况和临床预后的影响

Early enteral nutritional support on nutrition assessments and clinical outcomes of congenital heart disease postoperation

目的 探讨早期肠内营养支持对先天性心脏病术后患儿营养相关指标及临床结局的影响.方法 选取2013年10月至2014年10月,年龄6个月～2岁的100例先天性心脏病患儿,按照性别匹配随机分为对照组和早期肠内营养支持干预组.对照组不予以营养支持,营养干预组的营养补充根据早期肠内营养支持方案制订：术后当天撤离呼吸机,拔管后6h开始肠内营养;长期呼吸机辅助者,术后常规留置鼻-胃管并于12～24 h开始肠内营养.记录术前年龄、身高、体质量,血清C-反应蛋白（CRP）、视黄醛结合蛋白（RBP）和前白蛋白（Pre-ALB）水平.术后7天再观察和记录上述指标.同时在患儿住院时期观察并记录喂养中断次数、首次大便时间,重症监护（ICU）时间以及呼吸机辅助时间.结果 对照组和肠内营养干预组患儿的基础信息和临床症状差异无统计学意义.营养状况的评价中,术后营养干预组中年龄别体质量Z得分（WAZ）高于对照组,差异有统计学意义（-0.22±1.16对0.73±1.29,P=0.019）.营养干预组和对照组手术前、后年龄/身高Z得分（LAZ/HAZ）和身高/体质量Z得分（WLZ/WHZ）差异均无统计学意义.两组术前血清CRP、RBP和Pre-ALB差异无统计学意义.术后7天营养干预组的CRP水平显著低于对照组[（45.2±16.2）mg/L对（67.3±35.5）mg/L,P〈0.001],RBP[（0.3±0.1）mg/L对（0.2±0.1）mg/L,P=0.031]和Pre-ALB水平[（35.2±12.2）g/L对（25.2±14.2）g/L,P=0.029]高于对照组,差异均有统计学意义.临床结局的评价指标中,与对照组相比,早期肠内营养组首次大便时间早[（36±12）h对（65±15）h,P=0.008];两组患儿住ICU时间、呼吸机辅助时间、喂养中断次数等差异均无统计学意义,P〉0.05.结论 早期肠内营养促进先天性心脏病术后患儿恢复胃肠动力,改善患儿营养状况,降低血清CRP并升高RBP和Pre-ALB.喂养中断次数,ICU时间及呼吸机辅助时间与早期肠内营养支持无关.

Objective To investigate the effect and feasibility of early enteral nutrition support on postoperative nutrition assessments and clinical outcomes in children patients with congenital heart disease. Methods From October 2013 to October 2014, a number of 100 cases congenital heart disease aged six months to two years old were treated with early enteral nutrition support after operation. According to gender, fifty patients were randomly divided into the intervened group, who were treated with the early enteral nutrition support program. The other fifty patients were divided into control group with no nutrition sup-port. The detailed early enteral nutrition support project were（ a） withdraw breathing machine at the same day, giving enteral nutrition 6 hours later after postoperation;（ b） patients assist with long-term breathing machine, giving enteral nutrition 12-24 hours later after postoperation. The age, heigth, weight, serum C- reactive protein（CRP）, serum retinoic binding protein （ RBP） , serum prealbumin（ Pre-ALB） were recorded before operation. Seven days after operation, above indicators were ob-served again. In addition, the first time of excrete, the number of feeding interruption, the time of feeding, the time of ventila-tor, and the related complications were also recorded at hospitalization period. Results No difference of basic information and accompanying complications were observed between control and nutritional intervention group. As to nutritional status, weight-for-age z-score（WAZ） were significant higher in the nutritional intervention group than the control group（ -0. 22 ± 1. 16 vs. 0.73 ±1.29, P=0.019） after operation. However length/height-for-age z-score（LAZ/HAZ） and weight-for-length/height z-score（ WLZ/WHZ） were similar between control and nutritional intervention group whatever pre-operation and postoperation. Preoperative CRP, RBP, and Pre-ALB were no significant difference between early enteral nutrition and control group. After operation CRP levels in the early enteral nutrition group were significantly lower than that of control group[（45.2 ±16.2）mg/L vs.（67.3±35.5）mg/L,P〈0.001],whileRBP[（0.3±0.1）mg/Lvs.（0.2±0.1）mg/L]andPre-ALB[（35.2±12.2）g/Lvs.（25.2±14.2）g/L] weresignificantlyhigherthanthoseofcontrolgroup（Pvaluewere0.031and0.029,respective-ly） . In the early nutritional intervention group and control group, the first time of excrete were remarkable in advance in nutri-tionalinterventiongroupcompredtocontrolgroup[（36±12）hvs.（65±15）h,P=0.008],whilethedifferenceoffeeding interruption times, intensive care unit（ ICU） time and mechanical ventilation time in the two groups were not statistically signif-icant（P〉0. 05）. Conclusion Early nutritional intervention can help gastrointestinal function, enhance nutritional status, lower serum CRP levels and increased serum RBP and Pre-ALB concentrations. It did not add ICU time and ventilation time.