早产儿喂养不耐受临床特征及相关影响因素的研究

范敏; 陈信; 张阵; 贾文婷

doi:10.16766/j.cnki.issn.1674-4152.002370

早产儿喂养不耐受临床特征及相关影响因素的研究

doi: 10.16766/j.cnki.issn.1674-4152.002370

范敏^{1, 2},
陈信^1, ,,
张阵¹,
贾文婷²

1.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004
2.
蚌埠医学院第二附属医院儿科，安徽蚌埠 233000

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0378

详细信息

通讯作者:
陈信，E-mail：44783939@qq.com

中图分类号: R722.6
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出版历程
- 收稿日期: 2021-11-08
- 网络出版日期: 2022-08-13

Clinical characteristics and risk factors of feeding intolerance in preterm infants

FAN Min^{1, 2},
CHEN Xin^{1
, ,},
ZHANG Zhen¹,
JIA Wen-ting²

1.
Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析早产儿喂养不耐受(FI)的临床特点及相关影响因素。方法将2020年11月—2021年11月蚌埠医学院第一、第二附属医院住院的589例早产儿作为研究对象，分为喂养耐受组(FT组)与喂养不耐受组(FI组)，再将FI组按胎龄分为＜32周组(110例)和≥32周组(75例)；按出生体重分为＜1 500 g组(111例)和≥1 500 g组(74例)。详细记录FI组患儿一般资料(性别、胎龄、出生体重、有无窒息及用药情况)，喂养不耐受情况(出现时间、持续时间、消失时间)，总结FI的临床特点，分析FI的危险因素。结果 (1) FT组404例(68.59%)，FI组185例(31.41%)。(2)FI主要症状为腹胀、胃潴留、呕吐。(3)胎龄＜32周组FI出现时间较≥32周组更晚(P < 0.001)，持续时间更长(P < 0.001)，消失时间更晚(P=0.002)，差异有统计学意义，但主要症状差异无统计学意义(均P＞0.05)；出生体重＜1 500 g组FI临床表现较出生体重≥1 500 g组出现更晚(P=0.002)、持续时间更长(P=0.005)、消失时间亦更晚(P < 0.001)，但出生体重≥1 500 g组早产儿其呕吐发生率明显高于出生体重＜1 500 g组(P=0.034)，差异均有统计学意义。(4)胎龄大、出生体重高为FI的保护因素，而宫内感染、新生儿呼吸窘迫综合征等均为FI的独立危险因素(均P＜0.05)。结论胎龄越小、出生体重越轻的早产儿FI出现时间和消失时间越晚，持续时间也越长，出生低体重、宫内感染等为FI的独立危险因素。
- 早产儿 /
- 喂养不耐受 /
- 腹胀 /
- 胃潴留 /
- 危险因素
Abstract: Objective To analyse the clinical characteristics and related factors of feeding intolerance (FI) in preterm infants. Methods A total of 589 preterm infants hospitalised in the first and second affiliated hospitals of Bengbu Medical College from November 2020 to November 2021 were divided into the feeding tolerance (FT) group and FI group. They were divided into < 32 weeks group and ≥32 weeks group according to gestational age. They were divided into groups of < 1 500 g and ≥1 500 g according to birth weight. General information (gender, gestational age, birth weight, asphyxia and medication) and FI (occurrence time, duration and disappearance time) were recorded in detail in the FI group, clinical characteristics of FI were summarised, and risk factors of FI were analysed. Results (1) FT accounted for 68.59%, and FI accounted for 31.41%. (2) The main symptoms of FI were abdominal distention, gastric retention and vomiting. (3) The appearance of FI in the group with gestational age < 32 weeks appeared later (P < 0.001), lasted longer (P < 0.001), and disappeared later (P=0.002) than the group with gestational age ≥32 weeks. The difference was statistically significant (P < 0.05), but the difference of main symptoms was not statistically significant (P>0.05). Compared with the ≥1500g group, FI clinical manifestations appeared later (P=0.002), lasted longer (P=0.004) and disappeared later (P < 0.001) in < 1 500 g group. However, the vomiting of premature infants in the ≥1 500 g group was significantly higher than that in the < 1 500 g group (P=0.034). All had statistical significance (P < 0.05). (4) Gestational age and birth weight were protective factors of FI, whereas intrauterine infection and neonatal respiratory distress syndrome were independent risk factors of FI (all P < 0.05). Conclusion The younger the gestational age and the lighter the birth weight, the later the occurrence and disappearance time and the longer the duration of FI. Low birth weight and intrauterine infection are independent risk factors of FI.
- Premature infants /
- Feeding intolerance /
- Abdominal distention /
- Gastric retention /
- Risk factors

