三种不同奶粉喂养对早产儿喂养耐受性的影响

发布时间：2018-03-08 23:16

  本文选题：早产儿　切入点：喂养不耐受　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景近年来随着生殖医学及新生儿疾病救治水平的提高,早产儿的出生率和存活率逐渐升高。早产儿由于各脏器发育不成熟、抵抗力低下,容易出现呼吸窘迫综合征、感染、高胆红素血症等各种并发症。生后喂养对早产儿的存活、生长发育及远期预后有显著影响。早产儿由于胃肠道发育不成熟、胃蛋白酶及肠激酶活性低、对蛋白质的水解能力欠佳,临床上开始肠道喂养后,容易出现喂养不耐受问题,表现为呕吐、腹胀、便血、胃潴留、胃食管反流等情况,严重的甚至会出现新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)。NEC除了可以出现以上症状外,还可以发生肠穿孔、肠坏死、休克等危及生命情况。早产儿发生喂养不耐受或NEC后,可影响体质量增长,引起宫外生长发育迟缓,使其生存质量下降,存活率降低。合理喂养则可以减少早产儿喂养不耐受的发生,促进其体质量增长,改善其神经发育结局。早产儿的肠内喂养内容物有母乳、配方奶等。其中母乳营养非常丰富,含有各种营养素、免疫因子、激素及其他生物学成分,是婴儿的最佳食品,应作为早产儿的首选。但在某些情况下由于各种原因,早产儿可能无法实现母乳喂养,需要去选择一种配方奶来进行喂养。目前可供临床选择的配方奶种类比较多,包括液体配方奶、早产儿普通配方奶、深度水解蛋白配方奶等,但是何种奶粉可以减少喂养不耐受的发生,更适合早产儿喂养,现在尚无定论。目的比较早产儿液体配方奶、早产儿普通粉奶、深度水解蛋白配方奶三种不同奶粉喂养对早产儿的出生体重恢复时间及喂养不耐受、新生儿坏死性小肠结肠炎(NEC)的影响,为早产儿肠内营养选择提供依据。对象与方法1研究对象与分组选取2015年11月-2016年7月,我院胎龄37周、入院前尚未开始任何形式肠内喂养的入住新生儿科的280例早产儿作为研究对象,排除先天性消化道畸形、先天性遗传代谢病、先天性心脏病的患儿。按随机数字表法分为三组:早产儿液体配方奶组(A组100例);早产儿普通粉奶组(B组100例);深度水解蛋白配方奶组(C组80例)。记录早产儿的性别、胎龄、出生日期、出生体重、有无窒息及脐静脉置管等情况,观察并比较三组早产儿恢复至出生体重的时间及喂养不耐受级NEC的发生率。本研究在征得医院医学伦理委员会批准和家属知情同意的情况下实行。2统计分析采用SPSS21.0软件进行统计分析。计量资料用均数±标准差(x_±s)表示,比较采用t检验;计数资料用率(%)表示,比较采用χ2检验,P0.05为差异有统计学意义。结果1三组早产儿恢复至出生体重时间比较A组恢复至出生体重时间为(6.18±2.97)天,B组恢复至出生体重时间为(4.99±2.45)天,C组恢复至出生体重时间为(6.13±2.91)天,B组恢复至出生体重时间最短,差异有统计学意义(P0.05),而A组与C组恢复至出生体重时间差异无统计学意义(P0.05)。2三组早产儿喂养不耐受的比较A组出现喂养不耐受的有31例(31%),B组出现喂养不耐受的有18例(18%),C组出现喂养不耐受的有12例(15%),B组、C组的喂养耐受性均较A组好,差异有统计学意义,(P0.05),但B、C两组之间喂养耐受性差异无统计学意义(P0.05)。3三组早产儿NEC的比较A组有3例NEC的发生,B组有2例有NEC的发生,C组无NEC的发生,三组之间NEC的发生率比较无统计学意义(P0.05)。结论1.早产儿液体配方奶比早产儿普通粉奶、深度水解蛋白配方奶更易出现喂养不耐受;2.早产儿普通粉奶在恢复出生体重时间上优于早产儿液体配方奶、深度水解蛋白配方奶;3.早产儿NEC的发生与奶粉种类无关。
[Abstract]:In recent years, with the research background of reproductive medicine and neonatal disease treatment level, the birth rate and the survival rate of premature infants increased gradually. Because each organ development is not mature, low resistance, prone to respiratory distress syndrome, infection, hyperbilirubinemia and other complications. After feeding on premature infant survival, growth and development have a significant impact and the prognosis of premature infants. Because of gastrointestinal immaturity, pepsin and enterokinase activity is low, poor ability on the hydrolysis of protein, clinical start enteral feeding, prone to feeding intolerance, characterized by vomiting, abdominal distension, hematochezia, gastric retention, cases of gastroesophageal reflux, serious or even newborn necrotizing enterocolitis (neonatal necrotizing enterocolitis, NEC.NEC) in addition to the above symptoms, can also occur intestinal perforation, intestinal necrosis, Hugh Grams of life-threatening situation. Premature infant feeding intolerance or NEC, can affect the body weight growth caused by extrauterine growth retardation, the decline in the quality of survival, the survival rate decreased. Reasonable feeding can reduce the incidence of feeding intolerance in preterm infants, promote the body weight growth, improve the neurodevelopmental outcome of preterm infants. Enteral feeding contents of breast milk, formula milk. The milk nutrition is very rich, containing a variety of nutrients, immune factors, hormones and other biological components, is the best food for babies, as premature choice. But in some cases due to various reasons, premature infants may not achieve breastfeeding, need to choose a a formula for feeding. The more available clinical choice formula types, including liquid milk, infant formula milk ordinary, hydrolyzed protein formula milk depth, but what Milk powder can reduce the incidence of feeding intolerance, more suitable for feeding, now inconclusive. Objective to compare the premature infant formula milk powder liquid, infant milk, depth of hydrolyzed protein formula of three different milk feeding on premature birth weight recovery time and feeding intolerance, neonatal necrotizing enterocolitis (NEC) effect that provides the basis for the choice of enteral nutrition in premature infants. Subjects and methods 1 subjects and groups from November 2015 -2016 year in July in our hospital, 37 weeks of gestational age, has not yet begun any form of enteral feeding in neonatal infants 280 cases as the research object before admission, exclusion of congenital digestive tract malformation, congenital genetic metabolism disease, congenital heart disease were randomly divided into three groups: infant formula milk group liquid (group A 100 cases); premature infant milk powder group (group B, 100 cases); deep hydrolysis of egg White formula milk group (group C, 80 cases). The record of premature sex, gestational age, birth date, birth weight, without asphyxia and umbilical vein catheter etc., the incidence of three groups of preterm infants recovering to birth weight and the time of feeding intolerance in NEC were observed. The study carried out in medical consent the hospital ethics committee approval and informed consent cases were analyzed by SPSS21.0 statistical analysis software.2. The mean and standard deviation for the measurement data (x_ + s) said, compared with the t test; count data rate (%), compared with the 2 test P0.05, the difference was statistically significant. Results 1 three groups of premature recovery time to birth weight A group returned to the time of birth weight for (6.18 + 2.97) days, B group returned to the time of birth weight for (4.99 + 2.45) days, C group returned to the time of birth weight for (6.13 + 2.91) days, B group return to birth weight 闂存渶鐭，

本文编号：1585976