极低出生体重儿早期喂养的临床观察

Clinical observation of the early enteral feeding in very low birth weight

目的研究早期微量喂养对极低出生体重儿(VLBWI)的生长发育、胃肠功能成熟及生命体征的影响,为VLBWI的早期微量喂养提供依据。方法将2005年2月至2006年2月北京协和医院NICU住院的符合入选标准的29例VLBWI随机分为早喂组和晚喂组。两组一般情况及合并症差异无统计学意义。对两组的生长发育、胃肠耐受情况、血清胃泌素和胃动素水平、胃肠动力、胃电活动、肠系膜上动脉血流速度、胃食管返流情况进行观察监测。结果研究期间两组生长发育情况、平均肠外营养时间及住院时间差异无统计学意义;喂养耐受性早喂组较晚喂组明显增强(P=0.039);血清胃动素水平早喂组较晚喂组在第7、14天明显升高;两组血清胃泌素水平差异无统计学意义;第28天时早喂组的胃电图检查更为成熟;早喂组的胎便排完时间更短;卡红胃肠道转运时间第28天早喂组更短;血流动力学参数变化差异无统计学意义。结论早期喂养可以促进VLBWI的胃肠道成熟,改善喂养不耐受,包括减少喂养并发症、促进胃肠激素分泌、促进胃电生理活动成熟、加强胃肠动力。

Objectives To investigate the effects of early minimal enteral feeding on growth and development, maturation of the gastrointestinal function, feeding complications in very low birth weight infants（ VLBWI）, and provide the basis of early minimal enteral feeding in VLBWL Methods The study was conducted in the neonatal intensive care unit of Peking Union Medical College Hospital from Feb. 2005 to Feb. 2006. 29 infants who met the entry criteria were randomly assigned to two groups （early feeding group and late feeding group） . No significant difference in general condition and complication between two groups. The parameters including growth and development, tolerance to enteral feedings, serum gastrin and motilin concentrations, eleetrogastrography, gastrointestinal motility, SMA haemodynamics, and stomach-esophagus stream were monitored. Results There were no significant difference in development, time to full enteral feeds, parenteral nutrition time and hospitalization duration between two groups. In early feeding group, enteral feeding tolerance was significantly enhanced, serum motilin concentrations were enhanced on day 7 and day 14 after birth, eleetrogastrography type was more mature on day 28, complete passage of meeonium time was shorter, and complete passage of coccinellin time was shorter on day 28. No statistic difference could be found in SMA haemodynamies. Also, no significant difference in serum gastrin concentrations. Conclusions Our initial study indicates that early minimal enteral feeding can enhance the maturation of the small intestine function, lessen feeding intolerance （including reduce feeding complications, enhance serum motilin concentrations, enhance maturation of gastric electric control activity, enhance gastrointestinal motility）.