延长输注人血白蛋白治疗时间对新生儿胃穿孔术后住院预后的回顾性队列研究

The impact of prolonged human serum albumin infusion treatment in newborns with gastric perforation on hospitalization outcomes:A retrospective cohort study

背景新生儿胃穿孔(NGP)术后常规给予经验性补充白蛋白治疗,过多补充是否有益尚不明确。目的分析延长输注人血白蛋白治疗时间是否可改善NGP术后的近期预后。设计回顾性队列研究。方法纳入NGP术后予以静脉输注白蛋白(1~2 g·kg^(-1))的病例,根据经验性白蛋白应用时间取≤5 d为短疗程组,>5 d为长疗程组,采集围生期的情况、术前主要症状及体征、术前实验室结果、术前和术后合并症、手术情况(穿孔部位、病理改变等)、术后治疗和住院预后。主要结局指标术后营养状况、住院结局。结果短疗程组37例,长疗程组26例,两组围生期一般情况、术前症状和体征、术前实验室结果、合并症、穿孔位置、病理类型差异均无统计学意义(P>0.05)。短疗程组胎龄更小(P=0.005),母亲妊娠期糖尿病比例更高(P=0.034),发病日龄更早(P=0.035),手术日龄更小(P=0.035),术后白蛋白输注总量更少(P=0.00),达70%全肠内营养时间更长(P=0.019),达全肠内营养时间更长(P=0.005),住院时间更短(P=0.012),但两组在二次手术、住院时间、好转或治愈率和出院体重差异无统计学意义。选择出生体重相差<250 g、胎龄相差<1周、发病日龄相差<1 d匹配条件,按1∶1匹配,短疗程组及长疗程组各22例,两组术后抗生素使用时间、术后有创呼吸支持、输注血浆次数、胃肠减压时间、造瘘管留置时间、术后开始肠内喂养时间、达70%全肠内营养时间、达全肠内营养时间、二次手术、住院时间和出院体重差异均无统计学意义(P>0.05)。结论延长输注人血白蛋白治疗时间对NGP术后营养状况、住院结局不受益。

Background Human serum albumin infusion was empirical therapy after neonatal gastric perforation surgery.It is unclear whether excessive supplementation is beneficial.Objective To investigate whether prolonged human serum albumin infusion treatment in newborns with gastric perforation after abdominal surgery can improve the short⁃term outcomes.Design Retrospective cohort study.Methods The newborns who received intravenous infusion of albumin(1⁃2 g·kg^(-1))after gastric perforation were divided into short course group(≤5 days)and long course group(>5 days)according to the time of empirical application of albumin.The perinatal condition,main symptoms,signs,and laboratory results before operation,preoperative and postoperative complications,surgical condition(perforation site,pathological findings,etc.),postoperative treatment and hospital prognosis were collected.Main outcome measures Postoperative nutritional status and hospitalization outcomes.Results There were 37 cases in the short course group and 26 cases in the long course group.There was no significant difference in perinatal general condition,preoperative symptoms and signs,preoperative laboratory results,complications,perforation location and pathological findings between the two groups(P>0.005).In the short course group compared with the long⁃term treatment group,the gestational age was younger(P=0.005),the proportion of diabetes in pregnancy was higher(P=0.034),the age of onset was earlier(P=0.035),the age of operation was younger(P=0.035),the total amount of albumin infusion after operation was less(P=0.000),the 70%total enteral nutrition time was longer(P=0.019),the total enteral nutrition time was longer(P=0.005),and the hospital stay was shorter(P=0.012).However,there was no significant difference in secondary operation,length of stay,status of improvement or curation and weight at discharge between the two groups.Neonates with the difference of birth weight<250 g,gestational age<1 week and age of onset<1 d in short course group and long course group were matched at 1:1.Twenty⁃two cases were included in each group.There was no significant difference in postoperative antibiotic use time,postoperative invasive respiratory support,times of plasma transfusion,gastrointestinal decompression time,fistulostomy tube indwelling time,postoperative enteral feeding time,70%total enteral nutrition time,total enteral nutrition time,secondary operation,hospital stay and discharge weight between the two groups.Conclusion Prolonged treatment time of human serum albumin infusion is not beneficial to the nutritional status and hospitalization outcomes of newborns with gastric perforation.