早期微量喂养对我国低出生体重儿的效果评价——meta分析
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摘要
目的:为评价早期微量喂养对我国低出生体重儿的相关影响。方法:主题词交叉联合检索中国生物医学文献、中国学术期刊全文、万方、维普数据库。获得建库以来至2014年相关文献,检索MEDLINE以发现国内研究者在非中文期刊上发表的非重复报告。结果:共纳入24个临床试验,1早期微量喂养组达全胃肠时间短于对照组(WMD=-5.73;95%CI:-6.68~-4.78;P<0.01);2早期微量喂养组每日体重增长高于对照组(WMD=3.64;95%CI:1.85~5.44;P<0.001);3早期微量喂养组恢复至出生体重时间短于对照组(WMD=-2.59;95%CI:-3.35~-1.83;P<0.001);4早期微量喂养组新生儿坏死小肠结肠炎(NEC)发生率与对照组无明显差异(OR=0.70;95%CI:0.35~1.41;P=0.32);5早期微量喂养组喂养不耐受发生率明显低于对照组(OR=0.38;95%CI:0.24~0.60;P<0.001);6早期微量喂养组低血糖发生率低于对照组(OR=0.19;95%CI:0.10,0.35;P<0.001)。结论:早期微量喂养患儿在达足量肠内营养时间、恢复至出生体重时间、体重增长等方面优于静脉营养组;同时可减少低血糖、NEC、喂养不耐受等并发症的发生。
Objective:To evaluate the effect of early minimal feeding on low birth weight infants of China. Methods:We searched CBM,CAJ,Wanfang and CQVIP databases using keywords since databses established. Also we searched MEDLINE for Chinese papers. Results:Tweenty-four researches were included.(1)Time of parenteral nutrition in early minimal feeding group is shorter than control group WMD=-5.73;95% CI =[-6.68,-4.78];P < 0.00001;(2)Weight gain per day in early minimal feeding group is more than control group WMD= 3.64;95%CI=[1.85,5.44];P < 0.0001;(3)Time of returning to birth weight in early minimal feeding group is shorter control group WMD =-2.59;95% CI =[-3.35,-1.83];P < 0.00001;(4)Incidence of NEC in early minimal feeding group doesn't show statistical significance compared with control group OR = 0.70;95% CI =[0.35,1.41];P =0.32;(5)Incidence of feeding intolerance is lower than control group OR = 0.38;95% CI =[0.24,0.60];P < 0.0001;(6)Incidence of hypoglycemia is lower than control group OR = 0.19;95% CI =[0.10,0.35];P < 0.00001. Conclusion:The early minimal feeding group has an advantage over control group in time of parenteral nutrition,weight gain,time of returning to birth weight,incidence of NEC,feeding intolerance and hypoglycemia.
Objective:To evaluate the effect of early minimal feeding on low birth weight infants of China. Methods:We searched CBM,CAJ,Wanfang and CQVIP databases using keywords since databses established. Also we searched MEDLINE for Chinese papers. Results:Tweenty-four researches were included.(1)Time of parenteral nutrition in early minimal feeding group is shorter than control group WMD=-5.73;95% CI =[-6.68,-4.78];P < 0.00001;(2)Weight gain per day in early minimal feeding group is more than control group WMD= 3.64;95%CI=[1.85,5.44];P < 0.0001;(3)Time of returning to birth weight in early minimal feeding group is shorter control group WMD =-2.59;95% CI =[-3.35,-1.83];P < 0.00001;(4)Incidence of NEC in early minimal feeding group doesn't show statistical significance compared with control group OR = 0.70;95% CI =[0.35,1.41];P =0.32;(5)Incidence of feeding intolerance is lower than control group OR = 0.38;95% CI =[0.24,0.60];P < 0.0001;(6)Incidence of hypoglycemia is lower than control group OR = 0.19;95% CI =[0.10,0.35];P < 0.00001. Conclusion:The early minimal feeding group has an advantage over control group in time of parenteral nutrition,weight gain,time of returning to birth weight,incidence of NEC,feeding intolerance and hypoglycemia.
