超低出生体重早产儿机械通气早期口腔滴注初乳的效果研究

doi:10.3761/j.issn.0254-1769.2020.06.017

摘要/Abstract

摘要：

目的探讨超低出生体重早产儿机械通气早期口腔滴注初乳的效果。方法选取温州市某三级甲等医院行机械通气的130例超低出生体重早产儿为研究对象,采用随机数字表法分为试验组和对照组,每组各65例。试验组于出生后24 h内开始实施初乳口腔滴注,持续5 d;对照组初乳仅用于胃肠内营养,其余干预措施两组均相同。收集两组出生后第1次与第6天的气道分泌物和尿液标本,检测分泌型免疫球蛋白A（secretory immunoglobulin A,sIgA）与乳铁蛋白的浓度;观察两组并发症发生率,记录两组机械通气时间、住院日。结果出生后第6天试验组气道分泌物与尿液中sIgA、乳铁蛋白浓度高于对照组,差异具有统计学意义（P<0.05）;试验组败血症、新生儿坏死性小肠结肠炎及呼吸机相关性肺炎的发生率明显低于对照组,差异具有统计学意义（P<0.05）;试验组的机械通气时间、住院日均短于对照组,差异具有统计学意义（P<0.05）。结论超低出生体重早产儿机械通气早期初乳口腔滴注能提高早产儿免疫功能,降低近期并发症的发生率,缩短机械通气时间与住院时间,降低住院费用,应对该类早产儿尽早启动初乳口腔滴注,并提供更多的支持策略。

关键词: 超低出生体重儿, 机械通气, 初乳, 口腔滴注, 儿科护理学

Abstract:

Objective To investigate the effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight. Methods 130 cases of extremely low birth weight infants with invasive or non-invasive mechanical ventilation were selected and randomly allocated into an experimental group and a control group with 65 cases in each group. In the experimental group, oropharyngeal colostrum started within 24 hours after birth for 5d. Colostrum in control group was only usedfor gastrointestinal nutrition. Airway secretions and urine samples of 2 groups were collected on the 1st and 6th day after birth,and sIgA and lactoferrin concentrations were detected. The incidence of complications was observed in both groups. Mechanical ventilation time and hospital stay of 2 groups were recorded. Results On the 6th day after birth, the concentrations of sIgA and lactoferrin in airway secretions and urine samples in the experimental group were higher than those in the control group, with statistically significant differences（P<0.05）. The incidences of sepsis, neonatal necrotizing enterocolitis and ventilator-associated pneumonia were significantly lower in the experimental group than those in the control group, with statistically significant differences（P<0.05）. The duration of mechanical ventilation and average length of hospital stay in the experimental group were shorter than those in the control group （P<0.05）. Conclusion Early oral droplet colostrum can improve the immune function of infants with extremely low birth weight, reduce the incidence of recent complications, shorten the duration of mechanical ventilation and hospital stay, and reduce medical costs. Therefore, more supporting strategies should be provided to start oral droplet colostrum as early as possible.

Key words: Extremely Low Birth Weight, Mechanical Ventilation, Colostrum, Oropharyngeal Administration, Pediatric Nursing

李育梅, 潘迎洁, 陈赢赢, 陈晓春. 超低出生体重早产儿机械通气早期口腔滴注初乳的效果研究[J]. 中华护理杂志, 2020, 55(6): 884-888.

LI Yumei, PAN Yingjie, CHEN Yingying, CHEN Xiaochun. The effects of oral droplet colostrum during early mechanical ventilation in premature infants with extremely low birth weight[J]. Chinese Journal of Nursing, 2020, 55(6): 884-888.

图/表 4

表1 两组一般资料比较

表2 两组气道分泌物与尿液中分泌型免疫球蛋白A浓度比较（ug/ml,$\bar{x}±s$）

表3 两组气道分泌物与尿液中乳铁蛋白浓度比较（ug/ml,$\bar{x}±s$）

表4 两组并发症发生情况的比较[例（百分率,%）]

参考文献 20

[1]	Howson CP, Kinney MV, McDougall L, et al. Born too soon:preterm birth matters[J]. Reprod Health, 2013,10(Suppl 1):1-2. DOI URL
[2]	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
[3]	Johnson TJ, Patel AL, Bigger HR, et al. Economic benefits and costs of human milk feedings:a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants[J]. Adv Nutr, 2014,5(2):207-212. DOI URL
[4]	王静, 罗晓明, 古桂雄. 母乳成分及测定方法[J]. 中国妇幼健康研究, 2015,26(3):641-643,656.
[5]	Hsu YC, Chen CH, Lin MC, et al. Changes in preterm breast milk nutrient content in the first month[J]. Pediatr Neonatol, 2014,55(6):449-454. DOI URL
[6]	季福婷, 张玉侠, 胡晓静, 等. 初乳口腔滴注对极低出生体重儿喂养状况的效果研究[J]. 中华护理杂志, 2016,51(10):1157-1160.
[7]	Maron JL, Hwang JS, Pathak S, et al. Computational gene expression modeling identifies salivary biomarker analysis that predict oral feeding readiness in the newborn[J]. J Pediatr, 2015,166(2):282-288.
[8]	Seigel JK, Smith PB, Ashley PL, et al. Early administration of oropharyngeal colostrum to extremely low birth weight infants[J]. Breastfeed Med, 2013,8(6):491-495.
[9]	Rodriguez NA, Meier PP, Groer MW, et al. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother’s colostrum to extremely low-birth-weight infants[J]. Adv Neonatal Care, 2010,10(4):206-212.
[10]	安宗剑. 新生儿肠道菌群与坏死性小肠结肠炎发病关系的研究进展[J]. 临床小儿外科杂志, 2019,18(5):356-360.
[11]	刘兆娥, 韩波, 李刚, 等. 超低出生体重儿医院感染危险因素分析[J]. 中华围产医学杂志, 2016,19(12):941.
[12]	Lee J, Kim HS, Jung YH, et al. Oropharyngeal colostrum administration in extremely premature infants:an RCT[J]. Pediatrics, 2015,135(2):e357-e366.
[13]	Pribylova J, Krausova K, Kocourkova I, et al. Colostrum of healthy mothers contains broad spectrum of secretory Iga autoantibodies[J]. J Clin Immunol, 2012,32(6):1372-1380. DOI URL
[14]	Palmeira P, Carneiro-Sampaio M. Immunology of breast milk[J]. Rev Assoc Med Bras, 2016,62(6):584-593.
[15]	黄慧丽, 柏志英, 蓝惠兰, 等. 两种口腔护理方法对口咽部及呼吸机管道细菌定植影响的研究[J]. 护士进修杂志, 2014,29(10):869-871.
[16]	童笑梅, 封志纯. 早产儿母乳喂养[M]. 北京: 人民卫生出版社, 2017.
[17]	Committee on Fetus and Newborn, American Academy of Pediatrics. Respiratory support in preterm infants at birth[J]. Pediatrics, 2014,133(1):171-174. DOI URL
[18]	李秋芳, 王华, 柳珍月, 等. 极低和超低出生体重儿舌下黏膜涂抹亲母初乳的免疫效果研究[J]. 中华护理杂志, 2018,53(12):1424-1428.
[19]	许素环, 张巧梅, 但鑫, 等. 口腔免疫疗法对早产儿干预效果的Meta分析[J]. 中国护理管理, 2018,18(10):1340-1346.
[20]	胡金梅. 口咽途径给予母乳对早产儿影响的研究进展[J]. 中华护理杂志, 2017,52(1):107-110.