摘要
目的探讨小肠营养管在新生儿高位肠梗阻治疗中的价值。方法5例新生儿（其中男3例，女2例；早产儿1例，足月儿4例；十二指肠膜状闭锁2例，环状胰腺1例，近段小肠闭锁2例：合并旋转不良1例），行十二指肠隔膜切除、小肠盲端切除及肠吻合手术，合并旋转不良一并解决。术中在吻合完成前，由麻醉师经鼻置人日本CREATEMEDICCO．，LTD生产的6Fr小肠ED导管[注册号：国食药监械（进）字2007第2661620号]，术后24h拍腹平片，喂糖水；48h用静脉推注泵从营养管泵人配方奶，奶量据病情渐加至正常。初始3-4d使用静脉营养，术后1周不拔管经口喂养，辅以管内泵奶，停止补液。10-22d拔营养管出院。结果5例全部达到经管喂养目的，减少静脉营养的使用时间和避免造瘘手术。无1例脱管，无黄疸加重，肝肾功能正常。刚开始1例有奶瓣堵管，0．9％氯化钠液冲洗后恢复通畅，之后每次注奶后温开水冲洗管道1次。1例经口足量喂奶出现呕吐，上消化道造影未见吻合口狭窄和瘘，无肠梗阻，拔管喂养症状消失出院。1例腹泻，改无乳糖营养液同时给予复合乳酸菌制剂口服，症状消失。5例最短住院10d，最长住院22d，平均住院16d。术后3～5d体重恢复到出生体重，出院时体重均有增加，平均增长5．5g／（kg·d）。结论小肠营养管对新生儿高位肠梗阻术后营养的维持有重要价值。
Objective To explore the value of employing the smafl intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Method Five newborn infants （3 males and 2 females ; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation ）. The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan [ Registration number： the State Food and Drug Administration-instrument （Ira.） 2007- NO. 2661620 ]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. Result All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0. 9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out thetube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g （ kg · d）. Conclusion The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第9期705-707,共3页
Chinese Journal of Pediatrics
关键词
肠道营养
肠梗阻
婴儿
新生
外科手术
Enteral nutrition
Intestinal obstruction
Infant, newborn
Surgical procedures,operative
