發(fā)布時間：2018-03-08 23:16

  本文選題：早產(chǎn)兒　切入點：喂養(yǎng)不耐受　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景近年來隨著生殖醫(yī)學及新生兒疾病救治水平的提高,早產(chǎn)兒的出生率和存活率逐漸升高。早產(chǎn)兒由于各臟器發(fā)育不成熟、抵抗力低下,容易出現(xiàn)呼吸窘迫綜合征、感染、高膽紅素血癥等各種并發(fā)癥。生后喂養(yǎng)對早產(chǎn)兒的存活、生長發(fā)育及遠期預后有顯著影響。早產(chǎn)兒由于胃腸道發(fā)育不成熟、胃蛋白酶及腸激酶活性低、對蛋白質(zhì)的水解能力欠佳,臨床上開始腸道喂養(yǎng)后,容易出現(xiàn)喂養(yǎng)不耐受問題,表現(xiàn)為嘔吐、腹脹、便血、胃潴留、胃食管反流等情況,嚴重的甚至會出現(xiàn)新生兒壞死性小腸結(jié)腸炎(neonatal necrotizing enterocolitis,NEC)。NEC除了可以出現(xiàn)以上癥狀外,還可以發(fā)生腸穿孔、腸壞死、休克等危及生命情況。早產(chǎn)兒發(fā)生喂養(yǎng)不耐受或NEC后,可影響體質(zhì)量增長,引起宮外生長發(fā)育遲緩,使其生存質(zhì)量下降,存活率降低。合理喂養(yǎng)則可以減少早產(chǎn)兒喂養(yǎng)不耐受的發(fā)生,促進其體質(zhì)量增長,改善其神經(jīng)發(fā)育結(jié)局。早產(chǎn)兒的腸內(nèi)喂養(yǎng)內(nèi)容物有母乳、配方奶等。其中母乳營養(yǎng)非常豐富,含有各種營養(yǎng)素、免疫因子、激素及其他生物學成分,是嬰兒的最佳食品,應(yīng)作為早產(chǎn)兒的首選。但在某些情況下由于各種原因,早產(chǎn)兒可能無法實現(xiàn)母乳喂養(yǎng),需要去選擇一種配方奶來進行喂養(yǎng)。目前可供臨床選擇的配方奶種類比較多,包括液體配方奶、早產(chǎn)兒普通配方奶、深度水解蛋白配方奶等,但是何種奶粉可以減少喂養(yǎng)不耐受的發(fā)生,更適合早產(chǎn)兒喂養(yǎng),現(xiàn)在尚無定論。目的比較早產(chǎn)兒液體配方奶、早產(chǎn)兒普通粉奶、深度水解蛋白配方奶三種不同奶粉喂養(yǎng)對早產(chǎn)兒的出生體重恢復時間及喂養(yǎng)不耐受、新生兒壞死性小腸結(jié)腸炎(NEC)的影響,為早產(chǎn)兒腸內(nèi)營養(yǎng)選擇提供依據(jù)。對象與方法1研究對象與分組選取2015年11月-2016年7月,我院胎齡37周、入院前尚未開始任何形式腸內(nèi)喂養(yǎng)的入住新生兒科的280例早產(chǎn)兒作為研究對象,排除先天性消化道畸形、先天性遺傳代謝病、先天性心臟病的患兒。按隨機數(shù)字表法分為三組:早產(chǎn)兒液體配方奶組(A組100例);早產(chǎn)兒普通粉奶組(B組100例);深度水解蛋白配方奶組(C組80例)。記錄早產(chǎn)兒的性別、胎齡、出生日期、出生體重、有無窒息及臍靜脈置管等情況,觀察并比較三組早產(chǎn)兒恢復至出生體重的時間及喂養(yǎng)不耐受級NEC的發(fā)生率。本研究在征得醫(yī)院醫(yī)學倫理委員會批準和家屬知情同意的情況下實行。2統(tǒng)計分析采用SPSS21.0軟件進行統(tǒng)計分析。計量資料用均數(shù)±標準差(x_±s)表示,比較采用t檢驗;計數(shù)資料用率(%)表示,比較采用χ2檢驗,P0.05為差異有統(tǒng)計學意義。結(jié)果1三組早產(chǎn)兒恢復至出生體重時間比較A組恢復至出生體重時間為(6.18±2.97)天,B組恢復至出生體重時間為(4.99±2.45)天,C組恢復至出生體重時間為(6.13±2.91)天,B組恢復至出生體重時間最短,差異有統(tǒng)計學意義(P0.05),而A組與C組恢復至出生體重時間差異無統(tǒng)計學意義(P0.05)。2三組早產(chǎn)兒喂養(yǎng)不耐受的比較A組出現(xiàn)喂養(yǎng)不耐受的有31例(31%),B組出現(xiàn)喂養(yǎng)不耐受的有18例(18%),C組出現(xiàn)喂養(yǎng)不耐受的有12例(15%),B組、C組的喂養(yǎng)耐受性均較A組好,差異有統(tǒng)計學意義,(P0.05),但B、C兩組之間喂養(yǎng)耐受性差異無統(tǒng)計學意義(P0.05)。3三組早產(chǎn)兒NEC的比較A組有3例NEC的發(fā)生,B組有2例有NEC的發(fā)生,C組無NEC的發(fā)生,三組之間NEC的發(fā)生率比較無統(tǒng)計學意義(P0.05)。結(jié)論1.早產(chǎn)兒液體配方奶比早產(chǎn)兒普通粉奶、深度水解蛋白配方奶更易出現(xiàn)喂養(yǎng)不耐受;2.早產(chǎn)兒普通粉奶在恢復出生體重時間上優(yōu)于早產(chǎn)兒液體配方奶、深度水解蛋白配方奶;3.早產(chǎn)兒NEC的發(fā)生與奶粉種類無關(guān)。
[Abstract]:In recent years, with the research background of reproductive medicine and neonatal disease treatment level, the birth rate and the survival rate of premature infants increased gradually. Because each organ development is not mature, low resistance, prone to respiratory distress syndrome, infection, hyperbilirubinemia and other complications. After feeding on premature infant survival, growth and development have a significant impact and the prognosis of premature infants. Because of gastrointestinal immaturity, pepsin and enterokinase activity is low, poor ability on the hydrolysis of protein, clinical start enteral feeding, prone to feeding intolerance, characterized by vomiting, abdominal distension, hematochezia, gastric retention, cases of gastroesophageal reflux, serious or even newborn necrotizing