渐进式喂养策略在极低出生体重早产儿中的应用观察

Application of Gradual Feeding Models in Very Low Birth Weight Premature Infants

目的:探讨渐进式喂养策略在极低出生体重(VLBW)早产儿中的应用。方法:选取本院2016年1月-2018年1月接收的极低出生体重早产儿60例作为研究对象,按照随机数字表法将其分为对照组(n=30)和观察组(n=30)。观察组以低能量密度配方奶(20 kcal/30 m L)开奶,奶量达到90~100 m L/(kg·d)时改等量的普通早产儿配方奶(24 kcal/30 m L)继续喂养;对照组以普通早产儿配方奶(24 kcal/30 m L)开奶及喂养,加奶方式与观察组一致。观察两组的NEC发生和喂养不耐受及并发症发生情况,以及出生时、出生后第1天、1、2周的胃动素及胃泌素水平。结果:观察组NEC和喂养不耐受发生率均明显低于对照组,差异均有统计学意义(P<0.05)。观察组VLBWI达全量胃肠道营养、恢复出生体重、总住院时间及并发症发生情况与对照组比较,差异均无统计学意义(P>0.05);胃肠外营养使用时间明显长于对照组,差异有统计学意义(P<0.05)。两组出生时、出生第1天、1、2周的胃动素及胃泌素水平比较,差异均无统计学意义(P>0.05);但两组出生后的胃动素及胃泌素水平均呈上升趋势,差异有统计学意义(P<0.05)。结论:渐进式喂养能够有效降低极低体重早产儿喂养不耐受及坏死性小肠结肠炎(NEC)的发生率,具有临床推广价值。

Objective：To study the application of gradual feeding models in very low birth weight（VLBW） premature infants.Method：A total of 60 premature infants with very low birth weight admitted from January 2016 to January 2018 in our hospital were selected as the study objects.According to the random number table method,they were divided into control group（n=30） and observation group（n=30）.The observation group was taken the low energy-density milk formula（20 kcal/30 m L） and then common milk formula（24 kcal/30 m L） as the milk yield reached up to 90-100 m L/（kg·d）;the control group was taken the common milk formula（24 kcal/30 m L） in the same way.The incidence of necrotizing enterocolitis（NEC） and feeding intolerance and complications,and the motilin and gastrin levels upon delivery,after delivery 1 d,1 week and 2 weeks between the two groups were observed.Result：The incidence rates of NEC and feeding intolerance in the observation group were significantly lower than those in the control group,the differences were statistically significant（P〈0.05）.There were no significant differences in the time of total gastrointestinal nutrition,recovery of birth weight,total hospital stay and incidence of complications between the observation group and the control group（P〉0.05）;the support time of parenteral nutrition in the observation group was significantly longer than that in the control group,the difference was statistically significant（P〈0.05）.There were no significant differences in motilin and gastrin levels upon delivery,after delivery 1 d,1 week and 2 weeks between the two groups（P〉0.05）.However,the levels of motilin and gastrin in two groups showed an increasing trend after delivery,the differences were statistically significant（P〈0.05）.Conclusion：The gradual feeding models can effectively reduce the incidence rates of feeding intolerance and NEC.It is worthy of clinical promotion.