赖灵巧 高丽娟

[摘要] 目的 探討早期母乳微量喂养对喂养不耐受早产儿血清胃肠激素水平及生长发育的影响。 方法 选取2018年7月至2019年12月我院新生儿科住院治疗的喂养不耐受早产儿84例，随机分为微量喂养组和常规喂养组，每组各42例。常规喂养组早产儿予以实施常规母乳喂养，微量喂养组早产儿采用早期母乳微量喂养，两组均治疗3周。观察两组早产儿治疗前后血清胃肠激素[胃动素（MTL）和胃泌素（GAS）]水平的变化，并比较治疗3周时生长发育情况（恢复至出生体重时间、体重和头围增长幅度）和临床疗效。 结果 治疗3周后，两组早产儿血清MTL和GAS水平较前显著上升（P<0.05或P<0.01），且微量喂养组上升值较常规喂养组更显著（P<0.05）;微量喂养组早产儿恢复至出生体重时间短于普通喂养组，3周时体重和头围增长幅度较普通喂养组更明显（P<0.05）;同时微量喂养组早产儿临床总有效率（95.24%）显著高于常规喂养组（80.95%）（χ2=4.092，P<0.05）。 结论 早期母乳微量喂养治疗喂养不耐受早产儿的疗效优于常规母乳喂养，能促进体重和头围的增长，加快其生长发育，其作用机制可能与其能促进胃肠激素MTL和GAS的释放，使得血清MTL和GAS水平明显上升相关。

[关键词] 喂养不耐受;早产儿;早期母乳微量喂养;胃肠激素;生长发育

[Abstract] Objective To investigate the impacts of early breast milk minimal feeding on serum gastrointestinal hormone level and growth and development of premature infants with feeding intolerance. Methods A total of 84 premature infants with feeding intolerance who were admitted to the department of neonatal of our hospital from July 2018 to December 2019 were randomly divided into the minimal feeding group（n=42） and the conventional feeding group（n=42）. Premature infants in the conventional feeding group were given conventional breast feeding， while premature infants in the minimal feeding group were given early breast milk minimal feeding， and both groups were treated for 3 weeks. The changes of serum gastrointestinal hormones （motilin [MTL] and gastrin [GAS]） before and after treatment were observed and the growth and development（the time of returning to birth weight， the increase of weight and head circumference） and clinical efficacy after 3 weeks of treatment were compared. Results After 3 weeks of treatment， the serum MTL and GAS levels of premature infants in the two groups increased significantly（P<0.05 or P<0.01）， and the increase in minimal feeding group was more significant than that in the conventional feeding group（P<0.05）. The recovery time of premature infants in the minimal feeding group was shorter than that in the conventional feeding group， and the increase of body weight and head circumference at 3 weeks were more significant than those in the conventional feeding group（P<0.05）. Meanwhile， the total clinical efficacy rate of premature infants in the minimal feeding group was 95.24%， which was significantly higher than 80.95% in the conventional feeding group（χ2=4.092， P<0.05）. Conclusion The efficacy of early breast feeding on premature infants with feeding intolerance is better than that of conventional breast feeding， which can promote the growth of body weight and head circumference and accelerate their growth and development. Its mechanism may be related to its promotion of the release of gastrointestinal hormones MTL and GAS， resulting in a significant increase in serum MTL and GAS levels.

[Key words] Feeding intolerance; Premature infants; Early breast milk minimal feeding; Gastrointestinal hormone; Growth and development

喂养不耐受是新生儿科较常见的胃肠道功能紊乱性疾病，以早产儿多见，主要表现为频繁呕吐、腹胀、胃残留物增多，同时还可出现加奶困难、胃食道十二指肠返流等，影响肠道热量摄取，使新生儿营养摄入不足，导致蛋白摄入不足和发育异常，影响其生长发育[1-2]。喂養不耐受的发病机制至今国内外尚未完全阐明，其中胃肠激素水平分泌不足引起胃肠功能紊乱在其发病中的作用越来越受重视[3]。早期母乳微量喂养是指在新生儿早期采取摄入奶量≤20 mL/（kg·d）的喂养方式，可提高新生儿的喂养耐受性，用于治疗新生儿喂养不耐受具有一定的效果，但其对新生儿的胃肠激素水平的影响国内鲜有报道[4]。本研究探讨早期母乳微量喂养对喂养不耐受早产儿血清胃肠激素水平及生长发育的影响，现报道如下。……