基于反应范围模型的早产儿喂养不耐受风险因素分析

Risk factor analysis about feeding intolerance of preterm infants based on the reactive scope model

目的：在反应范围模型指导下探讨早产儿喂养不耐受相关风险因素，为其有效防治提供实证依据。方法按照入院先后顺序，选择2014年8月至2015年1月入住新生儿科的早产儿242例，通过文献查阅、专家问询等，在反应范围模型的指导下设计临床观察表，通过对喂养耐受组与喂养不耐受组的单因素分析及Logistic回归分析明确早产儿喂养不耐受风险因素。结果喂养不耐受的发生率为33.8%（70/207）；喂养不耐受主要发生于开奶后72 h内，且主要临床表现为胃潴留、腹胀及呕吐；单因素分析显示，胎龄、出生体质量、宫内窘迫、宫内感染、氨茶碱应用、母乳喂养及2次大便间隔时间与早产儿喂养不耐受有关；Logistic回归分析显示，胎龄与出生体质量是喂养不耐受的保护因素，宫内窘迫、氨茶碱应用、2次大便间隔时间超过3d是危险因素。结论胎龄与出生体质量是喂养不耐受的保护因素，宫内窘迫、氨茶碱应用及2次大便间隔时间超过3d是喂养不耐受的危险因素。

Objective To investigate risk factors for feeding intolerance of preterm infants under the reactive scope model guidance, and provided empirical evidence for effective prevention and treatment of feeding intolerance in preterm infants. Methods Checked the cases of 242 preterm infants been treated in the neonatal department from August 2014 to January 2015 according to the order of admission. Through literature reviewing and expert consultation, the clinical observation table was designed based on the reactive scope model, and risk factors for feeding intolerance of preterm infants were investigated by single factor analysis and logistic regression analysis from the feeding intolerance (FI) group and non-FI group. Results The incidence of feeding intolerance in preterm infants was 33.8%(70/207), feeding intolerance in preterm infants often occurred during the period of being fed within 72 hours, and the clinical manifestations were gastric retention, abdominal distension and emesis. Single factor analysis showed that gestational age, birth weight, fetal distress, aminophylline application, intrauterine infection, breast milk feeding and twice stool interval were the related factors to the feeding intolerance. Logistic regression analysis showed that gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval >3 d were the risk factors of FI. Conclusions Gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval>3 d were the risk factors of FI.