不同喂养方式在Ⅲ型先天性食道闭锁患儿术后营养支持中的应用效果对比及其对肠黏膜屏障功能的影响

Effects of different feeding methods on postoperative nutritional support and on intestinal mucosal barrier function in children with typeⅢcongenital esophageal atresia

目的:研究Ⅲ型先天性食道闭锁患儿术后实施十二指肠喂养后对其生长代谢水平、营养状态的影响。方法:选择我院113例行手术治疗的Ⅲ型先天性食道闭锁患儿作为研究对象,按照抽签法将患儿分为对照组56例,观察组57例。对照组患儿实施鼻胃管喂养,观察组患儿实施十二指肠喂养。对比两组患儿营养状态,包括术后7 d和14 d的血清白蛋白(Albumin,ALB)和血清前白蛋白(Prealbumin,PA)水平;生长代谢水平,包括术后7 d和术后14 d的总热卡、蛋白质及蛋白质能量比;肠黏膜屏障功能:血浆D-乳酸、血清肠型脂肪酸结合蛋白(Intestinal fatty acid binding protein,I-FABP)浓度。结果:两组术后7、14 d PA、Alb、总热卡、蛋白质含量、蛋白质能量比水平较喂养前均升高;D-乳酸、I-FABP水平较喂养前均降低(P<0.05);观察组术后7 d和术后14 d Alb、PA、蛋白质能量比和总热卡高于对照组(P<0.05),D-乳酸、I-FABP水平均低于对照组(P<0.05);术后14 d观察组患儿蛋白质含量高于对照组(P<0.05)。结论:十二指肠喂养可有效提高Ⅲ型先天性食道闭锁患儿术后营养状态,促进患儿的肠黏膜屏障功能恢复,提高其生长代谢水平。

Objective:To investigate the effects of duodenal feeding on growth,metabolic and nutritional status of children with typeⅢcongenital esophageal atresia.Methods:A total of 113 children with typeⅢcongenital esophageal atresia who underwent surgical treatment in our hospital were selected as the research objects.The children were divided into control group(56 cases)and observation group(57 cases)by lottery.The control group were fed with nasogastric tube,and the observation group were fed with duodenum.Nutritional status(serum Albumin(ALB)and Prealbumin(PA)),growth and metabolism levels(total calories,protein and protein energy ratio)and intestinal mucosal barrier function plasma concentrations of D-lactic acid and serum(Intestinal fatty acid binding protein(I-FABP))of the two groups were compared at day 7 and day 14 after surgery.Results:On day 7 and day 14 after surgery,the levels of PA,Alb,total calories,protein content and protein energy ratio in the two groups were higher than those before feeding.The levels of D-lactic acid and I-FABP were lower than those before feeding(P<0.05).The levels of Alb and PA,the protein energy ratio and total calorie in the observation group were higher than those in the control group on day 7 and day 14 after surgery(P<0.05).On day 7 and day 14 after surgery,the levels of D-lactic acid and I-FABP were lower than those in control group(P<0.05).The protein content of the observation group was higher than that of the control group on day 14 after surgery(P<0.05).Conclusion:Duodenal feeding can effectively improve the postoperative nutritional status of children with typeⅢcongenital esophageal atresia,promote the recovery of intestinal mucosal barrier function,and improve their growth and metabolism level.