早产儿血中胃肠激素水平及早期喂养影响的研究

Blood Gastrointestinal Hormones Concentration and Effect of Early Enteral Feeding in Premature Infants

目的 探讨早产儿生后血中胃肠激素水平的变化及早期喂养的影响。 方法 将 72例早产儿分为自吮奶组、胃管饲组、微量喂养组和非营养性吸吮组 ,给予喂养干预。应用放射免疫法对其生后 12 h内喂养前及第 3、7天空腹血中胃泌素、胃动素浓度进行测定 ,并以 16例正常足月新生儿作为对照组。 结果 (1)早产儿组生后开奶前及第 3、7天空腹血中胃泌素浓度分别为 (6 1± 2 4)ng/ L、(93± 37) ng/ L、(12 6± 45 ) ng/ L ,明显低于对照组的 (12 6± 30 ) ng/ L、(135± 34 ) ng/ L、(178±46 ) ng/ L (P值均 <0 .0 0 1) ;胃动素浓度分别为 (199± 5 8) ng/ L、(2 49± 5 6 ) ng/ L、(377± 139) ng/ L ,亦明显低于对照组的 (30 0± 6 7) ng/ L、(334± 84) ng/ L、(5 11± 180 ) ng/ L (P<0 .0 0 1及 0 .0 1) ;但随胎龄、日龄、奶量增加而升高 ,呈正相关。 (2 )早期喂养 (含微量喂养和非营养性吸吮 )能改善早产儿胃肠激素水平和胃肠动力 ,并提高其对喂养的耐受性。 结论 早产儿消化道机能能适应胃肠道营养 ,微量喂养和非营养性吸吮可促进早产儿胃肠道的发育和功能成熟 ,有助于从静脉营养过渡胃肠道营养 。

Objective To study the changes of blood gastrointestinal hormones concentration and effect of early feeding in premature infants on it. Methods Seventy-two premature infants were divided into 4 groups: self-sucking (group Ⅰ),tube feeding (group Ⅱ),minimal enteral nutrition (MEN, group Ⅲ), non-nutritive sucking (NNS, group Ⅳ). The plasma motilin and serum gastrin were measured within 12 hour before enteral feeding, on day 3 and day 7 of life by radioimmunoassay. 16 full-term neonates were studied as control. Results (1)The serum concentration of gastrin in premature infants before enteral feeding, on day 3 and day 7 were (61±24)ng/L,(93±37)ng/L,(126±45) ng/L respectively, which were significantly lower than that of control(126±30) ng/L,(135±34)ng/L,and (178±46)ng/L,(P<0.001). The plasma concentration of motilin were (199±58)ng/L,(249±56)ng/L,(377±139)ng/L respectively, which were significantly lower than that of control(300±67)ng/L,(334±84)ng/L,and (511±180)ng/L,(P<0.01),and there were positive correlation between motilin and gestational age, postnatal day age, and the volume of milk. (2)Early enteral feeding (including MEN and NNS) can improve the levels of gastrointestinal hormones, gastrointestinal motility, and nutritive tolerance in premature infants. Conclusions The gastrointestinal functions of premature infants are adaptable to enteral nutrition. MEN and NNS can promote the maturation and development of gastrointestinal function of premature infants, and can also be helpful for from intravenous feeding to enteral feeding, from tube feeding to oral feeding.