本文選題：早期腸內(nèi)營養(yǎng) + 腸外營養(yǎng)��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:探討胃腸道畸形患兒圍手術(shù)期不同的營養(yǎng)支持治療方案,即術(shù)后早期腸內(nèi)營養(yǎng)治療與常規(guī)營養(yǎng)支持治療方案,為胃腸道畸形患兒提供更優(yōu)的臨床營養(yǎng)治療。資料與方法:選擇2011-2014年來淄博市婦幼保健院普外科胃腸道畸形需要手術(shù)患兒115例,其中男性87例,女性28例,月齡1天-1月,術(shù)前相關(guān)血液檢驗(yàn)指標(biāo)無重大異常,術(shù)前行輔助檢查考慮胃腸道畸形。所有患兒均外科手術(shù)治療。圍手術(shù)期營養(yǎng)支持分為兩組:A組(常規(guī)治療組):術(shù)后給予全腸外營養(yǎng)支持,能量為基礎(chǔ)消耗(BEE)的1.2倍,5天后可經(jīng)鼻胃管或經(jīng)口進(jìn)食腸內(nèi)營養(yǎng),并逐漸增加腸內(nèi)營養(yǎng)量和減少腸外營養(yǎng)量,直至過渡為經(jīng)口全腸內(nèi)喂養(yǎng)。B組(早期加入腸內(nèi)營養(yǎng)組EEN組):術(shù)后盡早(鼻胃管內(nèi)無大量墨綠色胃液)開始經(jīng)鼻胃管或營養(yǎng)管滴入腸內(nèi)營養(yǎng),開始時(shí)為少量溫糖水,觀察患兒無明顯不適癥狀,可采用微量泵24h內(nèi)持續(xù)均勻泵入溫糖水,并逐漸改為泵入母乳或水解配方奶1ml/kg · h,可按1ml/kg · d遞增,至經(jīng)口全腸內(nèi)營養(yǎng)。其它營養(yǎng)支持部分與A組相同,兩組并分別根據(jù)需要給予抗生素等藥物。分析兩組患兒圍手術(shù)期不同方案的營養(yǎng)支持,對患兒術(shù)后恢復(fù)情況、術(shù)后并發(fā)癥、實(shí)驗(yàn)室指標(biāo)及2年出院隨訪結(jié)果的影響,有無統(tǒng)計(jì)學(xué)差異。結(jié)果:兩組患兒術(shù)前一般資料、手術(shù)時(shí)間無統(tǒng)計(jì)學(xué)差異,P0.05;術(shù)后初次排氣時(shí)間、住院費(fèi)用、住院時(shí)間、出院時(shí)體重增加情況,都有統(tǒng)計(jì)學(xué)差異,P0.05;喂養(yǎng)不耐受情況(嘔吐、腹脹)等有統(tǒng)計(jì)學(xué)差異,切口炎性反應(yīng)、膽汁淤積、壞死性腸炎等并發(fā)癥情況較對照組明顯減少,P0.05,有統(tǒng)計(jì)學(xué)差異;兩組患兒肺炎的發(fā)生率兩組無統(tǒng)計(jì)學(xué)差異,P0.05;兩組患兒術(shù)后7d實(shí)驗(yàn)室檢驗(yàn)結(jié)果,EEN組患兒的白蛋白、炎癥指標(biāo)、膽紅素值都有統(tǒng)計(jì)學(xué)差異;術(shù)后隨訪2年,兩組患兒隨訪3-24個(gè)月時(shí)所測生長發(fā)育指標(biāo)體重、身高比較差異均無統(tǒng)計(jì)學(xué)差異,P0.05,均達(dá)到我國2010年九省市7歲以下兒童生長參照標(biāo)準(zhǔn)。結(jié)論:胃腸道畸形患兒圍手術(shù)期,早期腸內(nèi)營養(yǎng)支持治療的實(shí)施方案可靠,盡早開始給予腸內(nèi)營養(yǎng),可改善患兒術(shù)后的營養(yǎng)狀況,促進(jìn)患兒術(shù)后的恢復(fù),降低圍手術(shù)期相關(guān)并發(fā)癥的發(fā)生率,縮短患兒住院日期,降低患兒的費(fèi)用。對胃腸道畸形患兒的以后生長發(fā)育的影響,兩者無明顯差異。
[Abstract]:Objective: to explore the different nutritional support treatment schemes in perioperative period for children with gastrointestinal malformation, that is, early postoperative enteral nutrition therapy and routine nutritional support therapy, so as to provide better clinical nutrition treatment for children with gastrointestinal malformation.Materials and methods: 115 children (87 males and 28 females) with Gastrointestinal malformation in general surgery department of Zibo Maternal and Child Health Hospital from 2011 to 2014 were selected. The age of one month to one month was one month to one month. There was no significant abnormality in blood test before operation.Preoperative adjuvant examination was performed to consider gastrointestinal malformation.All the children were treated surgically.Perioperative nutritional support was divided into two groups: group A (routine treatment group: total parenteral nutrition support after operation, energy based consumption of bee 1.2 times), after 5 days of feeding enteral nutrition through nasogastric tube or through mouth.And gradually increased the amount of enteral nutrition and reduced the amount of parenteral nutrition,Until the transition to oral total enteral feeding. Group B (early enteral nutrition group EEN group: early postoperative (no large amount of dark green gastric juice in the nasogastric tube) began to drip enteral nutrition through the nasogastric tube or nutrition tube, starting with a small amount of warm sugar water,It was observed that there were no obvious symptoms of discomfort in the children, and the warm sugar water could be pumped into the warm sugar water continuously and evenly within 24 hours by micropump, and then the 1ml/kg hs of breast milk or hydrolyzed formula milk could be gradually pumped into the breast milk or the hydrolyzed formula milk.Other nutritional support was the same as group A, and the two groups were given antibiotics and other drugs as needed.To analyze the effect of nutritional support in perioperative period on postoperative recovery, postoperative complications, laboratory indexes and 2 year follow-up results in the two groups, and whether there were statistical differences between the two groups.Results: there was no significant difference in the operation time between the two groups before operation (P 0.05), the first time of exhaust, the cost of hospitalization, the time of hospitalization, and the weight gain at discharge were all significantly different between the two groups (P 0.05).There were statistical differences in abdominal distension and other complications, such as incision inflammatory reaction, cholestasis, necrotizing enteritis and so on, which were significantly lower than those in the control group (P 0.05).There was no significant difference in the incidence of pneumonia between the two groups (P 0.05). There were significant differences in albumin, inflammatory indexes, bilirubin in EEN group 7 days after operation.There was no significant difference in body weight and height between the two groups during 3-24 months follow-up, which reached the growth standard of children under 7 years of age in nine provinces and cities in 2010.Conclusion: during the perioperative period of gastrointestinal malformation, the early enteral nutrition support therapy is reliable, and it can improve the nutritional status and promote the recovery of children with gastrointestinal malformation as early as possible.Reduce the incidence of perioperative complications, shorten the length of hospitalization, reduce the cost of children.There was no significant difference in the growth and development of children with gastrointestinal malformation.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R726.5

