rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2023-26-4-264-270wendsrrosped-46Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSОсобенности формирования некротизирующего энтероколита у кардиохирургических пациентов детского возрастаFeatures of the formation of necrotizing enterocolitis in cardiac surgery children patientshttps://orcid.org/0000-0002-7512-3991СарсенбаеваГульжан ИскендировнаSarsenbayevaGulzhan I.

Канд. мед. наук, кардиохирург, «Научный центр педиатрии и детской хирургии» Минздрава Республики Казахстан.

e-mail: gulzhan75@mail.ru

Ph.D. of Medical Sciences, Cardiac surgeon, "Scientific Center of Pediatrics and Pediatric Surgery" of the Ministry of Health of the Republic of Kazakhstan.

e-mail: gulzhan75@mail.ru

gulzhan75@mail.ruhttps://orcid.org/0000-0003-0065-7419КимАлексей ИвановичKimAleksey I.

Доктор мед. наук, проф., зам. директора по лечебной работе с детьми грудного и раннего возраста, «Нацио­нальный научный центр сердечно-сосудистой хирургии им А.Н. Бакулева» Минздрава России.

noemail@neicon.ruhttps://orcid.org/0000-0001-7717-4971БердибековАлмас БекбулатовичBerdibekovAlmas B.

Кардиохирург, зав. отд-нием детской кардиохирургии и интервенционной кардиологии, «Научный центр педиатрии и детской хирургии» Минздрава Республики Казахстан.

noemail@neicon.ru«Научный центр педиатрии и детской хирургии» Минздрава Республики КазахстанScientific Center of Pediatrics and Pediatric SurgeryScientific Center of Pediatrics and Pediatric Surgery«Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава РоссииA.N. Bakulev National Medical Research Center for Cardiovascular Surgery«Научный центр педиатрии и детской хирургии» Минздрава Республики КазахстанScientific Center of Pediatrics and Pediatric Surgery202313092023264264270Copyright © Сарсенбаева Г.И., Ким А.И., Бердибеков А.Б., 20232023Сарсенбаева Г.И., Ким А.И., Бердибеков А.Б.Sarsenbayeva G.I., Kim A.I., Berdibekov A.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/46Введение

Введение. Ведущими факторами формирования некротизирующего энтероколита (НЭК) в послеоперационном периоде у кардиохирургических пациентов детского возраста являются уменьшение перфузии органов брюшной полости, обусловленное низким перфузионным давлением во время искусственного кровообращения, и малый сердечный выброс, которые усугубляются симпатической вазоконстрикцией вследствие стрессового ответа на операцию и в связи с введением экзогенных катехоламинов.

Цель работы — определить особенности формирования НЭК у кардиохирургических пациентов детского возраста.

Материалы и методы

Материалы и методы. Проведён проспективный анализ 30 кардиохирургических пациентов детского возраста с развитием дисфункции желудочно-кишечного тракта после операции. Всем детям были выполнены инструментальные и лабораторные исследования.

Результаты

Результаты. Среди больных по возрастной структуре было 18 (60%) новорождённых, 10 (33,3%) детей до 6 мес; 2 (6,6%) ребёнка старше 1 года. У 19 (63,3%) больных, в том числе 8 (36,8%) новорождённых, выявлены признаки динамической кишечной непроходимости. Все пациенты были после операции на сердце: 2 больных после сужения лёгочной артерии, 10 детей были прооперированы в условиях искусственного кровообращения. Самой сложной и тяжёлой группой больных после операций на сердце и сосудах были 11 (36,7%) детей с врождёнными пороками сердца, у которых развились признаки НЭК: 10 новорождённых и 1 больной старше 5 лет. Описаны особенности микробиоты, клинических проявлений и рентгеновской картины в зависимости от типа нарушений кишечной функции. Выявлена роль гипоксии, гипоперфузии во время искусственного кровообращения, функционирования открытого артериального протока у «синих» пациентов в формировании рисков развития НЭК.  Показано решающее значение на развитие НЭК инфекционно-гипоксических причин, сердечной недостаточности, продолжительности искусственного кровообращения и диастолического обкрадывания сосудов.

