非营养性吸吮对早产儿胃排空及胃食管反流的影响  

Effects of nonnutritive sucking on gastric emptying and gastroesophageal reflux in premature infants

作　　者：赵翠霞[1] 岳晓红[1] 芦惠[1] 薛辛东[1] 

机构地区：[1]中国医科大学第二临床学院儿科,沈阳110004

出　　处：《中华儿科杂志》2004年第10期772-776,共5页Chinese Journal of Pediatrics

摘　　要：目的　评价非营养性吸吮 (NNS)对早产儿胃排空及胃食管反流的影响。方法　将 38例需经鼻胃管喂养 (INGF)的健康早产适于胎龄儿 ,用同一种配方乳喂养。根据是否辅以非营养性吸吮随机分为非营养性吸吮 (NNS)组和单纯鼻胃管喂养 (N NNS)组。记录入液量、奶量、热卡及肠道营养达 4 18 4kJ/ (kg·d)的时间 ,记录喂养相关情况 ;测定胃窦纵切面积 (ACSA) ,计算胃半排空时间(T1/2 :5 0 %ΔACSA) ;同时进行食管 2 4小时 pH监测 ,记录以下指标 :2 4小时内总反流次数 ;反流指数(RI) ;反流持续时间 >5分次数 ;pH <4总时间 ;最长酸反流时间。结果　NNS组胃半排空时间快于对照组 [分别为 (5 8 33± 2 2 94 )分 ,(73 75± 17 76 )分 ],差异有显著意义 (P <0 0 5 )。 38例早产儿中出现GER者 32例 ,占 84 2 % ;NNS组反流次数明显少于对照组 [分别为 9(2～ 31)次 ,(5～ 31)次 ,P<0 0 5 ];pH <4的总时间和反流指数与对照组比较 ,有下降趋势 ,但差异无显著意义 (P >0 0 5 )。NNS组胃残留发生率 (16 7% )低于对照组 (5 0 % ) ,差异有显著意义 (P <0 0 5 ) ;肠道营养达 4 18 4kJ/(kg·d)的时间比对照组明显缩短 [分别为 (12 36± 4 2 9)天 ,(15 5 0± 4 5 8)天 ,P <0 0 5 ]。结论鼻胃管喂养期间给予NNS是一种简单?Objective Although nonnutriti ve sucking (NNS) during tube feeding has some benefits on the physiology and dev elopment of premature infants, the effect on gastrointestinal function remains c ontroversial. The aim of the study was to evaluate the effects of NNS on the ga stric emptying and gastroesophageal reflux (GER) in premature infants. Methods Thirty eight healthy appropriate-for-gestational-age p remature infants (birth weight ranged from 1050 g to 1790 g, gestational age ran ged from 28 weeks to 35 weeks) accepting intermittent nasogastric feeding (INGF) were randomized into NNS group and N-NNS group according to INGF with and with out NNS and fed with the same milk formula. Group NNS ( n=18) received o ral stimulation by means of a pacifier immediately before feeding, during feedin g and then after feeding for 5 min. Group N-NNS (n=20) served as control a nd received INGF alone. The following data were collected and recorded, the flu id intake (including both intravenous and oral), milk intake, caloric intake, ti me of caloric intake reaching 418.4 kJ/ (kg·d) by enteral feeding and relevant condition to feeding. Gastric emptying was measured when oral intake reaching above 8 ml/kg while concurrently measuring 24 hour esophageal pH. Real time ult rasonic images of the gastric antrum were obtained and the antral cross sectiona l area (ACSA) was measured and the half emptying time ( 50%ΔACSA) was calculate d. Using 24-hour intraesophageal pH monitoring for evaluation of GER, the five parameters of esophageal pH were recorded: number of reflux episodes during 24 hours, reflux index, number of episodes lasting >5 min, the duration of longest episode and the total time of pH < 4.0. Results Within two weeks after feeding, there was no significant difference in the fluid intake , caloric intake between the two groups (P>0.05). Gastric emptying was mea sured on day 13.26, milk intake had no difference between the two groups and th ere was no difference in prefeed ACSA . The half gastric emptying time

关 键 词：对照组 早产儿 胃食管反流 胃排空 非营养性吸吮 鼻胃管 肠道营养 次数 结论 意义 

分 类 号：R722.6[医药卫生—儿科]