超低出生体重早产儿机械通气早期口腔滴注初乳的效果研究

The effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight

目的探讨超低出生体重早产儿机械通气早期口腔滴注初乳的效果。方法选取温州市某三级甲等医院行机械通气的130例超低出生体重早产儿为研究对象,采用随机数字表法分为试验组和对照组,每组各65例。试验组于出生后24 h内开始实施初乳口腔滴注,持续5 d;对照组初乳仅用于胃肠内营养,其余干预措施两组均相同。收集两组出生后第1次与第6天的气道分泌物和尿液标本,检测分泌型免疫球蛋白A(secretory immunoglobulin A,sIgA)与乳铁蛋白的浓度;观察两组并发症发生率,记录两组机械通气时间、住院日。结果出生后第6天试验组气道分泌物与尿液中sIgA、乳铁蛋白浓度高于对照组,差异具有统计学意义(P<0.05);试验组败血症、新生儿坏死性小肠结肠炎及呼吸机相关性肺炎的发生率明显低于对照组,差异具有统计学意义(P<0.05);试验组的机械通气时间、住院日均短于对照组,差异具有统计学意义(P<0.05)。结论超低出生体重早产儿机械通气早期初乳口腔滴注能提高早产儿免疫功能,降低近期并发症的发生率,缩短机械通气时间与住院时间,降低住院费用,应对该类早产儿尽早启动初乳口腔滴注,并提供更多的支持策略。

Objective To investigate the effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight.Methods 130 cases of extremely low birth weight infants with invasive or non-invasive mechanical ventilation were selected and randomly allocated into an experimental group and a control group with 65 cases in each group.In the experimental group,oropharyngeal colostrum started within 24 hours after birth for 5d.Colostrum in control group was only usedfor gastrointestinal nutrition.Airway secretions and urine samples of 2 groups were collected on the 1st and 6th day after birth,and sIgA and lactoferrin concentrations were detected.The incidence of complications was observed in both groups.Mechanical ventilation time and hospital stay of 2 groups were recorded.Results On the 6th day after birth,the concentrations of sIgA and lactoferrin in airway secretions and urine samples in the experimental group were higher than those in the control group,with statistically significant differences(P<0.05).The incidences of sepsis,neonatal necrotizing enterocolitis and ventilator-associated pneumonia were significantly lower in the experimental group than those in the control group,with statistically significant differences(P<0.05).The duration of mechanical ventilation and average length of hospital stay in the experimental group were shorter than those in the control group(P<0.05).Conclusion Early oral droplet colostrum can improve the immune function of infants with extremely low birth weight,reduce the incidence of recent complications,shorten the duration of mechanical ventilation and hospital stay,and reduce medical costs.Therefore,more supporting strategies should be provided to start oral droplet colostrum as early as possible.