|摘要||目的 探讨危重症早产儿早期微量喂养与其血清胃泌素动态变化之间的关系,评价早期微量喂养对早产儿胃肠发育及临床情况的影响.方法 本组共125例,其中出生时有合并症的早产儿(危重评分≤90)共95例,分为早喂组48例,非早喂组47例.30例出生时无合并症的早产儿(危重评分＞90)为正常对照组.并对其胃肠道喂养耐受情况,生长发育情况进行监测.对照组生后6 h开始试喂糖水,每次1～2 ml/kg,1～2次后喂配方乳,逐渐加量至足量.早喂组生后72 h内开始给予微量喂养刺激,0.5～1 ml/kg,3 h 1次,逐渐加量至足量.非早喂组病情平稳后(最早生后72 h),再给予胃肠内喂养.用放射免疫分析方法测定3组生后1、3、7 d的血清胃泌素的水平.结果 (1)胃泌素含量:对照组、早喂组的血清胃泌素在生后1、3、7 d均呈上升趋势.生后1 d,早喂组[(82.4±24.5)ng/L]和非早喂组[(87.0±40.2)ng/L]的血清胃泌素水平明显高于对照组[(66.4±19.7)ng/L](F=3.36,P＜0.05).3、7 d早喂组胃泌素[(96.3±14.6)ng/L,(113.0±16.5)ng/L]水平较非早喂组[(73.9±13.5)ng/L,(92.4 ±12.2)ng/L]高,差异有统计学意义(P＜0.05).(2)临床观察指标:对照组、早喂组、非早喂组喂养不耐受的人数(2/30,5/48,14/47)、达足量喂养的时间[(20.6±5.7)d,(27.8士6.1)d,(39.5 ±4.7)d]、住院天数[(29.0±4.6)d,(39.0±4.8)d,(48.0 ±5.6)d]等方面差异均有统计学意义(P＜0.05).(3)生长发育指标:早喂组与非早喂组患儿在出生1～2N体重增长差异无统计学意义[(5.9 ±2.9)g/d vs(5.0±2.1)g/d].恢复出生体重时间[(19.8±4.2)d vs(25.2±5.1)d],出生3～4周体重的增长差异有统计学意义[(19.1 ±2.4)g/d vs(11.9±3.3)g/d](P＜0.05).(4)出现合并症的情况:3组均无NEC及其他消化道合并症出现.早喂组与其他两组相比,感染、贫血、呼吸暂停、低血糖等合并症的发病人数差异无统计学意义.结论 危重症早产儿合适的早期微量喂养可以促进胃泌素的分泌,促进胃肠道发育,且不增加合并症的发生.
Objective To study serum gastrin levels in response to early minimal feeding in premature infants and evaluate the clinical effect of early minimal feeding.Methods Premature infants with critical score≤90 were randomly assigned into two groups:early minimal feeding group(n=48),non-early minimal feeding group(n=47).Other premature infants(n=30)without any complications(critical score>90)were assigned as normal control group.The premature infants in normal control group were fed with water at 6 h after birth,1-2 ml/kg every time,afer once or twice,they were fed with formula,increasing in the amount of formula gradually,until adequate.The premature infants in early minimal feeding group were fed with formula within 72 h after birth,0.5-1 mL/kg,once every 3 h,the amount of formula was increased gradually,until adequate.The premature infants without early minimal feeding were not fed with formula until the illness was stable,the amount of formula was increased gradually until adequate.Situation of gastrointestinal feeding tolerance,growth and development,and clinical symptoms were observed and recorded for the three groups.Serum gastrin levels were monitored at 1,3,7 day after birth by radioimmunoassay.Results Serum gastrin concentrations in the three groups elevated from 1 to 7 days.In early minimal feeding group[(82.4±24.5)ng/L]and non-early minimal feeding group[(87.0±40.2)ng/L],the concentrations were significantly higher than those in normal control group[(66.4±19.7)ng/L]at day 1(F=3.36,P<0.05).At day 3 and 7,the concentrations in early minimal feeding group[(96.3±14.6)ng/L,(113.0±16.5)ng/L]were significantly higher than those in non-early minimal feeding group[(73.9±13.5)ng/L,(92.4±12.2)ng/L](P<0.05).There were significant differences among the three groups in infants with feeding intolerance(2/30,5/48,14/47),the period reached full enteral feeding[(20.6±5.7)d,(27.8±6.1)d,(39.5±4.7)d],and in number of hospital day [(29.0 ±4.6)d,(39.0 ±4.8)d,(48.0±5.6)d](P<0.05).There were significant differences between early minimal feeding group and non-early minimal feeding group in the weight gain three and four weeks after birth[(19.1±2.4)g/d,(11.9 ±3.3)g/d],the period reached birthweight[(19.8±4.2)d,(25.2±5.1)d](P<0.05).There were no significant difference among the three groups in the weight gain in one and two weeks after biah[(5.9±2.9)g/d vs.(5.0 ±2.1)g/d],the numbers of premature infants with infection,anemia,apnea,or hypoglycemia.Conclusion Early minimal feeding in premature infants leads to secretion of gastrin,promotes the development of gastrointestine and may not be associated with occurrence of complications.|