益生菌对VLBWI的胃肠功能和胃肠外营养相关性胆汁淤积的影响

Effect of Probiotics on Gastrointestinal Function and Parenteral Nutrition-Associated Cholestasis in VLBWI

目的探讨益生菌的早期应用对极低出生体重儿(VLBWI)胃肠功能和胃肠外营养相关性胆汁淤积的影响。方法 60例极低出生体重儿随机分为益生菌组(30例)和对照组(30例)。除常规治疗外,益生菌组早产儿在开奶当天开始补充益生菌制剂(含两歧双歧杆菌、长双歧杆菌和植物乳杆菌)500 mg·kg^(-1)·d^(-1),持续至矫正胎龄满36周;对照组给予等量的糖粉。结果益生菌组早产儿的死亡数、消化道合并症[消化道出血、消化道穿孔、坏死性小肠结肠炎(NEC)]和喂养不耐受的发生率明显低于对照组(P<0.05)。两组早产儿的喂养不耐受持续时间、静脉营养时间及经外周静脉穿刺中心静脉置管(PICC)时间的差异无统计学意义。服用益生菌4周内,益生菌组早产儿的胃肠外营养相关性胆汁淤积(PNAC)发病率低于对照组。结论双歧杆菌和乳杆菌三联益生菌制剂的早期应用能改善VLBWI的存活率和胃肠功能。

OBJECTIVE The effect of probiotics on gastrointestinal function and parenteral nutrition-associated cholestasis in very low birth weight infants （VLBWI） is investigated. METHODS 60 VLBWIs were randomized into probiotics group （ n = 30） and control group （n = 30）. Besides conventional therapy, preterm infants in probiotics group were given 500 mg. kg-1. d-1 probiotics including Bifidobacterium bifidum ,Bifidobacterium longum and Lactobacillus plantarum following breast-feed until to the 36th week for correct gestational age. Infants in control group were administrated orally the same amount of glucose powder. RESULTS The mortality, incidence rates of gastrointestinal hemorrhage, gastrointestinal perforation, necrotizing enteroeolitis （NEC）, and feeding intolerance in VLBWI were markedly reduced following probiotics administration. The duration of feeding intolerance, intravenous nutrition,peripherally inserted central catheter （PICC） had not significant difference between the two groups. Additionally, the incidence rate of parenteral nutrition-associated cholestasis （ PNAC ） in probiotics group during 4 weeks of probiotics treatment was slightly lower than that in the control group. CONCLUSION Early administration of probiotics including Bifidobaeterium and Lactobaeillus can improve the survival rate and gastrointestinal function of VLBWI.