不同胎龄早产儿胃肠动力和分泌功能成熟特点研究

Study of the characteristics of the maturation of gastrointestinal motility and secretion function in preterm infants of different gestational age

目的探讨不同胎龄早产儿生后28天内胃肠动力和胃肠分泌功能成熟的特点。方法入选15例胎龄<32周的小胎龄组早产儿和15例胎龄32~37周的大胎龄组早产儿,并以15例足月儿作对照组。于早产儿出生第7、14、21、28天,足月儿生后第7天,用超声检测胃排空率(GER)、胃窦运动指数(MI),取胃液测胃液p H值、胃蛋白酶原(PG)。结果两组早产儿的GER、MI均随着日龄增加而逐渐升高;小胎龄组第21、28天的GER水平,及第14、21、28天的MI水平均低于大胎龄组,差异有统计学意义(P<0.05);与大胎龄组比较,小胎龄组GER、MI接近于足月儿水平的时间较晚。两组早产儿的胃液p H值均呈先上升后下降的趋势,小胎龄组第7、14、21天的胃液p H值高于大胎龄组,差异均有统计学意义(P<0.05);与足月儿第7天比较,仅小胎龄组第14、21天的胃液p H值高于足月儿(P<0.05)。小胎龄组各时间点的PG水平低于大胎龄组;两组早产儿的PG低于足月儿第7天水平,差异均有统计学意义(P<0.05),仅大胎龄组第28天PG水平与足月儿的差异无统计学意义(P>0.05)。结论小胎龄组早产儿胃肠动力及分泌功能低于大胎龄组及足月儿,应采取更谨慎的喂养策略。GER和MI可作为判断早产儿胃肠动力的客观指标。

Objective To investigate the characteristics of maturation of gastrointestinal motility and secretion function in different gestational age preterm infants within 28 days after preterm infant birth. Methods The preterm infants were divided into young gestational age（GA） group（32 weeks, n=15） and older GA group（32-37 weeks, n=15） by GA, and 15 term infants were selected as control group. On the 7 ^（th）, 14 ^（th）, 21 ^（th） and 28 ^（th） day after birth of preterm infants, and the 7^（th） day after birth of term infants, gastric emptying rate（GER） and gastric motility index（MI） were detected by ultrasound; p H and pepsinogen（PG） levels of gastric juice extracted by stomach tube were tested. Results In both GA groups, GER and MI gradually increased with age. GER on the 21 th and 28 th day and MI on the 14 ^（th） to 28 ^（th） day of young GA group were lower than that of older GA group（P0.05）. And the time of GER and MI levels up to term infants in young GA group was later than that of older GA group. The pH in two GA groups both increased at first and then decreased（P0.05）. Compared to the older GA group, the p H was higher at 7 ^（th）, 14 ^（th）and 21 ^（th）day in young GA group, and the difference was statistically significant（P0.05）. Only the gastric pH on the 14 ^（th） and 21 stday of young GA group was higher than that of term infants（P0.05）. PG level of young GA group in each point was lower than that of older GA group（P〈0. 05）. Compared to term infants, the PG level of both groups of preterm infants was lower（P〈0. 05）, and the PG level only on the 28 ^（th） day of older GA group showed no difference with that of term group（P〉0.05）. ConclusionsThe gastrointestinal motility and gastric secretion of young GA group was lower than that of older GA group and term group. More cautious feeding strategies should be adopted for preterm infants with younger GA. GER and MI can be used as objective indicators to evaluate gastrointestinal motility of preterm infants.