鼻塞式气道正压通气治疗早产儿早期微生态干预的前瞻性研究

Prospective study on early microecological treatment on intubation-surfactant-extubation premature infants

目的探讨应用气管插管-使用肺表面活性物质-拔管使用经鼻塞式气道正压通气(intubation surfactant-extubation,INSURE)策略的早产儿早期肠道内添加益生菌制剂金双歧的临床价值。方法将符合条件的给予INSURE策略治疗的患有呼吸窘迫综合征早产儿86例随机分为对照组42例和试验组44例,对照组给予常规治疗,试验组在此基础上给予口服双歧杆菌乳杆菌三联活菌片治疗,0.5 g/次,3次/d,对治疗效果进行统计学分析。结果与对照组相比,试验组喂养不耐受发生率低(x^2=4.693,P<0.05),达全胃肠喂养所需时间早(t=2.385,P<0.05),温盐水灌肠次数减少(t=2.925,P<0.05),更早恢复出生体质量(t=4.541,P<0.05),发生胆汁淤积比率降低(x^2=4.671,P<0.05)。2组坏死性小肠结肠炎发生率差异无统计学意义,试验组无益生菌相关性败血症发生。结论对INSURE策略治疗早产儿进行更为积极的保护性喂养策略,即早期微量喂养同时添加肠道益生菌,对胃肠功能恢复、促进生长发育、减少胆汁淤积并发症等方面效果良好,无明显不良反应,值得临床推广。

Objective To explore the clinical application value of early microecological treatment with golden bifid on the applying of intubation-surfactant-extubation（INSURE）for premature infants.Methods Eighty-six premature infants with respiratory distress syndrome （RDS）treated by applying INSURE were randomly divided into two groups.Patients of both groups were subjected to routine treatments.Besides,patients of the treatment group were given live combined Bifidobacterium and Lactobacillus tablets,0.5 g,3 times/day.Results There were significant differences in the incidence of feeding intolerance（χ2 =4.693,P 〈0.05）,enough feeding time（t = 2.385,P 〈 0.05 ）,the number of warm brine enema（t = 2.925,P 〈 0.05 ）,birth mass recovery time（t =4.541,P 〈0.05）,and incidence of cholestasis（χ2 =4.671,P 〈 0.05）.But,there were no significant differences in the incidence of necrotizing enterocolitis.The probiotics was not related to the occurrence of sepsis.Conclusion The premature infants with RDS treated by INSURE strategy benefit the implementation of early microecological treatment over to the full amount feeding by gastrointestinal tract,better growth weight,reduce cholestasis occurrence,no side effect was found.It is worth clinical promotion.