enterocolitis (neonatal necrotizing enterocolitis, NEC.NEC) in addition to the above symptoms, can also occur intestinal perforation, intestinal necrosis, Hugh Grams of life-threatening situation. Premature infant feeding intolerance or NEC, can affect the body weight growth caused by extrauterine growth retardation, the decline in the quality of survival, the survival rate decreased. Reasonable feeding can reduce the incidence of feeding intolerance in preterm infants, promote the body weight growth, improve the neurodevelopmental outcome of preterm infants. Enteral feeding contents of breast milk, formula milk. The milk nutrition is very rich, containing a variety of nutrients, immune factors, hormones and other biological components, is the best food for babies, as premature choice. But in some cases due to various reasons, premature infants may not achieve breastfeeding, need to choose a a formula for feeding. The more available clinical choice formula types, including liquid milk, infant formula milk ordinary, hydrolyzed protein formula milk depth, but what Milk powder can reduce the incidence of feeding intolerance, more suitable for feeding, now inconclusive. Objective to compare the premature infant formula milk powder liquid, infant milk, depth of hydrolyzed protein formula of three different milk feeding on premature birth weight recovery time and feeding intolerance, neonatal necrotizing enterocolitis (NEC) effect that provides the basis for the choice of enteral nutrition in premature infants. Subjects and methods 1 subjects and groups from November 2015 -2016 year in July in our hospital, 37 weeks of gestational age, has not yet begun any form of enteral feeding in neonatal infants 280 cases as the research object before admission, exclusion of congenital digestive tract malformation, congenital genetic metabolism disease, congenital heart disease were randomly divided into three groups: infant formula milk group liquid (group A 100 cases); premature infant milk powder group (group B, 100 cases); deep hydrolysis of egg White formula milk group (group C, 80 cases). The record of premature sex, gestational age, birth date, birth weight, without asphyxia and umbilical vein catheter etc., the incidence of three groups of preterm infants recovering to birth weight and the time of feeding intolerance in NEC were observed. The study carried out in medical consent the hospital ethics committee approval and informed consent cases were analyzed by SPSS21.0 statistical analysis software.2. The mean and standard deviation for the measurement data (x_ + s) said, compared with the t test; count data rate (%), compared with the 2 test P0.05, the difference was statistically significant. Results 1 three groups of premature recovery time to birth weight A group returned to the time of birth weight for (6.18 + 2.97) days, B group returned to the time of birth weight for (4.99 + 2.45) days, C group returned to the time of birth weight for (6.13 + 2.91) days, B group return to birth weight 闂存渶鐭，

本文編號：1585976