经胃肠道补充谷氨酰胺对极低出生体质量儿的作用

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 h 1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.

Effects of Enteral Glutamine Supplementation on Very Low Birth Weight Infants

Objective To research the effects of enteral glutamine(Gln) supplementation on very low birth weight infants(VLBWI).Methods Totally 218 cases of VLBWI(gestation age≤34 weeks,birth weight 1 001-1 499 g,hospitalized in NICU within 24 h after birth) were randomly divided into 2 groups: control group(116 cases) and treatment group(102 cases).The control group was given the routine nutrition support and symptomatic treatment.On the basis of treatment in the control group,the treatment group was given Gln 0.33 g during gastric tube whin the first 24 h after birth,after that given Gln every 12 h for 28 days.The incidence of feeding intolerance,incidence of necrotizing enterocolitis 28 d after birth,the incidence of hospital acquired infection,mortality,weight of 28 days and the ratio of total enteral nutrition when 28 days old,were compared between the 2 groups.Results The incidence of feeding intolerance in treatment group was 25.49%,which was significantly lower than that in control group(43.97%)(χ2=7.320 8,P=0.006 8).When 28 days old,the average weight in treatment group and control group were(1 785±247) g and(1 629±283) g,the former was significantly higher than the latter(t=-4.170 4,P=0.000 0);56.9% cases in treatment group reached total enteral nutrition and 40.5% cases in control group reached total enteral nutrition,the former was significantly higher than the latter(χ2=5.172 0,P=0.023 0).The incidence of NEC till 28 days after birth,in treatment group was 4.9% and control group was 7.8%,but there was no significant difference between both groups(χ2=0.338 3,P=0.560 8).The incidence of hospital acquired infection of treatment group and control group were 33.3% and 56.0%,the former was significantly lower than the latter(χ2=10.385 9,P=0.001 3).The mortality of treatment group and control group were 5.9% and 6.8%,there was no significant difference between them(χ2=0.000 8,P=0.977 7).Conclusions Early supplement enteral Gln can improve the VLBWI feeding tole-rance,decrease the incidence of hospital acquired infection,and make them early transit to total enteral nutrition.