生脉注射液联合非营养性吸吮对早产儿喂养不耐受的影响

发布时间：2018-10-20 11:16

【摘要】：背景早产儿尤其是极低出生体重儿,消化系统发育不健全,喂养不耐受发生率比较高,喂养不耐受可导致早产儿体重不增或负增长,体格和智能发育落后,静脉营养时间延长,而且增加坏死性小肠结肠炎(NEC)、血源感染及吸入窒息等疾病的风险。既往曾有不少研究报道应用多潘立酮、甲氧氯普胺、西沙必利等防治早产儿喂养不耐受,但临床发现这类药物存在中枢、心脏及肝脏等方面的副作用,故而临床应用受限。生脉注射液作为一种安全有效的传统中药,已证实其有改善循环保证肠道血流灌注、非特异性抗炎及增强免疫的作用；非营养性吸吮通过刺激迷走神经、促进胃肠激素释放等增加胃肠动力的成熟。因此,将生脉注射液和非营养性吸吮联合应用,为早产儿消化系统的成熟,改善喂养不耐受症状,促进早产儿生长发育,提供进一步临床研究思路。目的本研究在鼻胃管喂养、营养支持等常规治疗的基础上联合应用生脉注射液和非营养性吸吮治疗早产儿喂养不耐受,观察其对早产儿营养及生长发育的促进作用以及安全性。方法选取156例临床诊断为喂养不耐受早产儿作为研究对象,随机分为4组,四组患者均无先天畸形及代谢性疾病,均需鼻胃管喂养。对照组40例,常规给予鼻胃管喂养,静脉营养支持、蓝光照射等治疗。生脉组34例,在对照组的基础上,给予生脉注射液5m1/d静脉滴注。非营养性吸吮组32例,在对照组的基础上,给予非营养性吸吮。联合组50例,在对照组的基础上,同时加生脉注射液静脉滴注和非营养性吸吮。观察并对比四组对早产儿喂养不耐受的疗效及早产儿肝功指标变化。结果生脉组、吸吮组及联合组在腹胀、胃潴留消失时间、恢复至出生体重时间、达完全肠道喂养时间、黄疸消退时间及住院时间方面,与对照组比较,均明显缩短(p0.05或p0.01)；不同时间(3,7,14天)血清总胆红素和间接胆红素水平均明显降低(p0.01),联合组与单用生脉组或吸吮组比较具有非常显著性差异(p0.05)。早产儿各种相关并发症在上述三组也少于对照组,联合组与对照组比较具有非常显著性差异(P0.01)。血清白蛋白第7天、第14天增加,生脉组、吸吮组及联合组均比对照组高(p0.05或p0.01),说明其对早产儿营养起到促进作用。治疗过程中肝功能相关指标均正常。结论 1.生脉注射液、非营养性吸吮治疗早产儿喂养不耐受的效果优于常规传统治疗,联合应用疗效更佳。 2.联合应用生脉注射液、非营养性吸吮有利于早产儿生长发育。
[Abstract]:Background premature infants, especially very low birth weight infants, have poor digestive system and high incidence of feeding intolerance. Feeding intolerance can lead to weight loss or negative growth, physical and mental retardation, and prolonged venous nutrition time in premature infants. It also increases the risk of (NEC), hematogenous infection and inhalation asphyxia in necrotizing enterocolitis. Many previous studies have reported that domperidone, methoxyclopramide and cisapride are used to prevent and treat feeding intolerance in premature infants. However, clinical application of these drugs is limited because of the side effects of central, heart and liver. Shengmai injection, as a safe and effective traditional Chinese medicine, has been proved to improve circulation to ensure intestinal blood perfusion, non-specific anti-inflammatory and enhance immunity, non-nutritional sucking by stimulating vagus nerve, Promote gastrointestinal hormone release and increase the maturation of gastrointestinal motility. Therefore, the combination of Shengmai injection and non-nutritive sucking can improve the digestive system of premature infants, improve the symptoms of feeding intolerance, promote the growth and development of premature infants, and provide further clinical research ideas. Objective to study the efficacy and safety of Shengmai injection and non-nutritional sucking in the treatment of feeding intolerance in premature infants on the basis of nasogastric tube feeding and nutritional support. Methods 156 cases of preterm infants diagnosed as feeding intolerance were randomly divided into 4 groups. All the patients in the four groups were free of congenital malformation and metabolic diseases and were fed with nasogastric tube. In the control group, 40 cases were treated with nasogastric tube feeding, intravenous nutrition support, blue light irradiation and so on. Shengmai group (34 cases) was given Shengmai injection 5m1/d intravenous drip on the basis of control group. 32 cases of non-nutritional sucking group were given non-nutritional sucking on the basis of control group. The combined group of 50 cases, on the basis of the control group, combined with Shengmai injection intravenous drip and non-nutritional sucking. To observe and compare the effects of four groups on feeding intolerance of preterm infants and the changes of liver function in preterm infants. Results the time of abdominal distension, gastric retention disappearance, recovery to birth weight, complete enteral feeding time, jaundice regression time and hospitalization time in Shengmai group, sucking group and combination group were significantly shorter than those in control group (p0.05 or p0.01). The levels of serum total bilirubin and indirect bilirubin were significantly decreased at different time (3 ~ 7 ~ 14 days) (p0.01). There was a significant difference between the combined group and the single pulse group or sucking group (p0.05). All kinds of related complications of premature infants in the above three groups were also less than those in the control group, and there was a significant difference between the combined group and the control group (P0.01). Serum albumin was increased on day 7 and day 14. The levels of serum albumin in the Shengmai group, sucking group and combined group were higher than those in the control group (p0.05 or p0.01), which indicated that the serum albumin could promote the nutrition of premature infants. The related indexes of liver function were normal in the course of treatment. Conclusion 1. The effect of Shengmai injection and non-nutritive sucking on feeding intolerance of premature infants was better than that of conventional therapy. Combined use of Shengmai injection, non-nutritional sucking is conducive to premature growth and development.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.6

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