Early Gastrointestinal Nutrition Support For The Protection And Function Improvement Of Children's Gastrointestinal Tract After Cardiopulmonary Bypass Congenital Correction

Although the incidence of severe complications associated with Cardio-pulmonary Bypass（CPB）is not high（0.5%-4%）,the mortality rate can be as high as 26%-75%as soon as it occurs.Peptic ulcer,perforation,bleeding,weakening of bowel sounds,intestinal obstruction and hepatomegaly are common digestive complications after open heart surgery under cardiopulmonary bypass.Infants are more prone to develop digestive tract symptoms than adults.Enteral nutrition（EN）is the first choice for the nutritional support of severe patients with intestinal function.It has the advantages of preventing atrophy of mucous membrane,maintaining intestinal structural integrity and improving immunity,and enteral nutrition is more in line with physiological,economic and safe.With the improvement of surgical techniques,children with congenital heart disease tend to be more pronounced at lower age and lower body weight,and the risks faced by children include increased risk of gastrointestinal nutrition.However,the effectiveness of the early gastrointestinal nutrition in this part of the children is lack of effective and rapid physiological indicators.There is no sufficient understanding and objective criteria for the onset time,implementation process,effect evaluation and risk control of Congenital Heart Disease（CHD）for the treatment of early gastrointestinal nutrition.The purpose of this study is to find the pathophysiological mechanism of the protective effect of early gastrointestinal nutrition on the gastrointestinal function of children after CPB CHD orthodontic treatment by the changes of blood glucose,motilin and gastrin.At the same time,we should find more ways,such as quality control circle and Chinese massage to reduce the incidence of early feeding intolerance in children with congenital heart disease after external circulation.THE 1^st PART The protection effects of the standardized early enteral nutrition after congenital heart disease repair with cardio-pulmonary bypass on children patients’gastrointestinal function.Objective:The paper aims to discuss the protection effects of the standardized early enteral nutrition after congenital heart disease（CHD）repair with cardio-pulmonary bypass（CPB）on children patients’gastrointestinal function.Methods:Seventy three patients after ventricular septal defects（VSD）repair with CPB were randomly divided into two groups:Control Group and Experimental Group.They were fed with routine nutrition and standardized early enteral nutrition respectively and their blood glucose,gastric mucosa PH,change of gastrointestinal hormones,abdominal distention,vomit,feeding intolerance and feeding interrupt were observed.Results:The children patients’blood glucose 24 h and 48 h after surgery in the experimental group was significantly lower than that in the control group（p<0.05）;their gastric mucosa PH 24 h after surgery was significantly higher than that in the control group（p<0.05）;their gastrin and motilin 24 h and 48 h after surgery were higher than those in the control group（p<0.05）;and the frequency of abdominal distention,vomit,feeding intolerance and feeding interrupt of children patients in the experimental group were lower than those in the control group（p<0.05）.Conclusion:Standardized early eternal nutrition can ameliorate CHD children patients’disturbance of carbohydrate metabolism,promote the recovery of gastric mucosa PH,and properly increase the secretion of gastrin and motilin after surgery,thereby reducing the occurrence of gastrointestinal adverse reactions.THE 2^nd PART Quality control circle reduces the incidence of early feeding intolerance of children after congenital heart disease repair with cardio-pulmonary bypassObjective:To explore the role of quality control circle（QCC）in reducing the incidence of feeding intolerance（FI）and improving the quality of EN nursing.Methods:The QCC group was set up in children with congenital heart disease（CPB）correction in cardiac intensive care unit（CICU）,and the QCC activity of reducing the incidence of FI and improving the quality of EN nursing was carried out,and the change of FI incidence before and after QCC activity was analyzed.Results:After the QCC activity,the FI incidence related with early EN in children with congenital heart disease（CHD）correction under the cardio-p ulmonary bypass（CPB）was significantly lower（12.5%）（p<0.05）,which was conducive to postoperative blood glucose stability（p<0.05）.Conclusion:The application of QCC activity to the early EN of children with congenital heart disease（CHD）correction can reduce the occurrence of FI.