重度缺氧缺血性脑病新生儿应用输注泵早期肠内营养的效果观察

Observation of Effect of Early-stage Enteral Nutrient Pumping among Neonates with Severe Hypoxic-ischemic Encephalopathy

目的探讨重度缺氧缺血性脑病新生儿应用输注泵早期肠内营养的效果。方法将足月重度缺氧缺血性脑病新生儿120例,按入室时间顺序分为早期喂养组和常规喂养组各60例,早期喂养组入室后早期将配方奶或母乳使用输注泵以0.5～5 ml/（kg.h）持续输注。对照组使用传统方法,用注射器将配方奶或母乳经鼻饲管定时推注,每次间隔2～3 h,温度均控制在39-41℃。比较两组患儿留置胃管期间肠内营养并发症发生例数,包括腹胀、呕吐、反流、误吸、消化道出血、高血糖等,并统计患儿体质量增长、神经系统症状消失或缓解情况及住院时间。结果早期喂养组患儿肠内营养并发症腹胀、呕吐、反流、高血糖、误吸发生率明显低于常规喂养组,早期喂养组患儿住院期间体质量增长多于常规喂养组,神经系统症状恢复时间及住院时间均短于常规喂养组,差异均有统计学意义（P〈0.05或P〈0.01）。结论采用输注泵持续输注行早期肠内营养,可以明显减少重度缺氧缺血性脑病新生儿肠内营养的并发症,促进患儿康复,使肠内营养支持更为安全、有效。

Objective To explore the effect of early-stage enteral nutrient pumping among neonates with severe hypoxic-ischemic encephalopathy （HIE）. Methods 120 term neonates with server HIE were, in order of their admittance, divided into the earlystage nutrition group （the pumping group） and the conventional nutrition group （the control group）, each with 60 cases. For the pumping group, formula milk or breast milk was pumped continuously at the speed of 0.5-5 ml/（kg, h） in the early stage, and for the control group, formula or breast milk was fed with the syringe via the nasal feeding tube at the regular interval of 2-3 hours. The temperature of the milk for both groups was controlled between 39-41℃. Then a comparison was made of the incidences of enteral nutritional complications during the stay of the gastric tube, including the abdominal distension, vomiting, reflux, aspiration, gastrointestinal hemorrhaging and hyperglycemia. Records were also made of the patients＇ weight gain, the disappearance or alleviation of the nervous system symptoms and the duration of hospital stay. Results The incidences of enteral nutritional complications of the pumping group, including the abdominal distension, vomiting, reflux, aspiration and hyperglycemia were less than those of the control group, the weight gain of the pumping group, greater, and the time for the improvement of the nervous system symptoms and the duration of hospital stay, shorter, with all the differences being statistically significant（P〈0.05 or P〈0.01）. Conclusion Early-stage continuous enteral nutrition pumping can markedly reduce the enteral nutritional complications among neonates with HIE, facilitates the recovery, and make the enteral nutritional support more secure and effective.