加速康复外科模式下的早期肠内营养支持在穿孔性阑尾炎患儿围术期中的应用效果

Application effect of early enteral nutrition support based on enhanced recovery after surgery in perioperative period of children with perforated appendicitis

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)模式下的早期肠内营养支持在穿孔性阑尾炎患儿围术期中的应用效果。方法收集徐州市儿童医院2021年1月至2022年12月期间行ERAS模式下的早期肠内营养支持治疗的穿孔性阑尾炎手术患儿作为观察组,根据与观察组的性别、年龄、病程、病理类型、体质量指数等基线资料均衡可比的原则配对收集2019年1月至2020年12月期间同一医院行常规营养支持治疗的穿孔性阑尾炎手术患儿作为对照组。比较2组患儿术后首次排气或排便时间、住院时间以及术后第1天、术后第7天的营养指标(前白蛋白、白蛋白、血红蛋白)、免疫指标[免疫球蛋白(immunoglobulin,Ig)A、IgM、IgG]、血清炎性因子(C反应蛋白、白介素-6、肿瘤坏死因子-α)及不良反应发生情况。结果观察组和对照组各40例患者,2组患儿在性别、年龄、病程、病理类型、体质量指数等基线资料比较差异无统计学意义(P>0.05)。观察组术后首次排气或排便时间及术后住院时间均短于对照组(t=3.234,P=0.002;t=5.582,P<0.001);术后第7天时观察组的营养指标和免疫指标水平均高于对照组(P<0.05),血清炎性因子水平均低于对照组(P<0.05),且总不良反应发生率低于对照组[5.0%(2/40)比22.5%(9/40),χ^(2)=5.165,P=0.023]。结论从本研究结果看,ERAS模式下的早期肠内营养支持治疗有助于加快穿孔性阑尾炎患儿术后胃肠道功能恢复,纠正患儿营养状态,提高免疫功能,减轻机体炎症反应,且安全性较高。

Objective To investigate the effect of early enteral nutrition(EEN)support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery(ERAS).Methods The children with perforated appendicitis were collected as an observation group,who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital.At the same time,the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender,age,disease course,pathological type,and body mass index with the observation group.The time of first exhaust or defecation and the hospital stay after surgery were compared.Meanwhile,the nutritional indexes[prealbumin(PA),albumin(ALB),hemoglobin(Hb)],immune indexes[immunoglobulin(Ig)A,IgM,IgG],serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]before surgery,on day 1 and 7 after surgery were compared.And the adverse effects were observed.Results There were 40 children with perforated appendicitis in the observation group and the control group,respectively.There were no statistical differences in the baseline data such as the gender,age,course of disease,pathological type,and body mass index between the two groups(P>0.05).The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group(t=3.234,P=0.002;t=5.582,P<0.001).The levels of PA,ALB,Hb,IgA,IgM,and IgG in the observation group were higher than in the control group on day 7 after surgery(P<0.05).The levels of CRP,IL-6,and TNF-αin the observation group were lower than in the control group on day 7 after surgery(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group[5.0%(2/40)vs.22.5%(9/40),χ^(2)=5.165,P=0.023].Conclusions From on the results of this study,EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function,correct nutritional status,improve immune function,and reduce inflammation,and which has a higher safety for children with perforated appendicitis.