早产儿喂养不耐受的临床特征及危险因素  

Clinical features and risk factors of feeding intolerance in premature infants

作　　者：胡晓艳[2] 常艳美[1] 李在玲[1] Hu Xiaoyan;Chang Yanmei;Li Zailing(Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Pediatrics,Peking University Shenzhen Hospital,Shenzhen 518036,Chin)

机构地区：[1]北京大学第三医院儿科,100191 [2]北京大学深圳医院儿科,518036

出　　处：《中华围产医学杂志》2020年第3期182-187,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨早产儿喂养不耐受的临床特征及危险因素。方法本研究为回顾性研究。研究对象为2017年1月至2017年12月在北京大学第三医院新生儿科住院的早产儿,进一步将其中的喂养不耐受组患儿按出生胎龄分为<31周组和≥31周组,以及按出生体重分为<1250 g组和≥1250 g组。分析纳入对象的病历资料,探讨早产儿喂养不耐受的临床特征及其危险因素。采用独立样本t检验、χ^2检验和logistic回归分析等方法,对数据进行统计学分析。结果(1)符合标准的研究对象共612例,其中喂养不耐受组182例(29.7%),喂养耐受组430例(70.3%)。喂养不耐受组中,男婴103例(56.6%),女婴79例(43.4%);胎龄(30.6±2.3)周,其中93例(51.1%)胎龄<31周;出生体重(1298±417)g,其中93例(51.1%)<1250 g;134例(73.6%)为极低出生体重儿。喂养不耐受在极低出生体重早产儿中的发生率为63.2%(134/212)。(2)喂养不耐受的诊断日龄为(2.7±0.9)d,消失日龄为(13.2±6.9)d,持续时间为(10.5±6.7)d,主要症状包括胃潴留100.0%(182/182)、腹胀54.4%(98/182)和呕吐17.0%(31/182)。(3)与胎龄≥31周者相比,胎龄<31周的早产儿喂养不耐受诊断和消失更晚[(2.4±0.8)与(2.9±0.9)d,t=3.977;(10.4±5.2)与(16.0±7.3)d,t=5.935],持续时间更长[(8.0±5.0)与(13.0±7.3)d,t=5.450],恢复出生体重时间更晚[(9.4±4.1)与(12.0±5.1)d,t=3.672](P值均<0.05)。与出生体重≥1250 g的早产儿相比,出生体重<1250 g的早产儿喂养不耐受诊断和消失更晚[(2.5±0.9)与(2.8±0.9)d,t=2.540;(10.0±4.5)与(16.3±7.4)d,t=6.951]、持续时间更长[(7.5±4.3)与(13.5±7.3)d,t=6.690]、更少发生呕吐[23.6%(21/89)与10.8%(10/93),χ^2=5.308](P值均<0.05)。(4)出生体重是早产儿喂养不耐受的保护因素(OR=0.998,95%CI:0.997~0.998),新生儿呼吸窘迫综合征(OR=2.129,95%CI:1.163~3.897)、多胎(OR=1.812,95%CI:1.116~2.941)、生后48 h内应用枸橼酸咖啡因(OR=2.663,95%CI:1.619~4.381)、生后48 h内应用持续气道正压通�Objective To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017.Those in the feeding intolerance group(FI group)were further divided into subgroups of gestational age(GA)<31 weeks group and GA≥31 weeks group,as well as birth weight(BW)<1250 g group and BW≥1250 g group.Medical records of all subjects were reviewed to retrieve relevant clinical information.Independent-samples t-test,Chi-square test,and logistic regression tests were used for statistical analysis.Results There were 612 eligible subjects with 182(29.7%)in the FI group and 430(70.3%)in the feeding tolerance(FT)group.(1)In the FI group,there were 103(56.6%)males and 79(43.4%)females with an average GA of(30.6±2.3)weeks and BW of(1298±417)g,and 134(73.6%)were very low birth weight premature infants.Among the patients with FI,there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group,and 93 in the BW<1250 g group and 89 in the BW≥1250 g group.The FI infants accounted for 63.2%of very low birth weight premature infants in the same period.(2)The age at diagnosis was(2.7±0.9)d and(13.2±6.9)d at recovery.And the duration of FI was(10.5±6.7)d.The main symptoms were gastric retention(100.0%,182/182),abdominal distention(54.4%,98/182)and vomiting(17.0%,31/182).(3)FI in preterm infants with GA<31 weeks or BW<1250 g occurred and disappeared later[GA subgroups:(2.4±0.8)vs(2.9±0.9)d,t=3.977 and(10.4±5.2)vs(16.0±7.3)d,t=5.935;BW subgroups:(2.5±0.9)vs(2.8±0.9)d,t=2.540 and(10.0±4.5)vs(16.3±7.4)d,t=6.951;all P<0.05]and had a longer duration than those with GA≥31 weeks or BW≥1250 g[GA subgroups:(8.0±5.0)vs(13.0±7.3)d,t=5.450;BW subgroups:(7.5±4.3)vs(13.5±7.3)d,t=6.690;both P<0.05].Premature infants with smaller GA took longer time to regain their birth weight[(9.4±4.1)vs(12.0±5.1)d,t=3.672,P<0.05]and those with lower BW were less li

关 键 词：肠内营养 呕吐 肠胃胀气 危险因素 婴儿 早产 喂养不耐受 

分 类 号：R722[医药卫生—儿科]