益生菌在极低出生体质量儿营养支持策略中的应用

目的探讨益生菌在极低出生体质量儿（VLBWI）营养支持策略中的作用、用药安全性以及对早产儿早期生长发育的影响。方法将60例VLBWI随机分成治疗组和对照组,各30例。两组病儿基础治疗相同,治疗组在此基础上口服（或经口胃管给予）益生菌双歧四联活菌,每次0.25 g,每天2次,共2周。观察两组间足量喂养日龄、恢复出生体质量日龄;监测记录喂养不耐受的发生例数、临床表现及可能的药物不良反应、每日摄入热量、第10天胆红素值及肠外营养达足量水平的例数;记录每日体质量,计算其平均增长速度。结果治疗组喂养不耐受发生率低于对照组（χ2=4.02,P〈0.05）,过渡到全胃肠喂养时间短于对照组（t=3.52,P〈0.05）,第10天胆红素值低于对照组（t=2.12,P〈0.05）,肠外营养达足量水平的比率高于对照组（χ2=4.02,P〈0.05）,恢复至出生时体质量所需时间短于对照组（t=2.66,P〈0.05）,体质量增长速度快于对照组（t=2.71,P〈0.05）。治疗过程中无不良反应发生。结论益生菌可改善肠内营养,有效降低VLBWI喂养不耐受发生率;同时益于肠外营养顺利添加,全面促进VLBWI营养支持策略的实施及早期发育,应用安全,值得推广应用。

EFFECTS OF PROBIOTICS ON NUTRITIONAL SUPPORT FOR VERY LOW BIRTH WEIGHT INFANTS

Objective To evaluate the effect and safety of probiotics on nutritional support for very low birth weight（VLBW） infants,and its influence on the early growth and development of prematures. Methods Sixty VLBW infants wereequally randomized to treatment and control group.The basal therapy was the same for the two groups.To those in the treatment group,combined Bifidobacterium,lactobacillus,enterococcus and Bacillus cereus Tablets（Live） 0.25 g were offered orally or through a gastric tube,twice daily for two weeks.Days of sufficient feeding and recovery of birth weight were observed.The cases that intolerable to the therapy,their clinical manifestations,the possible adverse reactions,daily calory intake,and bilirubin levels on the 10th day were monitored and recorded. Results The average increase of body weight was measured.In comparison between the treatment and control group demonstrated that in the treatment group,the incidence of feeding intolerance was lower（χ2=4.02,P0.05）,the duration to achieve full feeding was shorter（t=3.52,P0.05）,the serum bilirubin levels were lower（t=2.12,P0.05）,the duration of recovering was shorter（t=2.66,P0.05） and body weight increase was faster than that in the control（t=2.71,P0.05）.There were no adverse reactions recorded during the medication. Conclusion Probiotics may improve enteral nutrition,effectively decrease feeding intolerance in VLBW infants,conducive to addition of parenteral alimentation,and overall promotion of nutritional support strategy for VLBW infants.This therapy is safe and worthy to be popularized and applied.