深化术前营养预康复管理在小儿先天性巨结肠中的应用效果评价

Application and effect evaluation of deepening preoperative nutritional pre-rehabilitation management in children with hirschsprung's disease

目的探讨深化术前营养预康复在小儿先天性巨结肠中的应用效果。方法回顾性分析2015—2020年右江民族医学院附属医院收治的先天性巨结肠患儿82例,男65例,女17例;年龄3~58个月,平均(5.2±1.8)个月;根据处理方法的不同分为对照组(36例,2015—2017年)、预康复组(46例,2018—2020年)。对照组采用传统处理模式,预康复组术前1~2个月施行预康复,进行营养评估及营养干预,围手术期采用加速康复外科模式,比较预康复组预康复前后营养不良的发生率以及两组的各项围手术期指标、术后随访观察指标。结果预康复组中,预康复后患儿体重指数(BMI)和前白蛋白(PA)优于预康复前(P<0.05);预康复组在术后留置胃管时间、肠功能恢复时间、术后住院时间、小肠结肠炎的发生率方面少于对照组(P<0.05),对照组术后24 h C反应蛋白(CRP)高于预康复组(P<0.05)。结论深化术前营养预康复的加速康复外科流程,能够矫正部分患儿的营养不良,使患儿更安全地耐受手术,降低术后炎症水平,并能够减少术后小肠结肠炎的发生率。

Objective To explore the application effect of pre-rehabilitation with deepening nutritional intervention in children with hirschsprung's disease(HSCR).Methods A retrospective analysis was carried out on 82 children(65 males and 17 females)with HSCR admitted to Affiliated Hospital of Youjiang Medical University for Nationalities from 2015 to 2020.They aged 3 to 58 months,with an average age of(5.2±1.8)months,and they were divided into control group(36 cases,from 2015 to 2017)and pre-rehabilitation group(46 cases,from 2018 to 2020).The control group were given traditional treatment mode,and the pre-rehabilitation group were given pre-rehabilitation,nutritional assessment and nutritional intervention 1-2 months before surgery,and enhanced recovery surgery model was used in perioperative period.And then,the incidence of malnutrition before and after pre-rehabilitation in the pre-rehabilitation group was compared,and perioperative and postoperative follow-up indicators were compared between the control group and the pre-rehabilitation group.Results In pre-rehabilitation group,body mass index(BMI)and prealbumin(PA)after pre-rehabilitation were better than those before pre-rehabilitation(P<0.05).In addition,the pre-rehabilitation group was superior to the control group in the time of indwelling gastric tube,recovery time of intestinal function,postoperative hospital stay and the incidence of enterocolitis(P<0.05),C-reactive protein(CRP)in the control group was higher than that in the pre-rehabilitation group 24 hours after surgery(P<0.05).Conclusion Deepening enhanced recovery after surgery process of preoperative nutritional pre-rehabilitation can correct malnutrition in some children,make children tolerate surgery more safely,reduce postoperative inflammation levels,and lower the incidence of postoperative enterocolitis.