摘要
目的：应用近红外光谱法（NIRS）观察极低出生体质量儿（VLBWI）早期喂养不耐受（生后14 d内）时肠道血氧饱和度的变化。方法选取符合纳入标准的 VLBWI 为研究对象。喂养不耐受（FI）定义为胃残留量增多：餐前胃储留量超过上次喂养量的50％、腹胀或呕吐或两者同时存在、其他原因导致的喂养计划中断。应用 NIRS 测定生后第1～14天肠道和脑组织血氧饱和度，分析监测期间出现喂养不耐受患儿肠道局部组织血氧饱和度的变化，并与喂养耐受的新生儿进行比较。结果总共93例 VLBWI 纳入研究。在生后14 d 的观察中，其中41例（44．09％）患儿表现为喂养耐受（FT）。52例（55.91％）出现不同程度的 FI，其中29例（31．19％）表现为以胃残留量增多为主，23例（24．73％）表现为以呕吐伴或不伴腹胀为主。喂养耐受组、胃潴留组、呕吐腹胀组生后24 h 内 SsO2和 SsO2／ScO2水平差异无统计学意义（P ＞0．05）。喂养耐受组生后14 d 内 SsO2变化率和 SsO2／ScO2的中位数无明显变化（P ＞0．05）。无论是胃残留组还是呕吐腹胀组均于症状出现前1 d 和出现症状当天出现明显的 SsO2变化（与前2 d 相比，P ＜0．01），症状出现前1 d 两组 SsO2下降率差异无统计学意义[（16．2±5．1）％比（17．4±3．6）％，t ＝0．733，P ＝0．476]。结论对 VLBWI 进行床旁连续 NIRS 监测腹部血氧饱和度变化，对于及时调整喂养计划具有重要意义。
Objective To observe the changes of abdominal oxygen saturation in very low birth weight infants （VLBWI）with feeding intolerance （FI）within 1 4 days after birth monitored by near infrared spectroscopy （NIRS）.Methods VLBWI fitting entry criteria were enrolled into this study.NIRS monitoring was carried out to detect cerebral oxygen saturation （ScO2 ）and abdominal oxygen saturation （SsO2 ）.Data were analyzed between FI infants and feeding tolerance （FT）infants.FI was defined as follows：gastric residual of more than 50% of the previous feeding volume;emesis or abdominal distention or both;decrease,delay or discontinuation of enteral feedings. Results 93 VLBWI were enrolled.52 cases（55.91 %）presented with FI,including 29 cases（31 .1 9%）of gastric residual increasing and 23 cases（24.73%）of emesis with or without abdominal distention within 1 4 days after birth. The levels of SsO2 and SsO2 /ScO2 showed no differences in infants with FT and with FI within 24h after birth （P 〉0.05）.The change rates of the median of SsO2 and SsO2 /ScO2 in FT infants were similar during 1 4 days （P 〉0.05）.While both the change rates of SsO2 and SsO2 /ScO2 were markedly decreased 1 day before and the day of FI （P 〈0.01 ）.The decreasing degree of SsO2 was similar between infants with gastric residual increasing and infants with emesis with or without abdominal distention[（1 6.2 ±5.1 ）vs （1 7.4 ±3.6）%,t =0.733,P =0.476]. Conclusion Abdominal oxygen saturation measured by NIRS may be a useful method for infants adjusting the feeding plan.
作者
李旭芳
关瑞莲
程婷婷
刘美仪
叶建红
孙黎
于欣
张炼
Li Xufang Guan Ruilian Cheng Tingting Liu Meiyi Ye Jianhong Sun Li Yu Xin Zhang Lian(Department of Neonatology , Guangzhou Women and Children＇s Medical Center, Guangzhou, Guangdong 510000, China)
出处
《中国基层医药》
CAS
2017年第1期76-79,J0002,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
广东省广州市医药卫生科技项目（20151 A011027）
关键词
近红外光谱法
极低出生体重儿
喂养不耐受
血氧饱和度
Near infrared spectroscopy
Very low birth weight infants
Feeding intolerance
Oxygen saturation
作者简介
通信作者：张炼，Email：zhliande@qq．com
