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目的 探讨肠外营养 (PN)在新生儿食道闭锁术后治疗中的必要性及与预后的关系。方法 选择新生儿ⅢB型食道闭锁 食道气管瘘患儿 2 1例 ,均采用食道一期吻合术 ,术后除常规治疗外加用PN治疗 14例 (PN组 ) ,另 7例仅常规治疗 (对照组 ) ,两组患儿胎龄、出生体重、术前禁食时间无显著性差异 (P >0 0 5 )。术后 13天开始PN组予脂肪乳剂 (1 9± 0 6 ) g/kg ,氨基酸 (2 1± 0 7)g/kg ,葡萄糖 (7 7± 2 1) g/kg ,平均热量摄入为 (2 39±46 )kJ/kg ,液体量 (119± 12 )mL/kg ,以“全合一”方式经周围静脉 ,2 4h均匀输入 ,PN平均应用时间为 7 6天。 结果 PN组治愈 13例 ,死亡 1例 ,病死率为 7 7% ,存活儿体重增加 7例 ,不变 5例 ,下降 1例 ,平均体重增加 (14± 2 7)g。对照组治愈 3例 ,死亡 4例 ,病死率为 5 7 1% ,存活儿体重均下降 ,平均体重降低 (2 2± 2 1) g ,两组病死率及体重变化经团队t检验及卡方检验存在显著差异 (P <0 0 5 )。结论 食道闭锁术后积极而合理地应用肠外营养支持可改善患儿的营养不良 ,降低病死率 ,从而改善预后。
Objective To investigate the necessity of parenteral nutrition (PN) in the treatment of neonatal esophageal atresia and its relationship with prognosis. Methods Twenty-one neonates with type ⅢB esophageal atresia of tracheoesophageal fistula were enrolled in this study. All patients underwent primary esophageal anastomosis. Among them, 14 patients (PN group) received conventional therapy plus PN, and the other 7 patients received conventional therapy (control group There was no significant difference in gestational age, birth weight and preoperative fasting time between the two groups (P> 0.05). After 13 days, the rats in PN group were given fat emulsion (1 9 ± 0 6) g / kg, amino acid (2 1 ± 0 7) g / kg and glucose (7 7 ± 2 1) g / (2 39 ± 46) kJ / kg and liquid volume (119 ± 12) mL / kg respectively. The animals were evenly infused via the peripheral vein in 24 hours. The average application time was 76 days. Results In PN group, 13 cases were cured and 1 died. The mortality rate was 77%. The weight of survivors was increased in 7 cases, unchanged in 5 cases, decreased in 1 case and average body weight increased by 14 ± 27 g. In the control group, 3 cases were cured and 4 cases died. The fatality rate was 57.1%. The weight of surviving children both decreased and the average body weight decreased (2 2 ± 2 1) g. The mortality and body weight of the two groups were determined by t- There was a significant difference in test (P <0 05). Conclusion The positive and rational application of parenteral nutrition after esophageal atresia can improve malnutrition, reduce mortality and improve prognosis in children.