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表 1 不同胎龄早产儿FI临床特征比较

Table 1. Comparison of clinical characteristics of FI in preterm infants with different gestational ages

组别	例数	腹胀 [例(%)]	呕吐 [例(%)]	胃潴留 [例(%)]	FI诊断日龄 (x±s，d)	FI持续时间 (x±s，d)	FI消失日龄 (x±s，d)	恢复出生体重时间(x±s，d)
胎龄＜32周	110	78(70.9)	21(19.1)	98(89.1)	3.1±0.5	7.8±1.4	10.5±2.4	9.4±3.8
胎龄≥32周	75	55(73.3)	15(20.0)	69(92.0)	2.6±0.8	6.5±2.1	9.1±3.8	7.9±3.1
统计量		0.129^a	0.023^a	0.429^a	5.229^b	5.053^b	3.070^b	2.834^b
P值		0.718	0.878	0.512	< 0.001	< 0.001	0.002	0.005
注：^a为χ²值，^b为t值。

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表 2 不同出生体重早产儿FI临床特征比较

Table 2. Comparison of clinical characteristics of FI in preterm infants with different birth weight

组别	例数	腹胀 [例(%)]	呕吐 [例(%)]	胃潴留 [例(%)]	FI诊断日龄 (x±s，d)	FI持续时间 (x±s，d)	FI消失日龄 (x±s，d)	恢复出生体重时间(x±s，d)
出生体重＜1 500 g	111	76(68.5)	16(14.4)	97(87.3)	3.3±0.5	6.9±2.2	10.8±2.4	9.2±3.1
出生体重≥1 500 g	74	57(77.0)	20(27.0)	70(94.5)	3.0±0.8	6.1±1.2	9.2±3.1	8.1±2.7
统计量		1.609^a	4.507^a	2.626^a	3.138^b	2.856^b	3.947^b	2.487^b
P值		0.205	0.034	0.105	0.002	0.005	＜0.001	0.014
注：^a为χ²值，^b为t值。

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表 3 早产儿FI相关影响因素的单因素分析

Table 3. Univariate analysis of FI related factors in preterm infants

组别	例数	男婴[例(%)]	小于胎龄儿[例(%)]	胎龄(x±s，周)	出生体重(x±s，g)	胎膜早破[例(%)]	胎儿窘迫[例(%)]	产前使用糖皮质激素[例(%)]	生后使用抗生素[例(%)]
FT组	404	200(49.5)	42(10.4)	32.5±1.7	1 520.1±304.2	199(49.3)	48(11.9)	178(44.1)	188(46.5)
FI组	185	98(53.0)	30(16.2)	31.3±1.4	1 318.2±224.4	92(49.7)	20(10.8)	101(54.6)	115(62.2)
统计量		0.611^a	4.006^a	8.385^b	8.086^b	0.011^a	0.142^a	5.649^a	12.406^a
P值		0.435	0.045	＜0.001	＜0.001	0.915	0.705	0.017	＜0.001

组别	例数	生后使用枸橼酸咖啡因[例(%)]	母亲合并妊娠期高血压[例(%)]	母亲合并妊娠期糖尿病[例(%)]	新生儿呼吸窘迫综合征[例(%)]	出生窒息[例(%)]	宫内感染[例(%)]	出生后使用辅助通气[例(%)]	早产儿配方乳开奶[例(%)]
FT组	404	158(39.1)	85(21.0)	41(10.1)	44(10.9)	48(11.9)	48(11.9)	48(11.9)	34(8.4)
FI组	185	97(52.4)	54(29.2)	32(17.3)	31(16.8)	35(18.9)	34(18.4)	35(18.9)	26(14.1)
统计量		9.175^a	4.674^a	5.972^a	3.929^a	5.191^a	4.469^a	5.191^a	4.409^a
P值		0.002	0.030	0.014	0.048	0.022	0.034	0.022	0.035
注：^a为χ²值，^b为t值。

