应用初乳对早产儿进行口腔护理干预效果的系统评价

The effects of oropharyngeal colostrum administration in preterm infants:a systematic review

目的系统评价早产儿应用初乳进行口腔护理干预的效果。方法检索PubMed、EMBASE、Cochrane Library、Web of Science、CINAHL、中国生物医学文献数据库、中国知网和万方数据库中应用初乳对早产儿进行口腔护理干预的随机对照试验和临床对照试验,采用Cochrane Handbook(5.1.0)对文献质量进行评价,采用RevMan 5.3软件进行Meta分析。结果共纳入10项研究。结果显示,应用初乳对早产儿进行口腔护理可以降低早产儿脓毒症[RR=0.54, 95%CI(0.36,0.79),P=0.002]和喂养不耐受[RR=0.59,95%CI(0.40,0.87),P=0.008]的发生率,缩短达到全肠道喂养的时间[MD=-3.70,95%CI(-6.38,-1.02),P=0.007],同时降低口咽致病微生物和细菌的检出率,增加唾液和尿液中免疫球蛋白A的水平。对新生儿坏死性小肠结肠炎发生率[RR=0.78,95%CI(0.43,1.42),P=0.420]、开始肠内营养时间[MD=0.07,95%CI(-0.67,0.81),P=0.850]以及开始经口喂养时间[MD=-2.45,95%CI(-4.99,0.09),P=0.060]没有影响。结论应用初乳进行口腔护理可以降低早产儿相关喂养并发症的发生率,一定程度上加快了喂养进程,同时增强了早产儿的免疫水平。但未来仍需要更多高质量、大样本的研究进一步探讨应用初乳对早产儿进行口腔护理的效果及最有效方式。

Objective To systematically evaluate the effects of oral care using colostrum in preterm infants.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Web of Science,CINAHL,CBM,CNKI and Wanfang. We included all randomized controlled trials and clinical controlled trials which using colostrum in preterm infants’ oral care. The quality of articles was appraised by the Cochrane Handbook(5.1.0),and RevMan 5.3 software was used to analyze the data. Results A total of 10 studies were included. The results showed that oral care using colostrum reduced the occurrence rate of sepsis [RR=0.54,95%CI(0.36,0.79),P=0.002]and feeding intolerance [RR=0.59,95%CI(0.40,0.87),P=0.008 ],shorten the time to reach full enteral feeding[MD=-3.70,95%CI(-6.38,-1.02),P=0.007]. At the same time,the detection rate of pathogenic microorganisms and bacteria in oropharynx decreased,and the level of sIgA in saliva and urine increased. There was no significant difference in occurrence rate of necrotizing enterocolitis [RR=0.78,95%CI(0.43,1.42),P=0.420],time to start enteral nutrition [MD=0.07,95%CI(-0.67,0.81),P=0.850],and time to start oral feeding [MD=-2.45,95%CI(-4.99,0.09),P=0.060]. Conclusion Oral care using colostrum can reduce feeding related complications in preterm infants,accelerate feeding process to a certain degree,and enhance immune levels of preemies. More high-quality,large sample studies are needed in order to further explore the effects and the most effective way of oral care using colostrum in preterm infants.