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉競;并發(fā)多種腸道畸形一例[J];中華普通外科雜志;2002年07期

2 何桂華,賈鳳蘭,王秀杰;先天性腸道畸形1例[J];中國基層醫(yī)藥;2002年01期

3 薛素蘭，吳毓貞;先天性Ⅲ度房室傳導(dǎo)阻滯伴心臟及腸道畸形1例報(bào)告[J];中國優(yōu)生與遺傳雜志;1994年02期

4 景東;唐偉椿;穆恒四;;誤診為闌尾炎的小兒先天性腸道畸形(附7例分析)[J];臨床誤診誤治;1991年02期

5 姚干;先天性腸道畸形再手術(shù)8例分析報(bào)告[J];新醫(yī)學(xué);1998年08期

6 Lee S.E.;Kim H.-Y.;Jung S.-E.;W.-K. Kim;王一飛;;內(nèi)臟異位和胃腸道畸形[J];世界核心醫(yī)學(xué)期刊文摘(兒科學(xué)分冊);2006年11期

7 林善平;靳凱;;小兒先天性腹裂并腸道畸形1例[J];西北國防醫(yī)學(xué)雜志;2009年05期

8 姚建芝;;超聲檢測胎兒腸道畸形的價(jià)值[J];中國現(xiàn)代醫(yī)生;2010年22期

9 楊興漢,王莉;嬰幼兒先天性胃腸道畸形(附83例臨床X線分析)[J];現(xiàn)代醫(yī)用影像學(xué);1994年06期

10 李衛(wèi)東;腸重復(fù)的醫(yī)技診斷探討[J];實(shí)用醫(yī)技雜志;1994年01期

相關(guān)會(huì)議論文 前2條

1 景東;唐偉椿;穆恒四;石正峰;叢林;;先天性腸道畸形所致急腹癥及其急診處理[A];中華醫(yī)學(xué)會(huì)全國第五次急診醫(yī)學(xué)學(xué)術(shù)會(huì)議論文集[C];1994年

2 田欣;;先天性腸道畸形誤診原因分析[A];2005年浙江省兒科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2005年

相關(guān)碩士學(xué)位論文 前1條

1 宋飛;胃腸道畸形患兒圍手術(shù)期腸內(nèi)腸外聯(lián)合營養(yǎng)療效分析[D];山東大學(xué);2017年

，

本文編號：1759156