经幽门喂养在超低出生体重儿的应用研究

Study of transpyloric feeding on extremely of birthweight infants.

目的:评价持续经幽门喂养在超低出生体重儿的作用,并与间歇经胃管喂养作比较.方法:澳大利亚墨尔本医学中心新生儿2000年1月～2002年12月住院的超低出生体重儿.分组:经幽门喂养(transpyloric feeding,TP)组及经胃管喂养组(intermittent nasogastric feeding,NG).TP组:比较TP前、后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,并与相对应胎龄的NG组的患儿比较呼吸暂停,心率减慢,喂养耐受性及体重增长速度.结果:TP组:患儿TP后与TP前比较,在纠正胎龄为30周及31周时,每日呼吸暂停及心率减慢的发生率明显减少,未再出现呕吐及腹胀,在摄入蛋白及能量相似的情况下,体重增长速度比TP前慢.与NG组比较,TP组较NG组呼吸暂停及心率减慢均明显减少,在摄入蛋白及能量相似的情况下,体重增长速度较NG组慢.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： To evalute the impact of transpyloric feeding on extremely low birthweight （ELBW） infants, and to compare the outcome of those who received continuous intermittent nasogastric feeding （NG） . Methods： Clincal data of ELBW infants admitted to newborn services , Monash Medical Centre, Australia, between January 2000 and December 2002 were retrospectively reviewed. In those who received transpyloric feeding , the severity of apnoea and bradycardia, feed tolerance , nutritional intake, and weight gain were compared before and after the commencement of transpyloric feeding. In addition, infants who received continuous transpyloric feeding were compared to those who received intermittent nasogastric feeding for their severity of apnoea and bradycardia, feed tolerance, nutritional intake and weight gain. Results： In infants who received transpyloric feeding, the number of episodes of apnoea and bradycardia per day decreased sig- nificantly, and vomiting and abdominal distension did not recur after the commencement of transpyloric feeding. There were no significant differences in protein and energy intake before and after tmnspyloric feeding, but the rate of weight gain after transpyloric was significantly less than that before transpyloric feeding was commenced. There were no significant differences in protein and energy intake and weight gain between infants who received transpyloric or nasogastric feeding. The apnoea and bradycardia in TP group were significantly less than that in NG group at the same postconceptional age of 30 and 31 weeks. Conclusion： In ELBW infants are unable to tolerate intragastric feeding, transpyloric feeding significantly reduced the severity of apnoea and bradycardia and improved feed tolerance.