不同鼻胃管喂养模式对食管闭锁术后恢复的影响

Effects of early nasogastric tube feeding modes on neonatal congenital esophageal atresia

目的探讨食管闭锁术后经鼻胃管进行高能量密度的早期肠内营养模式对术后恢复的影响。方法收集2016年1月至2022年12月在天津市儿童医院一期食管吻合手术治疗的Ⅲb型先天性食管闭锁36例患儿的资料,所有患儿均于术后早期经鼻胃管进行肠内营养(enteral nutrition,EN)。根据所使用配方奶能量密度分为两组:一组为早期微量EN组17例,其中男11例,女6例,胎龄为(38.8±1.3)周,出生体重为(2.6±0.3)kg,术后早期给予深度水解配方奶微量喂养;另一组早期强化EN组19例,其中男13例,女6例,胎龄为(38.5±1.8)周,出生体重为(2.8±0.4)kg,术后早期给予高能量密度深度水解配方奶喂养。两组均根据胃肠道耐受情况,逐步增加肠内营养量,最终过渡至完全经口喂养。采用IBM SPSS Statistics 26软件处理所有数据,符合正态分布的定量资料用独立样本t检验,非正态分布用非参数检验。结果两组在术前一般指标、手术方式、喂养不耐受、术后首次排便时间、术后14 d血清前白蛋白水平及术后1个月年龄别体重Z值(weight for age z score,WAZ)方面差异无统计学意义(P>0.05);早期强化EN组术后7 d血清前白蛋白水平、日均体重增长、达到全肠内营养时间、住院时长、住院总费用方面明显优于早期微量EN组,差异均有统计学意义(P<0.05)。结论新生儿食管闭锁术后早期高能量密度的肠内营养有助于改善围手术期营养状态,缩短住院时间及减少医疗花费,值得临床推广。

Objective To explore the effects of nasogastric tube feeding patterns with calorie-enriched formula on postoperative recovery of patients with typeⅢb congenital esophageal atresia(CEA).Methods Clinical data were reviewed for 36 CEA children undergoing one-stage esophageal anastomosis from January 2016 to December 2022.Enteral nutrition(EN)was offered through a nasogastric tube during early postoperative period.They were assigned into two groups of early extensively hydrolyzed EN and calorie enriched EN according to energy density of milk.In early extensively hydrolyzed EN group,there were 11 boys and 6 girls with a gestational age of(38.8±1.3)week and a birth weight of(2.6±0.3)kg.Micro-volume feeding with extensively hydrolyzed formula was offered.In early intensive EN group,there were 13 boys and 6 girls with a gestational age of(38.5±1.8)week and a birth weight of(2.8±0.4)kg.Calorie-enriched extensively hydrolyzed protein formula was offered.In both groups,EN volumes were gradually boosted according to gastrointestinal tolerance and finally transmitted to complete oral feeding.IBM SPSS statistical software was employed for statistical analysis.Independent sample t test was utilized for quantitative data conforming to normal distribution and nonparametric test for non-normal distribution.Results No statistically significant inter-group differences existed in preoperative general profiles,surgical approaches,gastrointestinal intolerance,time of initial defecation and serum level of pre-albumin at Day 14 postoperatively and weight-for-age z score(WAZ)at Month 1 postoperatively(P>0.05).Serum level of pre-albumin,average daily weight gain,time to total EN,length of stay and total hospitalization expense were significantly better in early calorie enriched EN group than those in early extensively hydrolyzed EN group at Day 7 postoperatively(P<0.05).Conclusions Early EN with high energy density after neonatal CEA may help to improve preoperative nutritional status,shorten hospital stay and lower medical expenses.It is worthy of wider clinical promotion.