本文選題：益生菌 + 極低出生體重早產(chǎn)兒�。� 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的探討口服益生菌對極低出生體重早產(chǎn)兒胃腸功能的影響，主要包括對新生兒壞死性小腸結(jié)腸炎、喂養(yǎng)不耐受以及胃腸外營養(yǎng)相關(guān)性膽汁淤積的影響，并評估其安全性。 方法對2010年1月-2011年11月，我中心收治的100例VLBW早產(chǎn)兒的臨床資料進行回顧性分析。益生菌組45例，其中男27例（60.0%），女18例（40.0%），胎齡30.1±1.7周，產(chǎn)重1260.13±194.82g；對照組55例，其中男25例（45.5%），女30例（54.5%），胎齡31.2±2.2周，產(chǎn)重1278.55±146.88g。評估兩組圍產(chǎn)期及臨床資料可比性，比較新生兒壞死性小腸結(jié)腸炎的發(fā)病率、嚴重程度、死亡率，，敗血癥發(fā)病率，喂養(yǎng)不耐受發(fā)生率、恢復(fù)出生體重時間、體重增長速度及胃腸外營養(yǎng)相關(guān)性膽汁淤積（PNAC）發(fā)生率；記錄益生菌不良作用。 結(jié)果益生菌組胎齡明顯低于對照組（30.1±1.7周vs31.2±2.2周；t=-2.804，P=0.006），有合并癥早產(chǎn)兒（呼吸暫停、呼吸衰竭、新生兒呼吸窘迫綜合征）例數(shù)明顯高于對照組（28/45vs22/55；χ~2=4.889，P=0.027），住院天數(shù)、靜脈營養(yǎng)天數(shù)、PICC及鼻飼時間均明顯長于對照組[（46.47±22.43dvs34.65±21.84d；t=2.658，P=0.009），（35.73±16.78dvs26.40±18.56d；t=2.611，P=0.010），（19.36±23.64dvs5.71±11.52d；Z=-3.291，P=0.001），（24.79±17.79dvs11.62±11.76d；Z=-3.784，P=0.000）]。兩組資料在胃腸功能相關(guān)危險因素的分布不均衡，影響試驗結(jié)果。益生菌組NEC發(fā)病率（6.7%）較對照組（21.8%）明顯下降，RR0.256（95%CI：0.067～0.972；χ~2=4.456，P=0.035）；嚴重NEC（Ⅲ級）3例均發(fā)生在對照組，但兩組比較并無統(tǒng)計學(xué)差異（0/45vs3/55；χ~2=1.003，P=0.317）。益生菌組死亡2例(NEC相關(guān)1例，非NEC相關(guān)1例)，對照組死亡5例(NEC相關(guān)3例，非NEC相關(guān)2例)，兩組比較，總死亡數(shù)（2/45vs5/55；χ~2=0.262，P=0.609）及NEC相關(guān)死亡數(shù)（1/45vs3/55；χ~2=0.912，P=0.634），差異均無統(tǒng)計學(xué)意義。兩組比較，敗血癥發(fā)病率（6/45vs6/55；χ~2=0.138，P=0.711）、喂養(yǎng)不耐受發(fā)生例數(shù)（24/45vs29/55；χ~2=0.004，P=0.952）、體重增長速度（10.82±5.93g/Kg/dvs8.98±5.13g/Kg/d；t=1.665，P=0.099）、恢復(fù)出生體重時間（7.98±6.41dvs9.11±5.88d；t=-0.919，P=0.361）和PNAC發(fā)病例數(shù)（9/44vs16/52；χ~2=1.317，P=0.251），差異均無統(tǒng)計學(xué)意義。無益生菌相關(guān)敗血癥、腦膜炎、腹瀉、皮疹等不良作用的記錄。 結(jié)論聯(lián)合應(yīng)用雙歧桿菌BB-12、鼠李糖乳桿菌LGG可顯著降低極低出生體重早產(chǎn)兒NEC發(fā)病風(fēng)險，有降低NEC疾病嚴重性及死亡率趨勢，對敗血癥、胃腸外營養(yǎng)相關(guān)性膽汁淤積有一定作用，但不能顯著降低極低出生體重早產(chǎn)兒喂養(yǎng)不耐受，也不能縮短恢復(fù)出生體重時間，加快體重增長速度。本試驗系回顧性研究，兩組圍產(chǎn)期及臨床資料不具可比性，影響了益生菌對極低出生體重早產(chǎn)兒胃腸功能作用的評估，因此，需進一步開展前瞻性隨機對照試驗研究其對胃腸功能的影響。本試驗無益生菌相關(guān)敗血癥、腦膜炎記錄，無腹瀉、皮疹等不良反應(yīng)。因此，聯(lián)合應(yīng)用雙歧桿菌BB-12、鼠李糖乳桿菌LGG于極低出生體重早產(chǎn)兒是相對安全的。
[Abstract]:Objective to investigate the effects of oral probiotics on gastrointestinal function of very low birth weight preterm infants, including neonatal necrotizing enterocolitis, feeding intolerance and parenteral nutrition associated cholestasis, and to evaluate its safety. Methods the clinical data of 100 premature infants with VLBW admitted in our center from January 2010 to November 2011 were analyzed