初乳灌肠对极低出生体重儿胎粪排出和免疫反应的影响

Effect of colostrum enemas on meconium evacuation and immune response in very low birth weight preterm infants

目的探讨初乳灌肠对极低出生体重儿胎粪排出和免疫反应的影响。方法将128例极低出生体重儿随机分为干预组和对照组各64例。干预组采用2 mL/kg初乳灌肠;对照组采用1 mL/kg开塞露+1 mL/kg生理盐水1∶1稀释灌肠。灌肠自早产儿出生后24 h开始,至胎粪排尽时停止。结果干预组脱落10例,对照组脱落9例。干预组胎粪排尽时间和达到完全肠内营养时间显著短于对照组,体质量增长速度显著高于对照组(均P<0.05);干预组首次排出与排尽时的胎粪中的分泌型免疫球蛋A浓度、出生后第1次与第6天尿液中的分泌型免疫球蛋A浓度显著高于对照组(均P<0.05);干预组坏死性小肠结肠炎、喂养不耐受发生率显著低于对照组(均P<0.05)。结论初乳灌肠能促进极低出生体重儿胎粪排出,缩短达到完全肠内营养时间,提高体质量增长速度,提高早产儿免疫功能,降低相关并发症发生率。

Objective To explore the effects of colostrum enemas on meconium evacuation and immune response in very low birth weight(VLBW)preterm newborns.Methods Totally,128 VLBW preterm newborns were randomly assigned into 2 groups of 64 cases each.The intervention group received enema with 2mL/kg colostrum,while the control group received enema with 1 mL/kg glycerin suppository plus 1 mL/kg saline solution diluted at a ratio of 1∶1.Enemas started 24 hours after birth and ceased upon complete meconium evacuation.Results Ten cases in the intervention group dropped out,versus 9 cases in the control group.The intervention group had significantly shorter time to complete meconium evacuation,and time to full enteral feeding,as well as faster weight gain rate,than the control group(all P<0.05);the former group also had significantly higher immunoglobulin A(sIgA)concentration in the first and last meconium discharge sample,as well as in the first-time and sixth-day urine sample,than the latter group(all P<0.05).The intervention group also had significantly lower rates of necrotizing enterocolitis and feeding into-lerance than the control group(both P<0.05).Conclusion Colostrum enemas can facilitate meconium evacuation in VLBW preterm newborns,expedite full enteral feeding,enhance weight gain,boost immunity,and reduce incidence of related complications.