中国大陆地区婴儿肠吻合术后早期喂养现状调查

Current status of early feeding after intestinal anastomosis in infants in China's Mainland

目的调查中国大陆地区婴儿肠吻合术后早期喂养的现状,为婴儿肠吻合术后早期喂养的安全性和有效性研究提供方向。方法对中国大陆地区51家医院的小儿外科医生进行问卷调查,内容包括婴儿肠吻合术后早期喂养了解程度、实施的必要性、禁忌证、影响实施的因素及目前实施情况;同时收集51家医院2020年10月至2021年12月期间接受肠吻合手术婴儿的临床病例资料,了解中国大陆地区婴儿肠吻合术后早期喂养的实施现状。计数资料采用χ^(2)检验或Fisher精确检验。结果61位小儿外科医师和745例接受肠吻合手术的婴儿参与并完成调查。分别有49.18%(30/61)和40.98%(25/61)的小儿外科医师都认可在婴儿肠吻合术后实施早期喂养必要或者非常必要;目前已经在大部分婴儿及少数婴儿肠吻合术后开展早期喂养的小儿外科医师比例分别为49.18%(30/61)和37.70%(23/61);39.34%(24/61)小儿外科医师认为新生儿肠吻合术后不适合行早期喂养,另有18.03%(11/61)的小儿外科医师认为小于3月龄的非新生儿肠吻合术后也不适合早期喂养;分别有40.98%(25/61)、32.79%(20/61)和18.03%(11/61)的小儿外科医师认为十二指肠吻合、空肠和回(结)肠吻合术后不适合早期喂养。分析745例患儿病例资料,总体早期喂养率仅为22.28%(166/745),其中华东、华中、华南、西南等地区早期喂养率分别为:28.86%(86/298)、25.14%(44/175)、25.42%(15/59)、22.09%(19/86)。新生儿(≤28 d)、≤3月龄婴儿(≥29 d至3个月)和>3月龄婴儿3个年龄组早期喂养率分别是16.3%(33/203)、20.3%(83/409)、37.6%(50/133),差异有统计学意义(χ^(2)=23.198,P<0.001)。十二指肠吻合、空肠吻合、回(结)肠吻合3个吻合部位类型早期喂养率分别是19.5%(15/77)、28.8%(63/219)、19.6%(88/449),差异有统计学意义(χ^(2)=7.534,P=0.023)。结论中国大陆地区婴儿肠吻合术后早期喂养总体实施率低,地区之间存在差异,手术年龄和吻合口部位可能是影响婴儿肠吻合术后早期喂养实施的重要因素。

Objective To explore the current status of early feeding after infantile intestinal anastomosis in China's Mainland and provide research rationales on the safety and efficacy of early feeding.Methods A questionnaire survey was conducted among pediatric surgeons at 51 domestic hospitals in China's Mainland.The topics included the status of understanding of early feeding after infantile intestinal anastomosis,necessity for implementation,contraindications,influencing factors of implementation and current status of implementation.Also clinical medical records were reviewed for infants undergoing intestinal anastomosis from October 2020 to December 2021.Categorical variables were examined by chi-square or Fisher's exact test.Results Sixty-one pediatric surgeons and 745 infants undergoing intestinal anastomosis participated in and completed the survey.Early feeding after infantile intestinal anastomosis was considered necessary or quite necessary by 49.18%and 40.98%of pediatric surgeons;49.18%and 37.7%of pediatric surgeons were already practicing early feeding after intestinal anastomosis respectively;39.34%of pediatric surgeons did not consider early feeding after neonatal intestinal anastomosis to be appropriate.Another 18.03%of pediatric surgeons also thought that early feeding was not suitable after non-neonatal intestinal anastomosis under an age of 3 months;40.98%,32.79%and 18.03%of pediatric surgeons thought that early feeding was not suitable after duodenal anastomosis,jejunostomy and ileo/colonic anastomosis respectively;overall early feeding rate was merely 22.28%and the figures in East China,Central China,South China and Southwest China were 28.86%,25.14%,25.42%and 22.09%;early feeding rates in neonates,small infants≤3 months and infants>3 months were 16.3%,20.3%and 37.6%with statistically significant differences(χ^(2)=23.198,P<0.001);early feeding rates for duodenal anastomosis,jejunal anastomosis and ileal/colonic anastomosis were 19.5%,28.8%and 19.6%respectively with a statistically significant difference(χ^(2)=7.534,P=0.023).Conclusions The overall implementation rate of early feeding after infantile intestinal anastomosis is low in China's Mainland.Regional differences,operative age and anastomotic site may be important influencing factors for implementing early feeding after infantile intestinal anastomosis.