谷氨酰胺及低乳糖配方乳对早产儿坏死性小肠结肠炎的预防

Prevention of Glutamine and Low-Lactose Milk on Necrotizing Enterocolitis in Premature Infants

目的观察谷氨酰胺及低乳糖配方乳对早产儿坏死性小肠结肠炎(NEC)的预防效果。方法选取新生儿科病房收治的早产极低出生体质量儿90例按不同营养方式分为3组。A组:予常规静脉营养及母乳或配方乳喂养;B组:静脉营养及喂养方法与A组相同,另外胃肠喂养开始即添加谷氨酰胺口服(0.25 g.kg-1,2次.d-1);C组:静脉营养方法与A组相同,胃肠喂养采用低乳糖配方乳,另外添加谷氨酰胺口服(0.25 g.kg-1,2次.d-1)。3组患儿均于出生24 h内、出生5 d、10 d后取静脉血测定其胱抑素C(CysC)和超敏C反应蛋白(hsCRP),出生10 d取2 g左右患儿大便定性测定乳糖水平,并在出生30 d内分别计算各组患儿NEC的发生率。结果经过不同营养方法处理后,3组患儿hsCRP均逐渐升高,但喂养5 d及10 d后C组升高不明显,与A、B组比较差异有统计学意义;各组CysC逐渐升高,A组升高明显,C组升高不明显,在出生10 d时最低,与A、B组比较差异有统计学意义。3组患儿大便乳糖分析显示A组阳性率较高,C组最低。患儿NEC发生率A组为6.7%,B、C组发生率相同为3.3%,A组与B、C组比较差异有统计学意义。结论早产儿喂养谷氨酰胺联合低乳糖配方乳可以减轻炎性反应,增加乳糖吸收,降低NEC的发生,对NEC的发生起到一定预防作用。

Objective To observe the effect of glutamine and low-lactose milk on the prevention of necrotizing enterocolitis（NEC） in premature infants. Methods Ninety cases of very low birth weight premature infants admitted in the neonatal wards were selected and divided into 3 groups according to different nutritional feeding methods.Group A was given conventional intravenous nutrition with breast milk or laboratory milk feeding;group B was given nutrition in the same way as group A,and enteral feeding with oral glutamine（0.25 g·kg-1 per day） was added;Group C was given intravenous nutrition in the same way as group A,and enteral feeding with low lactose milk and oral glutamine（0.25 g·kg-1,twice per day） was added.Blood samples were collected from three groups to measure cystatin C（CysC） and high sensitive C-reactive protein（hsCRP） within 24 h,5 days and 10 days later after birth.Stool samples（2 g） were collected from infants for qualitative determination of lactose content 10 days after birth.The incidence of NEC 30 days after birth was studied in each group. Results After children in 3 groups were managed in different ways,hsCRP in each group increased,but hsCRP in group C did not increase remarkably after 10 days of feeding,compared with group A and group B,which was statistically significant;CysC in each group increased gradually,group A increased significantly,while group C did not increase obviously.Ten days after birth,CysC in group C became the lowest,compared with group A and group B.The stool lactose analysis showed a higher positive rate of group A,the lowest of group C.The incidence of NEC was 6.7% in group A,3.3% in group B and group C.Compared with group B and group C,group A had a significant difference. Conclusions Glutamine combined with low lactose milk feeding in premature infants can reduce the inflammatory response,increase in lactose absorption,reduce the incidence of NEC.It can play a role in preventing the incidence of NEC.