暂停肠道喂养对新生儿输血相关性坏死性小肠结肠炎的保护作用分析

The protective effect of cessation of enteral feeding on transfusion-related necrotizing enterocolitis of newborn

目的 探讨暂停肠道喂养对新生儿输血相关性坏死性小肠结肠炎的保护作用.方法 选择2015年1月至2016年2月我院新生儿重症监护病房收治的需输血的患儿,输血时采用随机数字表法分为暂停喂养组（输血开始禁食6h）和喂养组.分析两组患儿输血前后腹围、血清肿瘤坏死因子α与白细胞介素6水平的变化,以及两组患儿坏死性小肠结肠炎的发生情况.结果 研究期间共纳入需输血患儿106例,其中暂停喂养组54例,喂养组52例.两组患儿性别、胎龄、出生体重、基础疾病、输血前腹围等差异均无统计学意义（P〉0.05）.暂停喂养组输血后48 h内出现输血相关性坏死性小肠结肠炎的比例低于喂养组（3.7％比17.3％）,出现呕吐、腹胀、血便等症状的比例低于喂养组,输血后6、12 h腹围小于喂养组,差异均有统计学意义（P〈0.05）.暂停喂养组输血后6、12 h血清肿瘤坏死因子α及白细胞介素6水平均低于喂养组,差异有统计学意义（P〈0.05）,但输血后6h与同组12 h比较,差异无统计学意义（P〉0.05）.结论 新生儿输血时暂停肠道喂养6h是积极的保护性措施,可降低输血相关性坏死性小肠结肠炎发生率.

Objective To study the protective effect of cessation of enteral feeding on transfusionrelated necrotizing enterocolitis of newborn （TRNEC）.Method Newborns who need blood transfusion in our neonatal intensive care unit （NICU） from January 2015 to February 2016 were randomly assigned to the cessative feeding group （fasting for 6 h when blood transfusion） and the feeding group according to the method of random number table.The abdominal perimeter,the level of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6）,and the incidence of NEC within 48 hours after transfusion in these newborns were analyzed and compared.Result A total of 106 newborns with blood transfusion were included in this study,54 in the cessative feeding group and 52 in the feeding group.There were no significant differences between the two groups in gender,gestational age,birth weight,underlying diseases and abdominal perimeter before transfusion （P 〈 0.05）.The incidence of TRNEC in the cessative feeding group was significantly lower （3.7%） than that in the feeding group （17.3%） （P 〈 0.05）.The abdominal perimeters at 6 h and 12 h a fter blood transfusion in the cessative feeding group were both significantly lower than that in the feeding group （P 〈 0.05）.Within 48 h after blood transfusion,the incidence of vomiting,abdominal distention and bloody stools in the cessative feeding group were all significantly lower than that in the feeding group （P 〈0.05）.Furthermore,at 6 and 12 h after receiving blood transfusion,the cessative feeding group both showed lower levels of the serum TNF-α and IL-6 than the feeding group （P 〈 0.05）.However,the levels of the serum TNF-α and IL-6 at 6 h after blood transfusion and 12 h after blood transfusion in both groups were all showed no significant differences （P 〉 0.05）.Conclusion Cessation of enteral feeding for 6 h during blood transfusion is a positive protective measure that can reduce the incidence of TRNEC.