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目的观察谷氨酰胺及低乳糖配方乳对早产儿坏死性小肠结肠炎(NEC)的预防效果。方法选取新生儿科病房收治的早产极低出生体质量儿90例按不同营养方式分为3组。A组:予常规静脉营养及母乳或配方乳喂养;B组:静脉营养及喂养方法与A组相同,另外胃肠喂养开始即添加谷氨酰胺口服(0.25 g.kg-1,2次.d-1);C组:静脉营养方法与A组相同,胃肠喂养采用低乳糖配方乳,另外添加谷氨酰胺口服(0.25 g.kg-1,2次.d-1)。3组患儿均于出生24 h内、出生5 d、10 d后取静脉血测定其胱抑素C(CysC)和超敏C反应蛋白(hsCRP),出生10 d取2 g左右患儿大便定性测定乳糖水平,并在出生30 d内分别计算各组患儿NEC的发生率。结果经过不同营养方法处理后,3组患儿hsCRP均逐渐升高,但喂养5 d及10 d后C组升高不明显,与A、B组比较差异有统计学意义;各组CysC逐渐升高,A组升高明显,C组升高不明显,在出生10 d时最低,与A、B组比较差异有统计学意义。3组患儿大便乳糖分析显示A组阳性率较高,C组最低。患儿NEC发生率A组为6.7%,B、C组发生率相同为3.3%,A组与B、C组比较差异有统计学意义。结论早产儿喂养谷氨酰胺联合低乳糖配方乳可以减轻炎性反应,增加乳糖吸收,降低NEC的发生,对NEC的发生起到一定预防作用。
Objective To observe the preventive effect of glutamine and low lactose formula on neonatal necrotizing enterocolitis (NEC). Methods Ninety cases of preterm low birth weight children admitted to neonatal ward were divided into three groups according to different nutritional methods. Group A: given conventional intravenous nutrition and breast milk or formula feeding; Group B: intravenous nutrition and feeding methods with the same group A, another gastrointestinal feeding began to add glutamine oral (0.25 g.kg-1, 2 times .d -1); Group C: intravenous nutrition method was the same as that of Group A, low lactose formula was used for gastrointestinal feeding, and glutamine orally (0.25 g.kg-1, 2 times .d-1) was also added. All the three groups were born within 24 hours of birth and were born for 5 days. Venous blood was taken for determination of cystatin C (CysC) and hsCRP 10 days after birth, and stool samples of 2 g The lactose level was qualitatively determined and the incidence of NEC in each group was calculated within 30 days of birth. Results After treatment by different nutrition methods, the hsCRP in all three groups increased gradually, but there was no obvious increase in group C at 5 d and 10 d after feeding, which was significantly different from that in group A and B High, A group increased significantly, C group increased not obvious, the lowest in 10 d after birth, and A, B group, the difference was statistically significant. Lactose analysis of stool in the three groups showed a higher positive rate in group A and the lowest in group C. The incidence of NEC in children was 6.7% in group A and 3.3% in groups B and C, respectively. The difference between group A and group B and C was statistically significant. Conclusion Prenatal feeding of glutamine combined with low lactose formula milk can reduce the inflammatory response, increase lactose absorption, reduce the occurrence of NEC and play a preventive role in the occurrence of NEC.