早期肠内营养干预对新生儿重症肺炎的临床疗效

The clinical effects of early enteral nutrition on severe neonatal pneumonia

目的:探讨早期肠内营养对新生儿重症肺炎的临床疗效、营养状态及胃肠功能运动的影响。方法:本试验为前瞻、随机、对照、单盲研究,将符合入组条件的病儿共123例纳入研究,最终103例病人完成试验,其中干预组54例,对照组49例。对照组在入院48 h后给予肠内营养,干预组在入院24~48 h内给予肠内营养,5~7 d内达到营养全量。比较2组病儿临床疗效、营养指标和炎症指标、血清胃泌素和胃动素水平、住院时间和住院费用等。结果:干预组与对照组病儿总有效率分别为98.1%和95.9%,差异无统计学意义(P>0.05);干预组病儿在开始肠内营养第4、7天时,前白蛋白水平、血清胃泌素和胃动素水平显著高于对照组,超敏C反应蛋白水平显著低于对照组,差异有统计学意义(P<0.05);2组病儿住院时间和住院总费用比较无统计学意义(P>0.05)。结论:早期肠内营养可改善营养和炎症状态,增加血清胃泌素和胃动素水平,促进胃肠道功能恢复。

Objective:To investigate the effects of early enteral nutrition(EN)on the clinical outcomes,nutritional status and gastrointestinal function of neonates with severe pneumonia.Methods:this is a prospective,randomized,controlled and single-blind clinical trial study.A total of 123 neonates eligible for admission were included,and finally 103 patients completed the trial,54 cases in the intervention group and 49 cases in the control group.The control group received EN later than 48 hours after admission,while the intervention group received EN within 24~48 hours after admission,and the energy target of EN was achieved within 5~7 days.The clinical outcomes,nutritional and inflammatory indicators,serum gastrin and motilin levels,length of hospital stay and cost-effectiveness between the two groups were compared.Results:The total effective rate was 98.4%in the intervention group,higher than 95.9%in the control group,with no statistical significance(P>0.05).At 4 and 7 days after EN initiation,the levels of pre-albumin,serum gastrin and motilin in the intervention group were significantly higher than those in the control group(P<0.05),and the level of hypersensitive C-reactive protein was significantly lower than those in the control group(P<0.05).There were no significant differences between the two groups in terms of the average hospital cost and length of hospital stay(P>0.05).Conclusion:Early EN can improve the nutritional and inflammatory status,increase levels of serum gastrin and motilin,as well as promote the early recovery of gastrointestinal function in neonates with severe pneumonia.