早期营养干预联合常规护理在行腹腔镜下经肛门巨结肠根治术患儿中的应用

Application of early nutritional intervention combined with routine nursing in children undergoing laparoscopic transanal radical operation for Hirschsprung's disease

目的探讨早期营养干预联合常规护理对行腹腔镜下经肛门巨结肠根治术(简称“Soave术”)患儿胃肠道功能及术后并发症的影响。方法以2022年1月至2023年5月山东大学齐鲁医院小儿外科收治的80例行Soave术的先天性巨结肠(HD)患儿作为研究对象,采用随机数字1∶1列表法将患儿分为对照组(40例)和观察组(40例)。对照组行常规护理,观察组在对照组干预方式的基础上施以早期营养干预。比较2组患儿的胃肠道功能状况、营养状态、排便功能及术后并发症发生率。结果观察组患儿术后进食、肠道通气和首次肛门排气的时间均明显早于对照组(P均<0.05)。经比较,2组在干预前的血红蛋白(HB)、前白蛋白(PAB)和白蛋白(ALB)水平均未见统计学差异(P均>0.05)。干预2周后,2组的HB、PAB和ALB水平与同组干预前相比均更高(P均<0.05),且观察组与同一时间对照组相比均更高(P均<0.05)。比较2组在干预2周后的排便功能和术后并发症发生情况,观察组的排便优良率高于对照组,术后并发症总发生率低于对照组(P均<0.05)。结论对行腹腔镜下Soave术的HD患儿施以早期营养干预联合常规护理,可有效改善患儿的营养状况,促进胃肠道功能的恢复,改善排便功能,降低并发症发生率。

Objective To explore the effect of early nutritional intervention combined with routine nursing on gastrointestinal function and postoperative complications in children undergoing laparoscopic transanal radical operation(Soave operation)for Hirschsprung's disease.Methods Eighty children with Hirschsprung's disease(HD)who underwent Soave operation in the Department of Pediatric Surgery at Qilu Hospital of Shandong University from January 2022 to May 2023 were selected as the study subjects.The children were randomly divided into a control group(40 cases)and an observation group(40 cases)using a 1∶1 random number listing method.The control group received routine care,while the observation group received early nutritional intervention on the basis of the intervention method in the control group.The gastrointestinal function,nutritional status,defecation function,and incidence of postoperative complications were compared between the two groups.Results The observation group had significantly earlier postoperative feeding,intestinal ventilation,and first anal exhaust time than the control group(all P<0.05).After comparison,there was no statistically significant difference in the levels of hemoglobin(HB),prealbumin(PAB),and albumin(ALB)between the two groups before intervention(all P>0.05).After 2 weeks of intervention,the levels of HB,PAB,and ALB in both groups were higher than those before intervention(all P<0.05),and they were higher in the observation group compared to the control group at the same time(all P<0.05).The defecation function and postoperative complications were compared between the two groups after 2 weeks of intervention,and the observation group had a higher excellent rate of defecation than the control group,and the total incidence of postoperative complications in the observation group was lower than that in the control group(both P<0.05).Conclusion Early nutritional intervention combined with routine care can effectively improve the nutritional status of HD children undergoing laparoscopic Soave operation,promote the recovery of gastrointestinal function,improve defecation function,and reduce the incidence of complications.