超低出生体重儿经幽门喂养的回顾性研究(英文)

A retrospective study of transpyloric feedingin extremely low birth weight infants

目的 反复呼吸暂停和心率减慢是超出生体重儿 (ELBWI)特别是有患有慢性肺部疾病的ELBWI的常见问题。胃食道返流是反复呼吸暂停和心动过缓的诱因。本研究的目的是评价持续经幽门喂养对不能耐受胃管喂养的超低出生体重儿的治疗意义 ,并与间歇经胃管喂养作比较。方法 回顾性分析 81例ELBWI的临床资料。分两组 :经幽门喂养 (TP)组 (n =30 )及经胃管喂养组 (IG组 ) (n =4 9)。TP组 :比较TP前 ,与TP期间呼吸暂停及心率减慢的发生情况 ,喂养耐受性 ,营养摄入及体重增长速度 ,并与NG组的患儿做比较。TP组 :患儿TP期间与TP前比较 ,每日呼吸暂停 (0 .6 6次vs 1.6 4次 )及心率减慢次数 (B12 .0 6次vs3.32次、B2 1.6 6次vs 3.18次 )明显减少 (P <0 .0 5 ) ,未再出现呕吐及腹胀 ,在摄入蛋白及能量相似的情况下 ,每日体重增长速度比TP前慢 (13.3±2 .6 g/kgvs 15 .3± 3.9g/kg) (P <0 .0 5 )。TP组在TP期间与IG组蛋白能量摄入和体重增长速度无显著差异。TP组ELBWI均未发生坏死性小肠结肠炎和肠穿孔。结论 对于不能耐受胃管喂养的超低出生体重儿 ,经幽门喂养能显著减少呼吸暂停及心率减慢的发生率及改善喂养的耐受性。

Objective Recurrent apnoea and bradycardia are common in extremely low birth weight (ELBW) infants, especially in the babies who suffered from chronic lung disease (CLD). Gasrtroesophageal reflux (GOR) is believed to be responsible for recurrent apnoea and bradycardia. The aim of the study was to evaluate the effects of transpyloric feeding on the frequency of apnea and bradycardia episodes in infants who had suspected GOR. Methods Clinical data of 81 ELBW infants were retrospectively reviewed. In those who received transpyloric feeding (TP group, n=30), the frequency of apnoea and bradycardia episodes, feeding tolerance, nutritional intake, and weight gain were recorded before and during transpyloric feeding and were compared to those who received intermittent intragastric feeding (IG group, n=49). The complications related to feeding were observed in the two groups. Results In the TP group, the number of apnoea episodes (from 1.64 to 0.66; P< 0.05) and bradycardia (B1 from 3.32 to 2.06 and B2 from 3.18 to 1.66; both P< 0.05) per day decreased significantly, and vomiting and abdominal distension did not recur after the commencement of transpyloric feeding. There were no significant differences in protein and energy intakes before and during transpyloric feeding, but the rate of weight gain per day during transpyloric feeding was significantly lower than that before transpyloric feeding (from 15.3 g/kg to 13.3 g/kg; P< 0.05). Protein and energy intakes and weight gain were the same for the two groups. Necrotising enterocolitis and duodenal perforation did not occur in the TP group. Conclusions Transpyloric feeding may significantly reduce the frequency of apnoea and bradycardia episodes and improve feeding tolerance in the ELBW infants who are unable to tolerate intragastric feeding.