早期经口喂养在婴儿一期肠吻合术后的应用——真实世界研究

Application of early oral feeding after primary intestinal anastomosis in infants:a real-world study

目的探讨早期经口喂养(early oral feeding,EOF)应用于婴儿一期肠吻合术后的价值。方法收集2020年10月至2022年5月期间,全国51家小儿外科中心555例行一期肠吻合婴儿的病历信息,根据初始经口喂养时间是否超过48 h,分为EOF组(116例,术后48 h内经口喂养)和传统喂养(traditional oral feeding,TOF)组(439例,术后48 h后经口喂养),将两组患儿按疾病分布、吻合口部位、性别、是否微创手术、手术年龄及手术体重进行倾向性评分1∶2匹配,最终分别有109例EOF组和200例TOF组患儿成功配对,比较配对后两组患儿的并发症发生情况和术后恢复指标差异。组间比较采用Mann-WhitneyU检验、卡方检验或Fisher精确检验。结果EOF组总体并发症及呕吐发生率高于TOF组(20.2%比11.0%,χ^(2)=4.87,P=0.027;9.2%比2.0%,χ^(2)=6.82,P=0.009),两组在腹胀、腹泻、血便、吻合口漏方面的发生率差异无统计学意义(均P>0.05);因并发症而导致的暂停喂养率在EOF组和TOF组差异无统计学意义(P>0.05)。EOF组的完全静脉营养时间、静脉营养总时间及术后住院时间较TOF组显著减少[2.0(1.0,2.5)d比5.0(3.0,6.0)d,Z=-10.17,P<0.001;6(5,8)d比9(6,13)d,Z=-5.05,P<0.001;10(7,14)d比14(10,17)d,Z=-5.62,P<0.001];两组患儿在体重变化、白蛋白变化及前白蛋白变化差异没有统计学意义(均P>0.05)。结论婴儿一期肠吻合术后进行EOF虽增加总体及呕吐并发症发生,但不增加吻合口漏等严重并发症发生,而且可减少静脉营养使用、缩短住院时间,值得临床推广。

Objective To evaluate the clinical application of early oral feeding(EOF)after primary intestinal anastomosis in infants.Methods From October 2020 to May 2022,the medical records were collected from 555 infants undergoing primary intestinal anastomosis at 51 pediatric surgery centers.Based upon initial oral feeding time was less or more than 48h,they were assigned into two groups of EOF(n=116)and traditional oral feeding(TOF,n=439).Two groups were propensity score matched(PSM,1∶2)according to disease distribution,anastomotic site,gender,mini-invasive procedure,operative age and weight for minimizing bias.Finally 109 EOF and 200 TOF samples were successfully matched.Postoperative recovery and complications were compared between two groups by Mann-Whitney U,chi-square or Fisher exact test after PSM.Results The rates of overall complication and vomiting were greater in EOF group than those in TOF group(20.2%vs 11.0%,χ^(2)=4.87,P=0.027;9.2%vs 2.0%,χ^(2)=6.82,P=0.009).However,no inter-group differences existed in the incidences of abdominal distension,diarrhea,hematochezia or anastomotic leakage(P>0.05).Also no inter-group difference existed in the rate of ceasing oral feeding due to complications.Durations of total parenteral nutrition(TPN),parenteral nutrition(PN)and postoperative hospitalization stay were significantly shorter in EOF group than those in TOF group[2.00(1.00,2.50)vs 5.00(3.00,6.00),Z=-10.17,P<0.001;6.00(5.00,8.00)vs 9.00(6.00,13.00),Z=-5.05,P<0.001;10.00(7.00,14.00)vs 14.00(10.00,17.00),Z=-5.62,P<0.001].No inter-group differences existed in weight,serum albumin or serum prealbumin(P>0.05).Conclusions EOF after primary intestinal anastomosis may elevate the rates of overall complications and vomiting in infants.However,it does not increase the incidence of serious complications,such as leakage.Also EOF may minimize the use of PN and shorten hospital stay.