Application effect of early enteral nutrition support based on enhanced recovery after surgery in perioperative period of children with perforated appendicitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Lei ,  XU Yan , CAO Hui , MENG Xiaowan , ZHANG Yuqi

Department of General Surgery, Xuzhou Children’s Hospital, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

XU Yan, Email: 779380101@qq.com

Keywords：

enhanced recovery after surgery; early enteral nutrition; perforated appendicitis; perioperative period

DOI：

10.7507/1007-9424.202303023

Video：

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Objective To investigate the effect of early enteral nutrition (EEN) support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery (ERAS). Methods The children with perforated appendicitis were collected as an observation group, who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital. At the same time, the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender, age, disease course, pathological type, and body mass index with the observation group. The time of first exhaust or defecation and the hospital stay after surgery were compared. Meanwhile, the nutritional indexes [prealbumin (PA), albumin (ALB), hemoglobin (Hb)], immune indexes [immunoglobulin (Ig) A, IgM, IgG], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before surgery, on day 1 and 7 after surgery were compared. And the adverse effects were observed. Results There were 40 children with perforated appendicitis in the observation group and the control group, respectively. There were no statistical differences in the baseline data such as the gender, age, course of disease, pathological type, and body mass index between the two groups (P>0.05). The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group (t=3.234, P=0.002; t=5.582, P<0.001). The levels of PA, ALB, Hb, IgA, IgM, and IgG in the observation group were higher than in the control group on day 7 after surgery (P<0.05). The levels of CRP, IL-6, and TNF-α in the observation group were lower than in the control group on day 7 after surgery (P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group [5.0% (2/40) vs. 22.5% (9/40), χ²=5.165, P=0.023]. Conclusions From on the results of this study, EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function, correct nutritional status, improve immune function, and reduce inflammation, and which has a higher safety for children with perforated appendicitis.

Citation： WANG Lei, XU Yan, CAO Hui, MENG Xiaowan, ZHANG Yuqi. Application effect of early enteral nutrition support based on enhanced recovery after surgery in perioperative period of children with perforated appendicitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(7): 827-832. doi: 10.7507/1007-9424.202303023 Copy

1.	Téoule P, Laffolie J, Rolle U, et al. Acute appendicitis in childhood and adulthood. Dtsch Arztebl Int, 2020, 117(45): 764-774.
2.	黄栩栩, 黄雪霏, 李萍萍, 等. 新生儿和婴儿急性阑尾炎的临床特点. 儿科药学杂志, 2020, 26(8): 20-21.
3.	Rassi R, Muse F, Cuestas E. Acute appendicitis in children under 4 years: a diagnostic dilemma. Rev Fac Cien Med Univ Nac Cordoba, 2019, 76(3): 180-184.
4.	岳亮. 腹腔镜手术与开腹手术治疗小儿穿孔性阑尾炎的临床疗效比较. 中国药物与临床, 2021, 21(11): 1910-1911.
5.	Talha A, El-Haddad H, Ghazal AE, et al. Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surg Endosc, 2020, 34(2): 907-914.
6.	Neogi S, Banerjee A, Panda SS, et al. Laparoscopic versus open appendicectomy for complicated appendicitis in children: a systematic review and meta-analysis. J Pediatr Surg, 2022, 57(3): 394-405.
7.	杜冬梅, 刘铭. 不同手术方法治疗小儿穿孔性阑尾炎的效果及对炎症应激反应和免疫功能的影响. 临床与病理杂志, 2022, 42(3): 641-646.
8.	郭苗. 基于加速康复外科的早期肠内营养支持对结直肠癌手术患者营养及免疫指标的影响. 现代诊断与治疗, 2021, 32(4): 637-639.
9.	潘威婕, 常悦, 刘沙, 等. 加速康复外科理念下肠内营养支持在胃癌患者围手术期的应用. 国际医药卫生导报, 2020, 26(7): 1019-1021.
10.	Ma BQ, Chen SY, Jiang ZB, et al. Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice. World J Gastroenterol, 2020, 26(46): 7405-7415.
11.	吴芳, 叶再元, 陈振光, 等. 胃癌患者术后早期肠内营养支持的临床研究. 浙江医学, 2020, 42(2): 161-163, 191.
12.	Gao X, Liu Y, Zhang L, et al. Effect of early vs late supplemental parenteral nutrition in patients undergoing abdominal surgery: a randomized clinical trial. JAMA Surg, 2022, 157(5): 384-393.
13.	Yirui L, Yin W, Juan L, et al. The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol, 2021, 45(3): 101594. doi: 10.1016/j.clinre.2020.101594.
14.	陈锦园, 吴娟, 李娜, 等. 基于循证理念指引下的护理干预在神经外科重症患者肠内营养支持中的应用. 中国医药导报, 2021, 18(22): 185-188.
15.	Lin A, Ye J, Wang Z, et al. Analysis of post-operative efficacy and pharyngeal fistula healing in patients with laryngeal cancer treated with post-operative enteral nutrition support nursing combined with early oral feeding. Oncol Lett, 2020, 19(6): 3964-3970.
16.	Herbert G, Perry R, Andersen HK, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev, 2019, 7(7): CD004080. doi: 10.1002/14651858.CD004080.pub4.
17.	谢周龙龙, 李倩, 张蓉, 等. 加速康复外科理念在儿童日间手术围术期的应用. 中国卫生质量管理, 2021, 28(12): 4-7.
18.	郭守强. 不同时间点肠内营养支持联合清胰汤对重度急性胰腺炎患者免疫因子的影响. 西部中医药, 2020, 33(4): 115-117.
19.	李欣瑜, 翁文骏, 王静文, 等. 小百肽营养配方粉在急性淋巴细胞白血病患儿营养支持中的有效性和安全性分析. 中国实用儿科杂志, 2020, 35(2): 120-125, 146.
20.	郑环宇, 夏巨坤. 内镜下逆行阑尾炎术治疗急性阑尾炎患儿的效果观察及对免疫功能和炎症因子水平的影响. 海军医学杂志, 2021, 42(4): 461-465.
21.	关丽萍, 尉志强, 关巍, 等. 不同时机肠内营养对重症急性胰腺炎患者炎性因子与免疫功能的影响. 河北医药, 2018, 40(13): 1949-1952.

