喂养不耐受早产儿喂养前后肠道氧合变化及影响因素

Changes and influencing factors of splanchnic regional oxygenation before and after feeding in preterm infants with feeding intolerance

目的探讨喂养不耐受(feeding intolerance,FI)早产儿喂养前后肠道氧合变化及影响因素。方法选择2018年12月至2019年8月生后24 h内入住温州医科大学附属第二医院新生儿重症监护病房的FI早产儿进行前瞻性自身对照研究,采用近红外光谱仪监测FI早产儿喂养前5 min和喂养后1 h肠道氧合(splanchnic regional saturation,rSsO_(2))及脑氧合(cerebral regional saturation,rScO_(2)),计算喂养前后rSsO_(2)和rScO_(2)均值、喂养前后rSsO_(2)与rScO_(2)比值(splanchnic-cerebral oxygenation ratio,SCOR),并记录监测时日龄、校正胎龄、喂养种类等临床资料。应用SPSS 18.0统计软件进行单因素相关分析及多元线性回归分析喂养前后rSsO_(2)变化的影响因素。结果共纳入符合条件的早产儿41例,喂养前后rSsO_(2)、rScO_(2)、SCOR差异均无统计学意义(P>0.05)。喂养种类影响喂养后rSsO_(2)及SCOR的变化值,与早产儿奶相比,母乳喂养后rSsO_(2)及SCOR变化更小,回归方程分别为Y=5.538-4.065X(模型复相关系数=0.414,决定系数R2=0.171,F=8.050,P<0.01),Y=0.109-0.075X(模型复相关系数=0.405,决定系数R2=0.164,F=7.655,P<0.01)。结论发生FI后合理喂养不会影响早产儿rSsO_(2),与早产儿奶相比,母乳喂养更有利于喂养后rSsO_(2)的稳定,应作为早产儿喂养的首选。

Objective To study the changes and influencing factors of splanchnic regional saturation before and after feeding in preterm infants with feeding intolerance(FI).Methods From December 2018 to August 2019,preterm infants with FI admitted to the neonatal intensive care unit of our hospital within 24 hours after birth were prospectively enrolled in this same-patient before-after study.Splanchnic regional saturation(rSsO_(2))and cerebral regional oxygenation(rSc02)5 minutes before feeding and 1 hour after feeding were monitored using near-infrared spectroscopy(NIRS).The average values of rScO_(2),rSsO_(2)and splanchnic-cerebral oxygenation ratio(SCOR)before and after feeding were calculated.The clinical data including postnatal age,corrected gestational age and feeding methods(breastfeeding or formula feeding)were collected.Single-factor correlation analysis and multiple linear regression were used to analyze the influencing factors of rSsO_(2)before and after feeding.Results A total of 41 preterm infants were included.No significant differences existed in rSsO_(2),rScO_(2)and SCOR before and after feeding(P>0.05).The feeding methods showed relative prominent influences on the changes of rSsO_(2)and SCOR before and after feeding.The breastfeeding infants had smaller changes of rSsO_(2)and SCOR before and after feeding compared with formula feeding infants,the regression equations were Y=5.538-4.065X(model complex correlation coefficient was 0.414 determination coefficient R²=0.171,F=8.050,P<0.01)and Y=0.109-0.075X(model complex correlation coefficient was 0.405 determination coefficient R=0.164²,F=7.655,P<0.01).Conclusions Proper feeding will not increase rSsO_(2)in preterm infants with FI.Comparing with formula feeding infants,breastfeeding infants has more stable post-feeding rSsO_(2).Breastfeeding should be the first choice for preterm infants with FI.