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表 4 早产儿FI相关影响因素的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of FI related factors in preterm infants

项目	B	SE	Wald χ²	P值	OR值	95% CI
胎龄	-0.003	0.001	9.000	0.002	0.997	0.995~0.999
出生体重	-0.005	0.002	6.250	0.012	0.995	0.991~0.999
NRDS	0.847	0.387	4.790	0.028	2.332	1.093~4.980
出生窒息	1.254	0.447	7.870	0.005	3.504	1.459~8.416
宫内感染	0.917	0.319	8.263	0.004	2.502	1.339~4.675
枸橼酸咖啡因	1.484	0.688	4.653	0.031	4.411	1.451~16.988
辅助呼吸	1.448	0.594	5.942	0.015	4.255	1.328~13.630

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参考文献(20)

[1]	YUAN Z, YAN J, WEN H, et al. Feeding intolerance alters the gut microbiota of preterm infants[J]. PLoS One, 2019, 14(1): e0210609. doi: 10.1371/journal.pone.0210609
[2]	李顺辉, 严顺添, 颜惠宇. 早产儿喂养不耐受的危险因素和预防策略的研究[J]. 哈尔滨医药, 2021, 41(2): 143-144. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYY202102074.htm LI S H, YAN S T, YAN H Y. Study on risk factors and prevention strategies of feeding intolerance in preterm infants[J]. Harbin Medical Journal, 2021, 41(2): 143-144. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYY202102074.htm
[3]	田俊华, 成影, 张慧敏. 口腔运动干预对吸吮吞咽功能障碍早产儿喂养表现的影响[J]. 黑龙江医药, 2019, 32(2): 470-472. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY201902110.htm TAIN J H, CHENG Y, ZHANG H M. Effect of oral motor intervention on feeding performance of preterm infants with sucking swallowing dysfunction[J]. Heilongjiang Medicine Journal, 2019, 32(2): 470-472. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYY201902110.htm
[4]	何洋, 李文星, 唐军, 等. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2020, 22(10): 1047-1055. doi: 10.7499/j.issn.1008-8830.2008132 HE Y, LI W X, TANG J, et al. Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants (2020)[J]. Chinese Journal of Contemporary Pediatrics, 2020, 22(10): 1047-1055. doi: 10.7499/j.issn.1008-8830.2008132
[5]	刘巧红, 谢映梅, 翟逢娣, 等. 早产儿喂养不耐受的原因分析与护理对策[J]. 护理实践与研究, 2019, 16(2): 21-24. doi: 10.3969/j.issn.1672-9676.2019.02.007 LIU Q H, XIE Y M, ZHAI F D, et al. Analysis of causes of feeding intolerance in premature infants and nursing strategies[J]. Nursing Practice and Research, 2019, 16(2): 21-24. doi: 10.3969/j.issn.1672-9676.2019.02.007
[6]	黄希, 陈琼, 彭文涛. 早产儿喂养不耐受的临床特征及其危险因素[J]. 中南大学学报(医学版), 2018, 43(7): 797-804. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201807019.htm HUANG X, CHEN Q, PENG W T. Clinical characteristics and risk factors for feeding intolerance in preterm infants[J]. Journal of Central South University (Medical Science), 2018, 43(7): 797-804. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201807019.htm
[7]	胡晓艳, 常艳美, 李在玲. 早产儿喂养不耐受的临床特征及危险因素[J]. 中华围产医学杂志, 2020, 23(3): 182-183, 187. doi: 10.3760/cma.j.cn113903-20190831-00527 HU X Y, CHANG Y M, LI Z L. Clinical features and risk factors of feeding intolerance in premature infants[J]. Chinese Journal of Perinatal Medicine, 2020, 23(3): 182-183, 187. doi: 10.3760/cma.j.cn113903-20190831-00527
[8]	SWEET D G, CARNIELLI V, GREISEN G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2019 update[J]. Neonatology, 2019, 115(4): 432-450. doi: 10.1159/000499361
[9]	聂莉莉, 邓春贵, 何建龙, 等. 重力管饲喂养联合口腔运动对早产儿喂养不耐受的影响[J]. 中华全科医学, 2017, 15(11): 1922-1924, 1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.030 NIE L L, DENG C G, HE J L, et al. The effect of combined treatment with gravitational tube feeding and oral motor in treatment of feeding intolerance in preterm[J]. Chinese Journal of General Practice, 2017, 15(11): 1922-1924, 1974. doi: 10.16766/j.cnki.issn.1674-4152.2017.11.030
