预见性鼻饲喂养对改善先天性心脏病患儿营养及喂养状况的效果评价

Effects of preemptive nasogastric lube placement on improving nutrition and feeding status of infants with congenital heart disease

目的评价预见性鼻饲喂养对改善住院先天性心脏病患儿营养状态及临床结局的有效性和安全性。方法连续纳入2018年2—7月复旦大学附属儿科医院心血管中心住院0~12个月的先天性心脏病患儿109例为对照组,采用常规喂养;2018年9月至2019年2月的先天性心脏病患儿101例为干预组,采用预见性鼻饲喂养。比较2组营养指标、喂养指标及临床结局情况。结果干预组患儿入院1周血清白蛋白、前白蛋白分别为(36.81±4.59)、(162.74±48.17)g/L,高于对照组的(34.80±5.21)、(142.98±33.96)g/L,差异有统计学意义(t值为-2.721、-3.169,均P<0.05);干预组患儿每天肠内摄入量、摄入热量及单次肠内摄入热量分别为(124.93±27.97)ml·kg^(-1)·d^(-1)、(376.48±88.53)kJ·kg^(-1)·d^(-1)、(48.39±9.13)kJ·kg^(-1)·次^(-1),高于对照组(114.74±30.63)ml·kg^(-1)·d^(-1)、(330.01±90.75)kJ·kg^(-1)·d^(-1)、(44.24±13.31)kJ·kg^(-1)·次^(-1),差异有统计学意义(t值为-2.511、-3.750、-2.382,均P<0.05);干预组患儿喂养困难发生率为4.95%(5/101)低于对照组的14.68%(16/109),差异有统计学意义(χ^(2)值为5.513,P<0.05);干预组患儿出院时达到目标喂养量比例为97.03%(98/101)高于对照组的84.40%(92/109),差异有统计学意义(χ^(2)值为9.699,P<0.05)。结论预见性鼻饲喂养对婴儿先天性心脏病患儿是安全有效的,适用于临床实践。

Objective To evaluate the effectiveness and safety of preemptive nasogastric tube placement for improving nutritional status and clinical outcomes in hospitalized infants with congenital heart disease.Methods Children from 0 to 12 months with congenital heart disease hospitalized in cardiovascular center of Children's Hospital of Fudan University from February to July 2018 were selected as control group through continuous sampling.Children hospitalized were selected from September 2018 to February 2019 as intervention group.The control group followed the current feeding method,the intervention group used preemptive nasogastric tube placement.The nutritional indicators,feeding indicators and clinical outcomes of the two groups were compared to evaluate the intervention effect.Results The serum albumin and prealbumin of the children in the intervention group were(36.81±4.59)g/L and(162.74±48.17)g/L,which were higher than those in the control group(34.80±5.21)g/L and(142.98±33.96)g/L,the difference between the two groups was statistically significant(t values were-2.721,-3.169,both P<0.05);the daily enteral intake,calorie intake and single enteral calorie intake of children in the intervention group were(124.93±27.97)ml·kg^(-1)·d^(-1),(376.48±88.53)kj·kg^(-1)·d^(-1),(48.39±9.13)kj·kg^(-1)·time^(-1),higher than the control group(114.74±30.63)ml·kg^(-1)·d^(-1),(330.01±90.75)kj·kg^(-1)·d^(-1),(44.24±13.31)kj·kg^(-1)·time^(-1),the difference between the two groups was statistically significant(t values were-2.511,-3.750,-2.382,all P<0.05).the incidence of feeding difficulties in the intervention group was 4.95%(5/101)lower than 14.68%(16/109)of the control group,the difference between the two groups was statistically significant(χ^(2) value was 5.513,P<0.05);the proportion of children in the intervention group reaching the target feeding amount when discharged from the hospital was 97.03%(98/101),higher than 84.40%(92/109)of the control group,the difference between the two groups was statistically significant(χ^(2) value was 9.699,P<0.05).Conclusions Preemptive nasogastric tube placement is safety and effectively for patients with congenital heart disease in clinical infants,but it still needs a large sample for a long time to confirm its effectiveness.