1. Téoule P, Laffolie J, Rolle U, et al. Acute appendicitis in childhood and adulthood. Dtsch Arztebl Int, 2020, 117(45): 764-774.
2. 黄栩栩, 黄雪霏, 李萍萍, 等. 新生儿和婴儿急性阑尾炎的临床特点. 儿科药学杂志, 2020, 26(8): 20-21.
3. Rassi R, Muse F, Cuestas E. Acute appendicitis in children under 4 years: a diagnostic dilemma. Rev Fac Cien Med Univ Nac Cordoba, 2019, 76(3): 180-184.
4. 岳亮. 腹腔镜手术与开腹手术治疗小儿穿孔性阑尾炎的临床疗效比较. 中国药物与临床, 2021, 21(11): 1910-1911.
5. Talha A, El-Haddad H, Ghazal AE, et al. Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surg Endosc, 2020, 34(2): 907-914.
6. Neogi S, Banerjee A, Panda SS, et al. Laparoscopic versus open appendicectomy for complicated appendicitis in children: a systematic review and meta-analysis. J Pediatr Surg, 2022, 57(3): 394-405.
7. 杜冬梅, 刘铭. 不同手术方法治疗小儿穿孔性阑尾炎的效果及对炎症应激反应和免疫功能的影响. 临床与病理杂志, 2022, 42(3): 641-646.
8. 郭苗. 基于加速康复外科的早期肠内营养支持对结直肠癌手术患者营养及免疫指标的影响. 现代诊断与治疗, 2021, 32(4): 637-639.
9. 潘威婕, 常悦, 刘沙, 等. 加速康复外科理念下肠内营养支持在胃癌患者围手术期的应用. 国际医药卫生导报, 2020, 26(7): 1019-1021.
10. Ma BQ, Chen SY, Jiang ZB, et al. Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice. World J Gastroenterol, 2020, 26(46): 7405-7415.
11. 吴芳, 叶再元, 陈振光, 等. 胃癌患者术后早期肠内营养支持的临床研究. 浙江医学, 2020, 42(2): 161-163, 191.
12. Gao X, Liu Y, Zhang L, et al. Effect of early vs late supplemental parenteral nutrition in patients undergoing abdominal surgery: a randomized clinical trial. JAMA Surg, 2022, 157(5): 384-393.
13. Yirui L, Yin W, Juan L, et al. The clinical effect of early enteral nutrition in liver-transplanted patients: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol, 2021, 45(3): 101594. doi: 10.1016/j.clinre.2020.101594.
14. 陈锦园, 吴娟, 李娜, 等. 基于循证理念指引下的护理干预在神经外科重症患者肠内营养支持中的应用. 中国医药导报, 2021, 18(22): 185-188.
15. Lin A, Ye J, Wang Z, et al. Analysis of post-operative efficacy and pharyngeal fistula healing in patients with laryngeal cancer treated with post-operative enteral nutrition support nursing combined with early oral feeding. Oncol Lett, 2020, 19(6): 3964-3970.
16. Herbert G, Perry R, Andersen HK, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev, 2019, 7(7): CD004080. doi: 10.1002/14651858.CD004080.pub4.
17. 谢周龙龙, 李倩, 张蓉, 等. 加速康复外科理念在儿童日间手术围术期的应用. 中国卫生质量管理, 2021, 28(12): 4-7.
18. 郭守强. 不同时间点肠内营养支持联合清胰汤对重度急性胰腺炎患者免疫因子的影响. 西部中医药, 2020, 33(4): 115-117.
19. 李欣瑜, 翁文骏, 王静文, 等. 小百肽营养配方粉在急性淋巴细胞白血病患儿营养支持中的有效性和安全性分析. 中国实用儿科杂志, 2020, 35(2): 120-125, 146.
20. 郑环宇, 夏巨坤. 内镜下逆行阑尾炎术治疗急性阑尾炎患儿的效果观察及对免疫功能和炎症因子水平的影响. 海军医学杂志, 2021, 42(4): 461-465.
21. 关丽萍, 尉志强, 关巍, 等. 不同时机肠内营养对重症急性胰腺炎患者炎性因子与免疫功能的影响. 河北医药, 2018, 40(13): 1949-1952.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application effect of early enteral nutrition support based on enhanced recovery after surgery in perioperative period of children with perforated appendicitis

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