双歧杆菌三联活菌散预防早产儿坏死性小肠结肠炎的初步探讨

A clinical study of preventing necrotizing enterocolitis in premature infants by bifido triple viable powder supplementation

目的评估双歧杆菌三联活菌散预防早产儿坏死性小肠结肠炎的临床效果。方法选取2012年1月至12月收住上海市儿童医院新生儿科早产儿室患儿224例,依据相关入组标准(排除先天性消化道畸形、复杂先天性心脏病、遗传代谢病、染色体病、入院时日龄>3 d、住院期间接受外科手术治疗,开始喂养前已出现呕吐、腹胀等严重消化道症状,入院时已诊断为坏死性小肠结肠炎;未使用促胃肠动力药物),最终入组190例,其中男婴106例,女婴84例;随机分为对照组及益生菌组,通过比较两组早产儿坏死性小肠结肠炎的发生率及其程度,来评价口服益生菌对NEC的预防效果;比较两组败血症发生率,了解并发症发生情况;通过比较达到全肠道营养的时间、恢复至出生体重时间、胎粪排尽时间、喂养不耐受的发生率,评估早产儿的喂养情况。结果两组胎龄(F=1.552,P=0.2144)、出生体重(F=1.415,P=0.2357)、1分钟Apgar评分(F=0.553,P=0.814 3)、5分钟Apgar评分(F=0.047,P=0.828)差异无统计学意义。在益生菌补充组中,坏死性小肠结肠炎(2.94%vs 13.6%,x^2=7.4316,P=0.0064)的发生率显著降低,且在发生NEC的患儿中,补充益生菌组的患儿疾病严重程度显著低下,虽补充益生菌组患儿败血症的发生率较对照组低下(2.9%vs 4.5%,x^2=0.342 6,P=0.56),但差异无统计学意义。益生菌补充组患儿更快达到全肠道喂养时间(F=3.83,P=0.048),恢复至出生体重(F=5.48,P=0.02),并排尽胎粪(F=16.02,P<0.01);而喂养不耐受(14.7%vs 30.09%,x^2=26.784,P<0.01)、出院时宫外生长发育迟缓(20.59%vs 42.05%,x^2=10.256,P=0.0014)的发生率低于对照组,差异有统计学意义。结论通过早期口服双歧杆菌三联活菌散可以有效降低早产儿坏死性小肠结肠炎的发生率,减轻疾病严重程度,有利于促进早产儿喂养耐受性,且相对安全,对于早产儿的生长发育具有促进意义。

Objetive To evaluate the effects of Bifido triple viable powder supplementation in preven- ting necrotizing enterocolitis in preterm infants. Methods An observation study was performed in inborn in- fants from Jan. to Dec. 2012 in the preterm ward of neonatal department in Shanghai Children＇s Hospital. Infants were excluded when they had congenital malformation, genetic and metabolic diseases, chromosomal disease, surgical operation during hospitalizing, necrotizing enterocolitis （NEC） , admitted after postage 1 day, prokinetic agents usage ,discharged before regain birth weight. During the study period, 190 patients were finally enrolled, with 106 male and 84 female. Infants enrolled were randomly divided into two groups, control group and probiot- ics supplementation group. The incidence of necrotizing enterocolitis were compared to determine the prevention effect of probiotics supplementation. The incidence of sepsis as complication were also compared. To evaluate feeding situation, we measured the time they achieved enternal feeding, meconium passage completed, regain birth weight, as well as the incidence of feeding intolerance. Last but not least, the incidence of extrauterine growth retardation were compared while the babies were discharge. Results Between the two groups, there were no significant differences among gestational age （ F = 1. 552 ,P = 0. 214 4） , birth weight （ F = 1. 415 ,P =0.235 7）, 1 minute Apgar score （ F = 0. 553, P = 0. 814 3 ） ,5minute Apgar score （ F = 0. 047, P = 0. 828 ）. In probiotic supplemention group, necrotizing enterocolitis （ 2.94% vs 13.6% , xa = 7.431 6, P = 0. 006 4） were significantly lower, and the NEC babies were less severity in the probiotics group. Although the incidence of sep- sis seems less in the probiotic supplement group ,there had no statistical significance （2.9% vs 4.5% ,low x2 = 0. 3426,P = 0.56）. Probiotic supplementation made it faster to achieve full enteral feeding time （ F = 3.83, P = 0. 048 ）, regain birth weight （ F = 5.48, P = 0.02 ） , complete meconium passage （ F = 16. 02, P 〈 0.01 ）. Feeding intolerance seemed less in the probiotics supplementation group （14.7% vs 30.09%, x2 = 26. 784 ,P 〈 0.01 ）, and the same trend could be found in extrauterine growth retardation （20.59% vs 42.05% , x2 = 10. 256,P =0.001 4）. Conclusions Early supplementation of bifido triple viable powder can effectively reduce the incidence and the severity of necrotizing enterocolitis in preterm infants, and it was safe and could pro-moting feeding tolerance, and the growth of premature infants.