首次喂养后腹部组织氧饱和度对早产儿喂养耐受的预测价值  

Predictive value of abdominal tissue oxygen saturation after first feeding on feeding tolerance of preterm infants

作　　者：陆镇奇[1,2] 戴怡蘅 LU Zhenqi;DAI Yiheng(Department of Neonatology,Foshan Women and Children Hospital,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市妇幼保健院新生儿科,广东佛山528000 [2]华南理工大学附属第六医院

出　　处：《上海医学》2024年第10期621-627,共7页Shanghai Medical Journal

基　　金：佛山市科学技术局科技创新项目(2020001005559)。

摘　　要：目的探讨早产儿首次喂养后腹部组织氧饱和度(A-rSO_(2))对喂养是否耐受的预测价值。方法选择2020年1月—2022年1月在佛山市妇幼保健院新生儿科住院的胎龄<37周、病情稳定能于出生后24 h内开奶的早产儿105例,其中男54例、女51例。根据早产儿出生后2周的喂养情况,分为喂养不耐受(FI组,52例)和喂养耐受(FT组,53例)。所有早产儿出生后均给予常规喂养(微量间歇喂养),于首次喂养前0.5 h至喂养后3.0 h监测其A-rSO_(2)和脑部组织氧饱和度(C-rSO_(2))。比较两组早产儿的临床资料[母乳喂养比例、出生后至开始全肠内营养的时间(达全肠道时间)、坏死性小肠结肠炎(NEC)发生率等],喂养前0.5 h和喂养后0.5、1.0、1.5、2.0、2.5、3.0 h的A-rSO_(2),以及A-rSO_(2)/C-rSO_(2)比值。采用ROC曲线分析A-rSO_(2)、A-rSO_(2)/C-rSO_(2)比值对喂养是否耐受的预测效能。结果FT组早产儿母乳喂养比例显著高于FI组[77.4%(41/53)比55.8%(29/52),P=0.019],达全肠道时间显著短于FI组[(15.7±3.4)d比(22.5±4.5)d,P=0.001],NEC发生率显著低于FI组[0比9.6%(5/52),P=0.021]。FI组与FT组喂养前A-rSO_(2)、A-rSO_(2)/C-rSO_(2)比值的差异均无统计学意义[59.0%(55.0%,62.0%)比58.0%(55.0%,61.0%),1.00(0.92,1.03)比0.97(0.92,1.03),P值均>0.05],FI组喂养后0.5、1.0、1.5、2.0、2.5、3.0 h的A-rSO_(2)、A-rSO_(2)/C-rSO_(2)比值均显著低于FT组同时间点(P值均<0.001)。喂养后1.0、1.5、2.0、2.5、3.0 h的A-rSO_(2)的AUC分别为0.769、0.781、0.757、0.836、0.875,最佳临界值分别为39.5%、40.5%、39.5%、41.5%、41.5%;喂养后1.0、1.5、2.0、2.5、3.0 h的A-rSO_(2)/C-rSO_(2)比值的AUC分别为0.759、0.788、0.752、0.848、0.868,最佳临界值分别为67.5%、67.8%、69.7%、70.3%、73.4%。结论首次喂养后FI早产儿的ArSO_(2)和A-rSO_(2)/C-rSO_(2)下降,监测ArSO_(2)及A-rSO_(2)/C-rSO_(2)对早期预测早产儿喂养是否耐受具有较高的临床价值。Objective To investigate the predictive value of abdominal tissue oxygen saturation(A-rSO_(2))on feeding tolerance of preterm infants after the first feeding.Methods A total of 105 premature infants(54 males and 51 females)with gestational age<37 weeks and stable condition who were hospitalized in our hospital from January 2020 to January 2022 and could be breastfed within 24 hours after birth were enrolled in this study.According to their two-week feeding after birth,they were divided into feeding intolerance group(n=52)and feeding tolerance group(n=53).All premature infants were given micro intermittent feeding after birth.A-rSO_(2)and cerebral tissue regional oxygen saturation(C-rSO_(2))were monitored from 0.5 h before the first feeding to 3.0 h after feeding.The clinical data,such as breastfeeding ratio,time to the whole intestine,and the incidence of necrotizing enterocolitis(NEC),as well as the A-rSO_(2)at 0.5 h before feeding and 0.5,1.0,1.5,2.0,2.5,and 3.0 h after feeding,and the ratio of A-rSO_(2)to C-rSO_(2)were compared between the two groups.The predictive efficacy of A-rSO_(2)and A-rSO_(2)/C-rSO_(2)on feeding tolerance was evaluated by ROC curve.Results The feeding tolerance group had higher breastfeeding rate(77.4%[41/53]vs.55.8%[29/52],P=0.019),shorter time to the whole intestine([15.7±3.4]d vs.[22.5±4.5]d,P=0.001),and lower incidence of NEC(0 vs.9.6%[5/52],P=0.021)than the feeding intolerance group.There was no statistically significant difference in the A-rSO_(2)or A-rSO_(2)/C-rSO_(2)between the feeding intolerance group and the feeding tolerance group before feeding(59.0%[55.0%,62.0%]vs.58.0%[55.0%,61.0%],1.00[0.92,1.03]vs.0.97[0.92,1.03],P>0.05).At 0.5,1.0,1.5,2.0,2.5,and 3.0 h after feeding,the A-rSO_(2)and A-rSO_(2)/C-rSO_(2)in the feeding intolerance group were significantly lower than those in the feeding tolerance group(P<0.001);the AUC of A-rSO_(2)were 0.769,0.781,0.757,0.836,and 0.875,with optimal cut-off of 39.5%,40.5%,39.5%,41.5%,and 41.5%,respectively;the AUC of A-rSO_(2)/C-rSO_(2)w

关 键 词：婴儿 早产 脑组织氧饱和度 腹部组织氧饱和度 喂养不耐受 小肠结肠炎 坏死性 

分 类 号：R722.6[医药卫生—儿科]