极低出生体重儿胃肠喂养的临床观察

The enteral feeds in very low birthweight infants

目的 总结极低出生体重儿 (VLBWI)胃肠喂养的临床特点、分析喂养不耐受的相关因素、探讨有利于喂养成熟的要点。方法 对NICU收治的极低出生体重并痊愈出院的 3 8例婴儿进行喂养相关因素和体重增长情况调查。本组患儿出生体重 ( 13 14± 180 )g。按是否有多次出现喂养后呕吐、腹胀、胃残余超过喂入量的 3 0 %、胃内咖啡样物、被禁食 >2次、第 2周末喂入量 <8ml/ (kg·次 )分为喂养不耐受或耐受两组 ,分析喂养不耐受的相关危险因素 ;按早开始 (≤ 6d)和晚开始 (≥ 7d)胃肠喂养分成两组 ,比较有关临床因素。结果 喂养不耐受的发生率为 5 5 % ( 2 1/ 3 8)。喂养耐受和不耐受两组的胎龄、出生体重、开奶日龄、达足量喂养日龄及住院天数差异有显著性。胎龄小、脐插管、应用氨茶碱及开始胃肠喂养日龄晚是喂养不耐受的显著相关危险因素。早开奶组达足量喂养日龄 [( 2 9 0± 11 2 )d]和住院天数 [( 41 7± 12 4)d]较晚开奶组明显缩短 [分别为 ( 41 8± 16 9)d和 ( 5 5 4± 17 5 )d],差异有显著意义。结论 如果VLBWI的生命体征平稳 ,在出生 6d内应尽可能早地开始胃肠道喂养或非营养性吸吮。早期微量喂养、缓慢加奶、谨慎禁食、促进排便 。

Objective The study aimed to investigate the clinical characteristics of enteral feeding in very low birthweight infants (VLBWI), to determine the risk factors associated with feeding intolerance, and to analysis the beneficial factors in order to improve gut motility and maturation. Methods The study was carried out in 38 VLBWI, birthweight (1 314±180)g, in the NICU of authors′ department. They were devided into feeding tolerance and intolerance groups, and earlier enteral feeding and later groups. Comparison was made between two groups about the associate factors. Results The incidence of feeding intolerance was 55 per cent. There was a significant difference in two groups about the clinical factors (gestational age, birth weight, the age of the first feeding, time of full enteral feeding and the hospitalized days). The significant risk factors associated with feeding intolerance were the smaller gestational age, umbilical catheterization, theophylline therapy, and delay of the time when the first feed was commenced. Conclusion If vital signs are stable, trophic feeding in VLBWI should be commenced as soon as possible during the first 6 days of life. Early trophic feeding, slowly increase the feeding volume, carefully fast, and moving bowel were suggested and will improve feeding tolerance and gastrointestinal maturation.