早产儿间断鼻十二指肠喂养和鼻胃管喂养时血清前白蛋白的变化

Changes of the Serum Prealbumin Level in Premature Infants by Intermittent Nasoduodenal and Intermittent Nasogastric Feedings

目的 早产儿存活率逐年提高 ,其生后早期经肠道喂养日益受到关注 ,目前国内普遍采用鼻胃管喂养。鼻十二指肠喂养有争议。该文比较早产儿生后早期间断鼻胃管喂养和鼻十二指肠喂养营养摄入量、生长情况、喂养相关并发症及血清前白蛋白的变化。方法 4 0例早产儿 (出生体重 1 0 5 0 g～ 1 92 0 g)随机分为间断鼻胃管喂养组和鼻十二指肠喂养组 ,用同一种配方乳喂养。记录喂养 1周的入液量、热能、蛋白质摄入量 ;体格生长指标 (体重、身长、头围 )的变化 ;大便性状 ;喂养相关并发症。喂养前和喂养后 1周用ELISA法测血清前白蛋白(PA)。结果 喂养后 1周鼻十二指肠喂养组较鼻胃管喂养组平均进奶量、热能、蛋白质摄入量均显著增加 (P <0 .0 1 )。肠道营养热能每日达 4 1 8.4kJ/kg 的时间、恢复出生体重的时间明显缩短 (P <0 .0 5 ) ;两组早产儿喂养前及 1周后身长、头围的差异均无显著性 (P >0 .0 5 )。喂养前两组PA差异无显著性 (P >0 .0 5 ) ;喂养 1周后胃十二指肠喂养组的PA明显增加 (P <0 .0 5 )。两组均无腹泻、坏死性小肠结肠炎发生 ;鼻十二指肠喂养组吸入性肺炎、呕吐、残留的发生率与鼻胃管喂养组比较差异无显著性 (P >0 .0 5 ) ,高胆红素血症发生率较后者显著减少 (P<0 .0 1 )。

Objective The issue of enteral feeding becomes a hotspot with the increasing survival rate of premature infants. Intermittent nasoduodenal feeding (INDF) is a common method of feeding premature infants in China and more discussion is needed at whether intermittent nasogastric feeding (INGF) is better than INDF. This paper aims at comparing the effects of INDF and INGF on nutrient intake, physical growth, feeding related complications, and serum prealbumin (PA) level in premature infants shortly after birth. Methods Forty premature infants (birth weights ranging from 1 050 g to 1 920 g) were randomly assigned into INDF and INGF groups that were fed with the same formula. The amount of liquid, caloric and protein intakes, variation of physical growth parameters (e.g. body weight, length and head circumference), stool characters, and feeding related complications were recorded in the first week of initial feeding. The serum PA level was detected by ELISA 1 week before and 1 week after feeding. Results After the first week the amount of milk input, caloric and protein intakes were significantly higher in the INDF group than those in the INGF group (P< 0.01 ). The time taken to reach the caloric value of 418.4 kJ /kg daily by enteral feeding and the birth weight regaining time in the INDF group were significantly shorter than those in the INGF group (P< 0.05 ). There was no significant difference in the increase of length and head circumference between the two groups. The serum PA level in the INDF group by the end of the first week was higher than that in the INGF group (P< 0.05 ). There were no occurrences of diarrhea and necrotizing enterocolitis in the two groups. The incidence of feeding related complications, such as aspiration pneumonia, vomiting and gastric residue, was lower in the INDF group than that in the INGF group, but no significant difference was found. The incidence of hyperbilirubinemia was significantly lower in the INDF group than that in the INGF group (P< 0.01 ). Conclusions In premature infants fed by INDF the amount of nutrition intake may increase, feeding related complications may decrease during the initial feeding and nutritional situations may be better than in those premature infants fed by INGF.