论文部分内容阅读
目的研究经胃肠道补充谷氨酰胺(Gln)对极低出生体质量儿(VLBWI)的作用。方法 VLBWI 218例(胎龄≤34周,出生体质量1 001~1 499 g,出生24 h内入住NICU)随机分为对照组(116例)和治疗组(102例)。对照组给予常规营养支持与对症处理,治疗组在对照组的基础上于出生24 h内即经胃管注入Gln 0.33 g,每12 h1次,连用28 d。观察比较二组喂养不耐受发生率,出生28 d时坏死性小肠结肠炎(NEC)发生率、医院感染发生率、病死率及出生28 d时体质量和达到完全胃肠内喂养的比例。结果治疗组喂养不耐受发生率为25.49%,与对照组(43.97%)比较差异有统计学意义(χ2=7.320 8,P=0.006 8)。出生28 d时,治疗组体质量为(1 785±247)g,对照组为(1 629±283)g,二组比较差异有统计学意义(t=-4.170 4,P=0.000 0);治疗组56.9%达到完全肠内喂养,与对照组(40.5%)比较差异有统计学意义(χ2=5.172 0,P=0.023 0)。观察至出生28 d,Gln治疗组NEC发生率为4.9%,较对照组(7.8%)低,但二组比较差异无统计学意义(χ2=0.338 3,P=0.560 8);治疗组医院感染发生率为33.3%,对照组为56.0%,二组比较差异具有统计学意义(χ2=10.385 9,P=0.001 3)。治疗组病死率(5.9%)与对照组(6.8%)比较,差异无统计学意义(χ2=0.000 8,P=0.977 7)。结论出生后尽早经胃肠道补充Gln,可改善VLBWI喂养的耐受性,降低医院感染发生率,并能使VLBWI尽早过渡到全胃肠道内营养。
Objective To investigate the effect of glutamine (Gln) supplementation on gastrointestinal tract to very low birth weight (VLBWI). Methods A total of 218 VLBWI patients (gestational age≤34weeks, birth weight range from1001to1499g and NICU within24h after birth) were randomly divided into control group (116 cases) and treatment group (102 cases). The control group was given routine nutritional support and symptomatic treatment. The treatment group was injected Gln 0.33 g intragastrically 24 h after birth on the basis of the control group, once every 12 h for 28 d. The incidence of feeding intolerance, the incidence of necrotizing enterocolitis (NEC) at 28 days of birth, the incidence of nosocomial infection, the case fatality rate, and body mass at 28 days of birth and the proportion of achieving complete gastrointestinal feeding were observed and compared. Results The incidence of feeding intolerance in the treatment group was 25.49%, which was significantly different from that in the control group (43.97%) (χ2 = 7.320 8, P = 0.006 8). At 28 days of birth, the body weight of the treatment group was (1785 ± 247) g and that of the control group was (1629 ± 283) g. The differences between the two groups were statistically significant (t = -4.1704, P = 0.0000). 56.9% of the treatment group achieved complete enteral feeding, compared with the control group (40.5%), the difference was statistically significant (χ2 = 5.172 0, P = 0.023 0). The incidence of NEC in the Gln-treated group was 4.9% at 28 days of birth, which was lower than that of the control group (7.8%), but there was no significant difference between the two groups (χ2 = 0.338 3, P = 0.5608) The incidence was 33.3% in the control group and 56.0% in the control group. The difference between the two groups was statistically significant (χ2 = 10.385 9, P = 0.001 3). There was no significant difference between the treatment group (5.9%) and the control group (6.8%) (χ2 = 0.0008, P = 0.9777). Conclusions As soon as possible after birth, Gln supplemented by gastrointestinal tract can improve the tolerance of VLBWI feeding, reduce the incidence of nosocomial infection and make VLBWI transition to total gastrointestinal tract as soon as possible.