新生儿复杂先天性心脏病术后不同时间肠内营养的效果

Effects of Enteral Nutrition at Different Postoperative Periods in Neonates with Complicated Congenital Heart Disease

目的探讨新生儿复杂先天性心脏病(CHD)术后不同时间肠内营养(EN)的效果。方法分析2018年1月至2020年12月郑州大学第三附属医院心脏重症监护病房(CICU)收治的98例复杂CHD新生儿术后的临床资料。将术后24 h开始接受EN的32例患儿纳入24 h组,将术后6 h开始接受EN的66例患儿纳入6 h组。比较两组术后喂养不耐受、营养相关实验室检查[白蛋白、前白蛋白和视黄醇结合蛋白(RBP)]和临床结果(机械通气时间、CICU住院时间和术后住院时间)。结果24 h组喂养不耐受、胃潴留、术后使用促胃动力药物发生率均高于6 h组(P<0.05)。与24 h组相比,6 h组前白蛋白和RBP水平较高(P<0.05)。6 h组观察窗时间达到目标热量患儿占比高于24 h组,术后CICU住院时间、CICU总住院时间、术后住院时间和总住院时间均短于24 h组(P<0.05)。结论术后早期EN可改善复杂CHD患儿的营养状况和临床预后,且无明显喂养不耐受。

Objective To explore the effects of enteral nutrition(EN)at different postoperative periods in neonates with complicated congenital heart disease(CHD).Methods The postoperative clinical data of 98 neonates with complex CHD admitted to Cardiac Intensive Care Unit(CICU)of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were analyzed.Thirty-two children who started receiving EN 24 hours after surgery were included in 24 h group,and 66 children who started receiving EN 6 hours after surgery were included in 6 h group.The postoperative feeding intolerance,nutrition-related laboratory tests,including albumin,prealbumin and retinol binding protein(RBP)and clinical results,including mechanical ventilation time,CICU hospital stay and postoperative hospital stay were compared between the two groups.Results The incidences of feeding intolerance,gastric retention and postoperative use of prokinetic drugs in 24 h group were all higher than those in 6 h group(P<0.05).Compared with 24 h group,the levels of prealbumin and RBP were both higher in 6 h group(P<0.05).The proportion of children who reached the target calories in the 6-hour observation window in 6 h group was higher than that in 24 h group,and the postoperative CICU hospital stay,total CICU hospital stay,postoperative hospital stay and total hospital stay in 6 h group were shorter than those in 24 h group(P<0.05).Conclusion Early postoperative EN can improve the nutritional status and clinical prognosis of children with complicated CHD without obvious feeding intolerance.