小剂量红霉素干预早产儿胃食管返流临床研究

Clinical Study of Low-dose Erythromycin Meddling Gastro Esophageal Reflux in Preterm Infants

目的:探讨小剂量红霉素对早产儿胃食管反流及喂养不耐受的影响。方法:200例胎龄≤34周的早产儿随机分为干预组和对照组各100例,干预组给予红霉素剂量(2.5 mg·kg^(-1)),用0.9%氯化钠溶液配成浓度为5 mg·ml^(-1)溶液鼻饲q6h,对照组给予等量0.9%氯化钠溶液鼻饲。通过24 h食管pH测定及喂养耐受情况评估,了解两组患儿胃食管反流情况。结果:200例患儿胃食管反流发生率为92.5%(185/200);鼻饲红霉素治疗后,干预组胃食管反流发生率从94%(94/100)降至32%(32/100),对照组从91%(91/00)降至77%(77/100),DeMeester评分干预组从36.9±10.8降至16.8±56.4,对照组从34.3±11.1降至29.0±10.8,两组比较差异均有统计学意义(P<0.01);干预组达到出生体重及喂奶量120 ml·kg^(-1)·d^(-1)的天数都比对照组平均提前4 d(P<0.01),静脉营养天数及胃储留次数均低于对照组(P<0.01)。结论:鼻饲小剂量红霉素可以降低胃食管反流的发生率,建议尽早建立胃肠道喂养。

Objective： To evaluate the efficacy of low-dose erythromycin in the intervention of gastroesophageal reflux and feeding intolerance in preterm infants. Method： Two hundreds preterm infants of gestatioual age ≤ 34 weeks were divided into interventiom group and contro grop, all 100 cases. The intervention group was given erythromycin dose 2. 5 mg. kg-1 paired with the saline concentra-tion of 5 mg · ml - 1 solution, nasal feeding q6h. The control group was give equal normal solution nasal feeding. The gastroesophageal re- flux was evaluated through monitoring 24-hour pH value and investigated feeding intolerance. Result： Of these 200 patients, the total incidence rate of gastroesophageat reflux were 92. 5% （185/200） . The incidence rate of gastroesophageal reflux in prevention group decreased from 94% （93/100） to 32% （32/100） , while decreased from 91% （91/100） to 77% （77/100） in control group, DeMeester score in the intervention group from 36. 9 ± 10. 8 to 16. 8 ± 5.4, control group from 34. 35 ±11.1 to 29.0 ± 10. 8. There was significant difference in two groups （P 〈 0. 01 ）. Compared with control group ,the intervetion group preceded born weight and milk capacity 120 mlo kg-1·d-11 by a mean of 4 days, respectively, and the time of intravenous nutrition and gastric retention was less （P 〈 0. 01 ） . Conclusion： Nasogastric feeding low-dose erythromycin can decrease the incidence rate of gastroesophageal reflux and should set up gastrointestinal tract feeding early.