[10]	KIM H Y, BANG K S. The effects of enteral feeding improvement massage on premature infants: A randomised controlled trial[J]. J Clin Nurs, 2018, 27(1): 92-101.
[11]	FORD S L, LOHMANN P, PREIDIS G A, et al. Improved feeding tolerance and growth are growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mothers own milk compared with donor breast milk[J]. Am J Clin Nutr, 2019, 109(4): 1088-1097.
[12]	高燕, 张瑛, 颜新艳. 早产儿喂养不耐受的改善策略研究进展[J]. 新乡医学院学报, 2019, 36(3): 295-298. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201903023.htm GAO Y, ZHANG Y, YAN X Y. Research progress on strategies for improving feeding intolerance in preterm infants[J]. Journal of Xinxiang Medical University, 2019, 36(3): 295-298. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYX201903023.htm
[13]	ASSAD M, ELLIOTT M J, ABRAHAM J H. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet[J]. J Perinatol, 2016, 36(3): 216-220. doi: 10.1038/jp.2015.168
[14]	马丙南, 林菁, 朱炜春, 等. 人类免疫缺陷病毒母婴阻断新生儿喂养不耐受的临床特点分析[J]. 安徽医药, 2019, 23(3): 502-504. doi: 10.3969/j.issn.1009-6469.2019.03.020 MA B N, LIN J, ZHU W C, et al. Clinical features of feeding intolerance in infants who were implemented prevention of mother-to-child transmission of HIV[J]. Anhui Medical and Pharmaceutical Journal, 2019, 23(3): 502-504. doi: 10.3969/j.issn.1009-6469.2019.03.020
[15]	SUBRAMANIAM P, HO J J, DAVIS P G. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants[J]. Cochrane Database Syst Rev, 2016(6): CD001243.
[16]	高晓燕, 冯琳, 邱玉芬, 等. 加温湿化高流量鼻导管通气在胎粪吸入综合征并肺动脉高压机械通气撤机中的应用研究[J]. 中国当代儿科杂志, 2017, 19(4): 393-397. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201704007.htm GAO X Y, FENG L, QIU Y F, et al. Application of humidified high-flow nasal cannula in neonates with meconium aspiration syndrome and pulmonary hypertension after extubation[J]. Chinese Journal of Contemporary Pediatrics, 2017, 19(4): 393-397. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201704007.htm
[17]	赵立明, 高健东, 王海君, 等. 益生菌联合抚触对喂养不耐受早产儿的治疗效果和血清胆红素及生长发育的影响[J]. 河北医药, 2018, 40(3): 347-351. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ201803006.htm ZHAO L M, GAO J D, WANG H J, et al. Effects of probiotics combined with touching on curative effects, serum bilirubin, growth and development of premature infants with feeding intolerance[J]. Hebei Medical Journal, 2018, 40(3): 347-351. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ201803006.htm
[18]	ABDEL W M A, ISSA H M, KHAFAGY S M, et al. Effect of caffeine on superior mesenteric artery blood flow velocities in preterm neonates[J]. J Matern Fetal Neonatal Med, 2019, 32(3): 357-361.
[19]	彭东风, 仇宁, 范莉莉. 非营养性吸吮联合口腔按摩刺激对早产儿经口喂养效果的系统评价[J]. 安徽医学, 2018, 39(11): 1363-1366. doi: 10.3969/j.issn.1000-0399.2018.11.018 PENG D F, QIU N, FAN L L. A systematic review of the effect of non-nutritive sucking combined with oral massage stimulation on oral feeding in premature infants[J]. Anhui Medical Journal, 2018, 39(11): 1363-1366. doi: 10.3969/j.issn.1000-0399.2018.11.018
[20]	武梦骅, 赵艳男, 郑峥. 不同胎龄早产儿喂养不耐受影响因素分析[J]. 中南医学科学杂志, 2017, 45(2): 160-164. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYY201702013.htm WU M Y, ZHAO Y N, ZHENG Z. Factors affecting feeding intolerance in preterm infants of different gestational ages[J]. Medical Science Journal of Central South China, 2017, 45(2): 160-164. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYY201702013.htm