retrospectively. The probiotics group (n = 45) included 27 males (n = 27) and 18 females (n = 18). The gestational age was 30.1 鹵1.7 weeks, and the birth weight was 1260.13 鹵194.82 g, while in the control group, there were 55 cases, including 25 males, 45.5g, 30 females, 31.2 鹵2.2 weeks gestational age, and 1278.55 鹵146.88 g gestational weight. To evaluate the comparability of perinatal and clinical data between the two groups, and to compare the incidence, severity, mortality, septicemia, feeding intolerance and time of recovery of birth weight of neonatal necrotizing enterocolitis. The rate of weight gain and the incidence of parenteral nutrition associated cholestasis (PNAC) were recorded and the adverse effects of probiotics were recorded. Results the gestational age of probiotics group was significantly lower than that of control group (30.1 鹵1.7 weeks vs31.2 鹵2.2weeks vs31.2 鹵2.804). The number of premature infants with complications (apnea, respiratory failure, neonatal respiratory distress syndrome) was significantly higher than that of control group (28 / 45 vs 2255 / 55; 蠂 ~ (2) = 24.889P0.02727). The days of intravenous nutrition and the nasal feeding time were significantly longer than those in the control group (46.47 鹵21.84 d) and 2.658 d (2.658d), 35.73 鹵18.56 16.78dvs26.40 鹵18.56 d ~ (2.611D) ~ 0.010 ~ (10) 23.64dvs5.71 ~ (19.36 鹵11.52) 23.64dvs5.71 ~ (-3.291) P ~ (0.001) ~ (?) ~ (24.79 鹵17.79dvs11.62 鹵11.76? d ~ (-3.784D) P ~ (0. 000). The distribution of risk factors related to gastrointestinal function in the two groups was uneven, which affected the results of the experiment. The incidence of NEC in probiotics group was significantly lower than that in control group (RR0.25695% CI: 0.067% 0.972; 蠂 2 + 4.456% PU 0.035%; severe NECs occurred in the control group, but there was no statistical difference between the two groups in 0 / 45 vs 355; 蠂 2 = 1.003). In probiotics group, there were 2 cases of NEC-associated death, 1 case of non-NEC-related death, 5 cases of non-NEC-related death in control group, and 2 cases of non-NEC-related death. The total mortality of the two groups was 2.45 vs 5 / 55; 蠂 ~ (2 +) 0.262 P ~ (2 +) 0.609) and NEC related death number was 1 / 45 vs 355; 蠂 ~ (2 +) = 0.912 ~ P ~ (0.634); there was no significant difference between the two groups. 涓ょ粍姣旇緝,璐ヨ鐥囧彂鐥呯巼(6/45vs6/55;蠂~2=0.138,P=0.711),鍠傚吇涓嶈

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