Заключение

Заключение. Дисфункция желудочно-кишечного тракта после операции на сердце у детей — одна из актуальных проблем кардиохирургии. НЭК, возникающий у новорождённых в послеоперационном периоде, часто не распознаётся своевременно, что приводит к неблагоприятным исходам.

Участие авторов

Участие авторов:Сарсенбаева Г.И. — концепция и дизайн исследования, написание текста;Ким А.И. — редактирование и консультации;Бердибеков А.Б. — сбор и обработка материала.Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов. 

Поступила 30

Поступила 30.05.2023Принята к печати 20.06.2023Опубликована 31.08.2023

Introduction

Introduction. Currently, despite the rapid development of pediatric cardiac surgery, there is a problem of postoperative dysfunction of the gastrointestinal tract (GIT) in patients. Necrotizing enterocolitis (NEC) remains the most complex and least studied problem in pediatrics, including cardiac surgery. In pediatric cardiac surgery, the decrease in perfusion of the internal organs of the abdominal cavity is due to low perfusion pressure during cardiopulmonary bypass, low cardiac output in the postoperative period, aggravation of sympathetic vasoconstriction due to the stress response to surgery, and the introduction of exogenous catecholamines. Objective: analysis of the features of the development of NEC in cardiac surgery children patients.

Materials and methods

Materials and methods. A prospective analysis of thirty cardiac surgery children patients with the development of gastrointestinal dysfunction after surgery was performed. All children underwent standard research methods.

Results

Results. In 63.3% of cases, children showed signs of dynamic intestinal obstruction; 36.7% of newborns have signs of necrotizing enterocolitis of varying degrees. The features of the bacteriological landscape, clinical manifestations and X-ray picture depending on the type of intestinal function disorder are presented. The role of hypoxia, hypoperfusion during cardiopulmonary bypass, the functioning of the open ductus arteriosus in “blue” patients in the formation of the risks of developing necrotizing enterocolitis is shown. Among the studied patients, according to the age structure, there were newborns — 18 (60%) patients, children under 6 months — 10 (33,3%); older than 1 year — 2 (96,6%). An analysis of clinical manifestations in children in the preoperative and postoperative periods showed 19 cases (63.3%) to have signs of dynamic intestinal obstruction. This group of children consisted of 8 newborns (36.8%) and 12 patients of the postnatal period. All patients were after heart surgery (2 patients after narrowing of the pulmonary artery and 10 cases cc were operated on under cardiopulmonary bypass). The most difficult and severe group of patients after heart and vascular surgery were children with congenital heart defects, who developed signs of NEC — 11 patients (36.6%). 10 children were neonates, 1 patient was ovet 5 years. It is shown that the development of such complications including infectious and hypoxic causes, heart failure, the duration of cardiopulmonary bypass and diastolic stealing of vessels is of decisive importance.

Conclusions

Conclusions. Dysfunction of the gastrointestinal tract after heart surgery in children is one of the urgent problems of cardiac surgery. In the group of severe sick patients undergoing prolonged ventilation, morphine infusion, muscle relaxants, with signs of anasarca, the interpretation of the X-ray picture and the clinic of acute surgical pathology in the abdominal cavity may be difficult. NEC, occurred in newborns over the postoperative period, is often not recognized in a timely manner and leads to an unfavourable outcome.

Contribution

Contribution:Sarsenbayeva G.I. — concept and design of the study, writing the text;Kim A.I. — editing and consulting;Berdibekov A.B. — collection and processing of the material.Аll co-authors — аpproval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: May 30, 2023Accepted: June 20, 2023Published: August 31, 2023

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The authors declare that there are no conflicts of interest present.