经口吸吮喂养联合部分静脉营养对极低出生体重儿喂养效果的临床研究

Clinical study of oral sucking feeding combined with partial parenteral nutrition for very low birth weight infants

目的探讨经口吸吮喂养联合部分静脉营养对极低出生体重儿喂养的效果。方法将NICU住院的极低出生体重儿分为2组,在营养管理策略上,对照组47例给予管饲喂养联合部分静脉营养,试验组53例采用经口吸吮喂养联合部分静脉营养,对比2组在喂养进程、喂养结局及并发症方面的差异。结果2组患儿在达到全肠道内营养[120 mL/(kg·d)]的日龄差异无统计学意义(P>0.05),试验组在经口吸吮奶瓶喂养达5 min的日龄、经口吸吮完成全肠道内营养的日龄、开始排过度便的日龄方面均明显早于对照组(P<0.05)。试验组患儿住院天数、平均体重增长优于对照组(P<0.05)。2组患儿在喂养不耐受、支气管肺发育不良、院内感染及晚发性败血症、症状性动脉导管未闭、早产儿视网膜病变、代谢性骨病发生率方面差异无统计学意义(P>0.05);经试验组坏死性小肠结肠炎、静脉营养相关性胆汁淤积及静脉营养相关性肝功能损害、需要输血方面的发生率低于对照组(P<0.05)。结论经口吸吮喂养联合部分静脉营养可促进极低出生体重儿吸吮、吞咽功能成熟,促进排便,有助于早日达到完全经口胃肠内营养,能减少坏死性小肠结肠炎、静脉营养相关胆汁淤积、静脉营养相关性肝损害等并发症,减少了输血。

Objective To study the effect of oral sucking feeding combined with partial parenteral nutrition on infants with very low birth weight.Methods In terms of nutrition management strategy, the infants in control group were given tube feeding combined with partial parenteral nutrition, and the infants in experimental group were given oral sucking feeding combined with partial parenteral nutrition. The differences in feeding process, feeding outcome and complications between the two groups were compared.Results There was no significant difference in the age of total enteral nutrition(120 mL/kg/d) between the two groups(P>0.05). The oral sucking group was significantly earlier than the tube feeding group in the age of 5 minutes of bottle feeding, the age of complete oral nutrition, and the age of excessive defecation. The length of hospital and average weight gain of the oral feeding group were better than those of infants in the tube feeding group(P<0.05). There was no significant difference in feeding in tolerance, bronchopulmonary dysplasia, nosocomial infection and late-onset sepsis, symptomatic patent ductus arteriosus, retinopathy of prematurity and metabolic bone disease between the two groups(P>0.05). However, the incidence of necrotizing enterocolitis, parenteral nutrition associated cholestasis, parenteral nutrition associated liver disease and the need for blood transfusion in the oral feeding group was significantly lower than that in the tube feeding group(P<0.05).Conclusion Oral sucking feeding combined with partial parenteral nutrition can improve the maturation of sucking and swallowing function of infants with very low birth weight, it can promote defecation, and it can help to achieve complete oral enteral nutrition as soon as possible. The incidence of necrotizing enterocolitis, parenteral nutrition associated cholestasis, parenteral nutrition associated liver disease, and the need for blood transfusion were decreased between two groups.