引文
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[19]陈华虹.早期营养支持对早产低出生体重儿的临床效果观察[J].广西医学,2011,33(11):1454-1456
[20]商广芝,李松,李淑芹.早期微量喂养联合非营养性吸吮对极低出生体重儿喂养耐受性的影响[J].齐鲁护理杂志,2011,17(19):12-13
[21]曾玉友韩芳黄荣辉.早期间歇持续微量喂养对早产极低出生体重儿肠道喂养不耐受及早期生长发育的影响[J].当代护士,2011,19(8):73-75
[22]李怡帆,白冬梅,朱航.早期微量喂养联合静脉营养对早产低出生体重儿的疗效分析[J].中国妇幼健康研究,2012,23(2):194-196
[23]李洁,谢晓曼,汤蔽蔽,等.早期喂养干预预防极低出生体重儿喂养不耐受临床探讨[J].蚌埠医学院学报,2012,37(10):1201-1202
[24]沓小玉,杨慧勤.早产低出生体重儿早期微量肠道营养的护理观察[J].国际医药卫生导报,2012,18(11):1659-1660
[25]曾淑娟,杨皓,雷立容,等.早产极低出生体重儿早期微量喂养的临床研究[J].岭南急诊医学杂志,2013,18(1):64-65
[26]王妍琦.早期喂养干预预防极低出生体重儿喂养不耐受临床探讨[J].吉林医学,2013,34(30):6248
[27]何蓉,严洁,肖志辉.早期微量喂养对极低出生体重早产儿营养状况和并发症的影响[J].中华临床医师杂志,2013,(7):3155-3157
[28]Gomez FE,Lan J,Kang W,et al.Parenteral nutrition and fasting reduces mucosal addressin cellular adhesion molecule-1(MAd CAM-1)m RNA in Peyer's patches of mice[J].J Parenter Enteral Nutr,2007,31(1):47-52
[29]Agarwal R,Aggarwal R,Deorari AK,et al.Minimal enteral nutrition[J].Indian J Pediatr,2001,68(12):1159-1160
[30]王丹华.早产儿的营养问题[J].实用儿科临床杂志,2003,18(4):246-248
[31]Fallon EM,Nehra D,Potemkin AK,et al.American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)Board of Directors,Puder M.A.S.P.E.N.clinical guidelines:nutrition support of neonatal patients at risk for necrotizing enterocolitis[J].J Parenter Enteral Nutr,2012,36(5):506-523
[32]Senterre T.Practice of enteral nutrition in very low birth weight and extremely low birth weight infants[J].See comment in Pub Med Common2s below World Rev Nutr Diet,2014,110:201-214
[33]De Nisi G,Berti M,De Nisi M,et al.Early enteral feeding with human milk for VLBW infants[J].J Biol Regul Homeost Agents,2012,26(3Suppl):69-73
[2]Di Renzo GC,Gadzinowski J.Prepared by the study group on perinatal nutrition,of the European Association of Perinatal Medicine[J].J Maternal-Fetal Neonatal Med,2004,16(2):73-78
[3]胡亚美,江载芳.实用新生儿科学[M].7版.北京:人民卫生出版社,2011:509-511
[4]韦秋文,王琳琳,李小容,等.早产低出生体重儿早期微量胃肠喂养的临床研究[J].广西医学,2005,27(9):1334-1337
[5]陈震,陈静,杨震英,等.极低出生体重儿早期经口微量喂养的临床研究[J].中华全科医师杂志,2006,5(12):730-733
[6]钟劲松,闫淑媛.静脉营养联合早期微量喂养及非营养性吸吮在低出生体重儿中的应用[J].中国现代医生,2008,46(7):30-31
[7]王院方.极低体重儿早期微量喂养的临床观察[J].中国误诊学杂志,2008,8(7):1599-1600
[8]亢安娜,钟小兰.早产低体重儿早期微量肠道喂养的临床观察[J].华南国防医学杂志,2009,23(2):58-59
[9]李月彦,彭君.微量喂养在早产儿中的临床应用[J].中国社区医师,2009,11(17):118-119
[10]罗晓萍,胡春梅,胡丽珍.早期微量喂养联合非营养性吸吮对极低出生体重儿喂养耐受性的影响[J].护理与康复,2009,8(8):639-640
[11]魏恩焕,杨惠,陈奋湘,等.早期微量喂养联合静脉营养对早产极低出生体重儿的临床效果观察[J].中外健康文摘,2010,7(28):18
[12]佘远凤,梁高莲,田岚.极低出生体重儿早期微量喂养联合静脉营养的疗效观察[J].右江医学,2010,38(2):173-174
[13]罗带姨,蒙乐妹.32例极低出生体重儿实施早期喂养的临床观察[J].当代医学,2010,16(9):93
[14]韩桂云,赵秀平,王晓真.极低出生体重儿早期经口微量喂养23例临床护理[J].齐鲁护理杂志,2010,16(16):35-36.
