早期应用微生态制剂对极低出生体重儿影响的临床观察

Effects of early application of probiotics on very low birth weight infants:Clinical observation

目的观察早期应用微生态制剂对极低出生体重儿黄疸、喂养、生长以及免疫功能的影响。方法我院NICU收治的生后24h内极低出生体重儿84例,随机分为观察组46例,对照组38例。观察组生后4h内开始口服或鼻饲胃管服用妈咪爱0.5g,2次/d,连用14d。观察两组达到高胆红素血症标准的人数,以及生后24h、5d总胆红素值;喂养不耐受人数;生后5d生理性体重下降及1个月体重增长情况;生后1个月免疫学指标。并加以对比。结果24h内血清胆红素比较无统计学意义(P>0.05),治疗5d后观察组血清总胆红素明显低于对照组(P<0.05),观察组出现高胆红素血症人数明显低于对照组(P<0.05);观察组喂养不耐受出现例数明显低于对照组(P<0.01);观察组生后5d体重下降的克数低于对照组(P<0.05),1个月时体重增长克数高于对照组(P<0.01);观察组IgA水平较对照组明显增加(P<0.05),但IgG及IgM含量与对照组比较差异无统计学意义(P>0.05)。结论早期应用微生态制剂能降低血清胆红素水平,对预防极低出生体重儿高胆红素血症有一定作用;能提高喂养的耐受性,有利于患儿生长发育;对极低出生体重儿的肠道功能及免疫功能有明显影响,能增加免疫球蛋白IgA水平,从而促进体液免疫的发展。

Objective To observe the effects of early application of probiotics on very low birth weight（VLBW）infants in regards to jaundice,feeding,growth and immune function.Methods 84 VLBW infants within 24 hours after birth were randomly divided into the observation group（46cases）or control group（38cases）,and were given conventional treatment;the observation group was additionally given Medilac-Vita0.5g b.i.d.,starting 4hours after birth,for 14 days.The rate of hyperbilirubinemia,levels of total bilirubin 24 hours and 5days after birth,rate of feeding intolerance,physiologic weight loss 5days after birth,weight increase and immunological indexes 1month after birth were observed and compared between the two groups.Results There was no significant difference in serum bilirubin level within 24 hours after birth between the two groups（P〉0.05）.The total bilirubin in observation group was obviously lower than in the control group（P〈0.05）5days after treatment,so was the rate of hyperbilirubinemia（P〈0.05）.The rate of feeding intolerance in observation group was significantly lower than in control group（P〈0.01）.The weight loss in observation group 5days after birth was lower than in the control group（P〈0.05）,while the weight increase 1month after birth was higher than in the control group（P〈0.01）.The IgA level in observation group was significantly increased than the control group（P〈0.05）,but no significant differences were seen in the levels of IgG and IgM（P〉0.05）.Conclusion Early application of probiotics can reduce the serum bilirubin level,help to prevent hyperbilirubinemia,improve feeding tolerance,and promote the development of humoral immunity of VLBW infants by increasing the level of immunoglobulin IgA.