不同喂养方式对极低出生体质量儿胃肠功能影响的比较

Comparison of the gastrointestinal function in very low birth weight infants among different modes of feeding

目的:探讨经幽门喂养(TP)和经胃管喂养(IG)对极低出生体质量儿胃肠功能的影响,以制订合理的早期肠内营养(EEN)方案。方法:将60例极低出生体质量儿随机分为TP组和IG组,每组各30例。观察两组病儿呼吸暂停发生频率、体质量增长速度、达出生体质量时间、喂养不耐受时间、达TEN时间、宫外发育迟缓(EUGR)发生率以及胃动素、胃泌素、住院时间、喂养相关并发症、坏死性小肠结肠炎和肠穿孔等指标。结果:TP组病儿喂养不耐受时间和达TEN时间均明显低于IG组(P<0.05),呼吸暂停发生频率明显低于IG组(P<0.01)。两组病儿的体质量增长速度、出院时EUGR发生率、并发症坏死性小肠结肠炎和住院时间均无显著性差异(P>0.05)。两组病儿胃动素和胃泌素水平出生后第8天与喂养前比较有显著性差异(P<0.01),且胃动素水平TP组明显高于IG组,差异有显著性统计学意义(P<0.01)。结论:TP可用于胃管喂养耐受性差或反复出现呼吸暂停的极低出生体质量儿,在进行喂养时应针对不同情况制订个体化方案。

Objective： To explore the effect of feeding via the transpyloric route on the gastrointestinal function in very low birth weight（VLBW）infants and find the best early enteral nutrition protocol. Methods： Sixty VLBW infants were randomly devided into transpyloric feeding group（TP group）（n = 30） and intragastric feeding group（IG group）（n = 30）. The frequency of apnoea, weight gain, the time of birth-weight regain, feed intolerance, time of reaching full enteral feeding, the incidence of extrauterus-growth-retardation（EUGR）, motilin, gastrin, the length of hospital stay, necrotizing enterocolitis and duodenal perforation were observed in two groups. Results： The intolerance and time of reaching full enteral feeding were reduced significantly during transpyloric feeding compared with intragastric feeding（ P〈0.05）.The number of episodes of apnoea was decreased significantly during transpyloric feeding compared with intragastric feeding（ P〈0.01）. Conclusion： Transpyloric feeding can be used in VLBW infants.