益生菌对极低出生体重早产儿胃肠功能的影响的临床研究

发布时间：2018-05-01 11:42

  本文选题：益生菌 + 极低出生体重早产儿　； 参考：《重庆医科大学》2012年硕士论文

【摘要】：目的探讨口服益生菌对极低出生体重早产儿胃肠功能的影响，主要包括对新生儿坏死性小肠结肠炎、喂养不耐受以及胃肠外营养相关性胆汁淤积的影响，并评估其安全性。 方法对2010年1月-2011年11月，我中心收治的100例VLBW早产儿的临床资料进行回顾性分析。益生菌组45例，其中男27例（60.0%），女18例（40.0%），胎龄30.1±1.7周，产重1260.13±194.82g；对照组55例，其中男25例（45.5%），女30例（54.5%），胎龄31.2±2.2周，产重1278.55±146.88g。评估两组围产期及临床资料可比性，比较新生儿坏死性小肠结肠炎的发病率、严重程度、死亡率，，败血症发病率，喂养不耐受发生率、恢复出生体重时间、体重增长速度及胃肠外营养相关性胆汁淤积（PNAC）发生率；记录益生菌不良作用。 结果益生菌组胎龄明显低于对照组（30.1±1.7周vs31.2±2.2周；t=-2.804，P=0.006），有合并症早产儿（呼吸暂停、呼吸衰竭、新生儿呼吸窘迫综合征）例数明显高于对照组（28/45vs22/55；χ~2=4.889，P=0.027），住院天数、静脉营养天数、PICC及鼻饲时间均明显长于对照组[（46.47±22.43dvs34.65±21.84d；t=2.658，P=0.009），（35.73±16.78dvs26.40±18.56d；t=2.611，P=0.010），（19.36±23.64dvs5.71±11.52d；Z=-3.291，P=0.001），（24.79±17.79dvs11.62±11.76d；Z=-3.784，P=0.000）]。两组资料在胃肠功能相关危险因素的分布不均衡，影响试验结果。益生菌组NEC发病率（6.7%）较对照组（21.8%）明显下降，RR0.256（95%CI：0.067～0.972；χ~2=4.456，P=0.035）；严重NEC（Ⅲ级）3例均发生在对照组，但两组比较并无统计学差异（0/45vs3/55；χ~2=1.003，P=0.317）。益生菌组死亡2例(NEC相关1例，非NEC相关1例)，对照组死亡5例(NEC相关3例，非NEC相关2例)，两组比较，总死亡数（2/45vs5/55；χ~2=0.262，P=0.609）及NEC相关死亡数（1/45vs3/55；χ~2=0.912，P=0.634），差异均无统计学意义。两组比较，败血症发病率（6/45vs6/55；χ~2=0.138，P=0.711）、喂养不耐受发生例数（24/45vs29/55；χ~2=0.004，P=0.952）、体重增长速度（10.82±5.93g/Kg/dvs8.98±5.13g/Kg/d；t=1.665，P=0.099）、恢复出生体重时间（7.98±6.41dvs9.11±5.88d；t=-0.919，P=0.361）和PNAC发病例数（9/44vs16/52；χ~2=1.317，P=0.251），差异均无统计学意义。无益生菌相关败血症、脑膜炎、腹泻、皮疹等不良作用的记录。 结论联合应用双歧杆菌BB-12、鼠李糖乳杆菌LGG可显著降低极低出生体重早产儿NEC发病风险，有降低NEC疾病严重性及死亡率趋势，对败血症、胃肠外营养相关性胆汁淤积有一定作用，但不能显著降低极低出生体重早产儿喂养不耐受，也不能缩短恢复出生体重时间，加快体重增长速度。本试验系回顾性研究，两组围产期及临床资料不具可比性，影响了益生菌对极低出生体重早产儿胃肠功能作用的评估，因此，需进一步开展前瞻性随机对照试验研究其对胃肠功能的影响。本试验无益生菌相关败血症、脑膜炎记录，无腹泻、皮疹等不良反应。因此，联合应用双歧杆菌BB-12、鼠李糖乳杆菌LGG于极低出生体重早产儿是相对安全的。
[Abstract]:Objective to investigate the effects of oral probiotics on gastrointestinal function of very low birth weight preterm infants, including neonatal necrotizing enterocolitis, feeding intolerance and parenteral nutrition associated cholestasis, and to evaluate its safety. Methods the clinical data of 100 premature infants with VLBW admitted in our center from January 2010 to November 2011 were analyzed retrospectively. The probiotics group (n = 45) included 27 males (n = 27) and 18 females (n = 18). The gestational age was 30.1 卤1.7 weeks, and the birth weight was 1260.13 卤194.82 g, while in the control group, there were 55 cases, including 25 males, 45.5g, 30 females, 31.2 卤2.2 weeks gestational age, and 1278.55 卤146.88 g gestational weight. To evaluate the comparability of perinatal and clinical data between the two groups, and to compare the incidence, severity, mortality, septicemia, feeding intolerance and time of recovery of birth weight of neonatal necrotizing enterocolitis. The rate of weight gain and the incidence of parenteral nutrition associated cholestasis (PNAC) were recorded and the adverse effects of probiotics were recorded. Results the gestational age of probiotics group was significantly lower than that of control group (30.1 卤1.7 weeks vs31.2 卤2.2weeks vs31.2 卤2.804). The number of premature infants with complications (apnea, respiratory failure, neonatal respiratory distress syndrome) was significantly higher than that of control group (28 / 45 vs 2255 / 55; 蠂 ~ (2) = 24.889P0.02727). The days of intravenous nutrition and the nasal feeding time were significantly longer than those in the control group (46.47 卤21.84 d) and 2.658 d (2.658d), 35.73 卤18.56 16.78dvs26.40 卤18.56 d ~ (2.611D) ~ 0.010 ~ (10) 23.64dvs5.71 ~ (19.36 卤11.52) 23.64dvs5.71 ~ (-3.291) P ~ (0.001) ~ (?) ~ (24.79 卤17.79dvs11.62 卤11.76? d ~ (-3.784D) P ~ (0. 000). The distribution of risk factors related to gastrointestinal function in the two groups was uneven, which affected the results of the experiment. The incidence of NEC in probiotics group was significantly lower than that in control group (RR0.25695% CI: 0.067% 0.972; 蠂 2 + 4.456% PU 0.035%; severe NECs occurred in the control group, but there was no statistical difference between the two groups in 0 / 45 vs 355; 蠂 2 = 1.003). In probiotics group, there were 2 cases of NEC-associated death, 1 case of non-NEC-related death, 5 cases of non-NEC-related death in control group, and 2 cases of non-NEC-related death. The total mortality of the two groups was 2.45 vs 5 / 55; 蠂 ~ (2 +) 0.262 P ~ (2 +) 0.609) and NEC related death number was 1 / 45 vs 355; 蠂 ~ (2 +) = 0.912 ~ P ~ (0.634); there was no significant difference between the two groups. 涓ょ粍姣旇緝,璐ヨ��鐥囧彂鐥呯巼(6/45vs6/55;蠂~2=0.138,P=0.711),鍠傚吇涓嶈

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