早期初乳口腔滴注对机械通气超低出生体重儿喂养状况的效果研究  

The effects of early oropharyngeal administration of microdosed colostrum on feeding status in extremely low-birth-weight infants on mechanical ventilation

作　　者：陈晓春[1] 郑芝蕾 陈琼[1] 潘迎洁[1] Chen Xiaochun;Zheng Zhilei;Chen Qiong;Pan Yingjie(The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou Zhejiang 325000)

机构地区：[1]温州医科大学附属第二医院,浙江温州325000

出　　处：《护士进修杂志》2020年第19期1778-1782,共5页Journal of Nurses Training

基　　金：浙江省医药卫生科技计划项目(编号:2018KY529)。

摘　　要：目的探讨机械通气超低出生体重儿早期口腔滴注初乳对喂养状况的影响。方法选取2017年3月-2019年3月在我院以有创或无创机械通气的超低出生体重儿130例为研究对象。采用随机数字表法分为观察组与对照组,各65例。根据纳排及剔除标准最终有104例患儿进入研究,观察组51例、对照组53例。观察组于生后24 h内必须完成首次初乳口腔滴注,1次/4 h,0.2 mL/次,持续5 d;对照组初乳仅用于胃肠内营养,其余干预措施与观察组一致。(1)收集并比较两组患儿出生第1天与第6天的气道分泌物、尿液标本,检测sIgA与乳铁蛋白的浓度。(2)记录两组喂养状况(包括开始肠内营养胎龄、完全不潴留胎龄、达到全肠内营养胎龄、出现吸吮动作胎龄、开始经口喂养胎龄)及记录患儿每日体质量增长。(3)比较两组喂养不耐受、新生儿坏死性小肠结肠炎(NEC)的发生率。结果 (1)两组开始肠内营养胎龄差异无统计学意义(P>0.05),生后第6天,观察组气道分泌物与尿液标中sIgA、乳铁蛋白浓度浓度高于对照组,差异有统计学意义(P<0.05),且观察组出生第6天与第1天气道分泌物与尿液标中sIgA、乳铁蛋白浓度组内比较,差异也有统计学意义(P<0.05),对照组差异无统计学意义(P>0.05)。(2)观察组喂养完全不潴留胎龄、达全胃肠道营养胎龄均小于对照组(P<0.05);出现吸吮动作胎龄、开始经口喂养胎龄、恢复至出生体质量时间均早于对照组(P<0.05)。(3)观察组喂养不耐受与NEC发生率也明显低于对照组(P<0.05)。结论早期初乳口腔滴注可提高机械通气超低出生体重儿的胃肠道局部免疫功能与全身抗感染能力,促进其胃肠道功能的成熟,从而改善其喂养状况,降低喂养不耐受、NEC的危险性。Objective To study the effect of early oropharyngeal administration of microdosed colostrum on feeding status in extremely low birth weight infants on mechanical ventilation.Methods 130 cases of extremely low birth weight infants with invasive or noninvasive mechanical ventilation in our hospital from March 2017 to March 2019 were selected as the research objects.According to the natriuretic criteria,104 patients entered the study.They were randomly divided into experimental group(n=51)and control group(n=53).The first oral drip of colostrum in the experimental group must be completed within 24 hours after birth,once/4 hours,0.2 mL/time,lasting for 5 days;Colostrum in the control group was only used for enteral nutrition,and other intervention measures were the same.(1)The levels of SIgA and lactoferrin in airway secretions and urine samples on the first and sixth day of birth were detected.(2)The feeding status of the two groups was recorded,including gestational nutritional age,complete non retention age,total enteral nutrition,gestational age,and daily weight gain.(3)The incidence of feeding intolerance and neonatal necrotizing enterocolitis(NEC)were compared between the two groups.Results(1)There is no significant different in gestational nutritional age.On the 6th day of admission,the concentrations of sIgA and lactoferrin in airway secretions and urine of the intervention group were significantly higher than those of the control group(P<0.05).There were also significant differences in sIgA and lactoferrin concentrations between the first and the 6th day airway secretions and urine in the same intervention group(P<0.05).(2)The intervention group showed gestational age at complete non-retention,gestational age at onset of total gastrointestinal nutrition,onset of sucking,oral feeding and recovery of birth weight were all younger those of the control group(P<0.05).(3)The rate of feeding intolerance and the incidence of NEC in observation group was significantly lower than that of the control group.Conclusions

关 键 词：超低出生体重儿 机械通气 初乳 口腔滴注 喂养状况 儿科护理 

分 类 号：R473.72[医药卫生—护理学]