早产儿早期胃潴留量的临床研究

Clinical study on early gastric residual volume in preterm infants

目的探讨早产儿早期胃潴留量（GRV）及其安全范围。方法对2013年9月至2015年3月住院、出生体质量≤1800g或胎龄≤32周早产儿，按喂养指南开始喂养并留置胃管观察生后第1周GRV。无喂养禁忌证并可连续喂养的早产儿按体质量及胎龄分组，描述不同出生体质量及胎龄早产儿出生早期GRV的变化，并分析其与并发症的关系及相关影响因素。结果符合标准的早产儿165例，早期平均最大GRV（3．3±2．2）ml／kg，生后24h内平均最大GRV（2．4±1．9）ml／kg，不同体质量及胎龄组早产儿出生早期最大GRV比较差异无统计学意义（P〉0．05）。不同出生体质量组早产儿胃潴留完全消失时间的差异有统计学意义（P〈0．05），体质量≤1250g早产儿胃潴留消失最晚（37．5±17．6）d。第3天最大GRV达6．2ml／kg预示出生4-7d上消化道出血的风险，受试者工作特征曲线的AUC=O．641（95％CI：0．500～0．782，P=0．035），早期最大GRV与出生2-3周新生儿坏死性小肠结肠炎的发生无明显相关。结论早产儿胃潴留可持续存在，出生体质量越低，持续时间越长；动态监测及评估GRV情况下可以进行肠道内营养；较大量的GRV可能预示合并喂养危险因素。

Objective To evaluate the mean gastric residual volume （GRV） and its safe range in early life of premature infants. Methods One hundred and sixty-five premature infants, birth weight ≤ 1800 g or gestational age ≤ 32 weeks, admit- ted from Sep.2013 to Mar. 2015, were fed following a standardized protocol. The GRV of first week after birth was recorded by retention stomach tube. The premature infants were grouped according to body weight and gestational age. The changes of GRV in the early stage of birth of premature infants with different birth weight and gestational age were observed. The relationships between the GRV and the complications and related factors were analyzed. Results Total of 165 premature infants was quali- fied. The average early maximum GRV were 3.3±2.2 ml/kg. The average GRV in 24 hours after birth were 2.4 ±1.9 ml/kg. There was no significant difference in the early maximum GRV （ml/kg） in different body weight and gestational age groups （P〉0.05）. The time of gastric retention disappeared was significantly different in different birth weight groups （p〈0.05）. The longest time of gastric retention appeared was 37.5±17.6 days in infants with birth weight ≤ 1250 g. On a receiver operating characteristic （ROC） curve, infants with the maximum GRV up to 6.2 ml/kg at third days had the risk of gastrointestinal bleeding at the 4-7 days after birth. The area under curves （AUC） was 0.641 （95%CI： 0.500-0.782）. There was no significant correlation between the early maximum GRV and the occurrence of neonatal necrotizing entercocolitis in 2-3 weeks after birth. Conclusions Gastric retention maybe sustained for a long time in premature infants after birth. The lower the birth weight, the longer the duration. The enteral nutrition can be performed under the dynamic monitoring and assessment of GRV. The large volume of GRV may predict the feeding complications.