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目的:分析低出生体重儿胃肠喂养不耐受的临床特点及危险因素,探讨减少低出生体重儿喂养不耐受发生率的临床防治办法。方法:收集2010年1月-2010年10月在绵阳市中心医院住院的222例低出生体重儿基本信息,根据喂养不耐受诊断标准分为喂养耐受组和喂养不耐受组,采用χ2检验及Logistic回归分析对数据进行分析。结果:喂养不耐受发生率为31.08%,其中临床表现以腹胀和胃内咖啡样物质最为突出,发生率分别为11.26%(25/222)和9.46%(21/222)。单因素分析结果显示喂养不耐受组和喂养耐受组低出生体重儿的出生体重、胎龄、开奶时间及窒息、肺炎、败血症、新生儿缺氧缺血性脑病(HIE)、呼吸暂停发生率比较差异有统计学意义(P<0.05);多因素分析结果显示胎龄和HIE与胃肠不耐受有相关性。讨论:小胎龄和发育不成熟是喂养不耐受的根本原因,胃肠动力受中枢和肠道神经系统双重控制,HIE可直接或间接抑制胃肠中胃泌素和胃动素的分泌,影响胃肠功能。总结:积极治疗原发病,及时纠正患儿缺氧状态,预防HIE发生,同时给予早期干预如非营养性吸吮、腹部抚触及适当药物治疗可以最大程度减少喂养不耐受的发生。
Objective: To analyze the clinical features and risk factors of gastrointestinal feeding intolerance in low birth weight infants, and to explore the clinical approaches to reduce the incidence of feeding intolerance in low birth weight infants. Methods: The basic information of 222 low birth weight infants hospitalized in Mianyang Central Hospital from January 2010 to October 2010 were collected. According to the diagnostic criteria of feeding intolerance, the patients were divided into feeding tolerant group and feeding intolerance group, using χ2 Tests and Logistic Regression Analysis Data were analyzed. Results: The incidence of feeding intolerance was 31.08%. The clinical manifestations were abdominal distension and coffee-like substance in the stomach. The incidence rate was 11.26% (25/222) and 9.46% (21/222) respectively. Univariate analysis showed that birth weight, gestational age, opening time, asphyxia, pneumonia, septicemia, neonatal hypoxic-ischemic encephalopathy (HIE), apnea (P <0.05). The results of multivariate analysis showed that gestational age and HIE were correlated with gastrointestinal intolerance. Discussion: Small gestational age and immaturity are the root causes of feeding intolerance, gastrointestinal motility by the central and intestinal nervous system dual control, HIE can directly or indirectly inhibit the gastrointestinal gastrin and motilin secretion, Affect gastrointestinal function. Summary: Active treatment of primary disease, timely correction of hypoxia in children with HIE prevention, while giving early intervention such as non-nutritive sucking, abdominal touching and appropriate medication can minimize the incidence of feeding intolerance.