[15]李朝晖.极低出生体重儿早期胃肠母乳微量喂养的临床观察[J].中国当代医药,2010,17(36):31-32
[16]勾育松.极低出生体重儿40例实施早期微量喂养的体会[J].中国社区医师,2010,12(24):98
[17]谢剑平,肖吉平,彭新平,等.早期微量喂养在体重小于1 500 g早产儿中的应用[J].医学临床研究,2011,28(1):71-73
[18]蒋晓宏,王柏林.早期微量喂养在早产低体重儿中临床观察[J].安徽医药,2011,15(6):745-746
[19]陈华虹.早期营养支持对早产低出生体重儿的临床效果观察[J].广西医学,2011,33(11):1454-1456
[20]商广芝,李松,李淑芹.早期微量喂养联合非营养性吸吮对极低出生体重儿喂养耐受性的影响[J].齐鲁护理杂志,2011,17(19):12-13
[21]曾玉友韩芳黄荣辉.早期间歇持续微量喂养对早产极低出生体重儿肠道喂养不耐受及早期生长发育的影响[J].当代护士,2011,19(8):73-75
[22]李怡帆,白冬梅,朱航.早期微量喂养联合静脉营养对早产低出生体重儿的疗效分析[J].中国妇幼健康研究,2012,23(2):194-196
[23]李洁,谢晓曼,汤蔽蔽,等.早期喂养干预预防极低出生体重儿喂养不耐受临床探讨[J].蚌埠医学院学报,2012,37(10):1201-1202
[24]沓小玉,杨慧勤.早产低出生体重儿早期微量肠道营养的护理观察[J].国际医药卫生导报,2012,18(11):1659-1660
[25]曾淑娟,杨皓,雷立容,等.早产极低出生体重儿早期微量喂养的临床研究[J].岭南急诊医学杂志,2013,18(1):64-65
[26]王妍琦.早期喂养干预预防极低出生体重儿喂养不耐受临床探讨[J].吉林医学,2013,34(30):6248
[27]何蓉,严洁,肖志辉.早期微量喂养对极低出生体重早产儿营养状况和并发症的影响[J].中华临床医师杂志,2013,(7):3155-3157
[28]Gomez FE,Lan J,Kang W,et al.Parenteral nutrition and fasting reduces mucosal addressin cellular adhesion molecule-1(MAd CAM-1)m RNA in Peyer's patches of mice[J].J Parenter Enteral Nutr,2007,31(1):47-52
[29]Agarwal R,Aggarwal R,Deorari AK,et al.Minimal enteral nutrition[J].Indian J Pediatr,2001,68(12):1159-1160
[30]王丹华.早产儿的营养问题[J].实用儿科临床杂志,2003,18(4):246-248
[31]Fallon EM,Nehra D,Potemkin AK,et al.American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)Board of Directors,Puder M.A.S.P.E.N.clinical guidelines:nutrition support of neonatal patients at risk for necrotizing enterocolitis[J].J Parenter Enteral Nutr,2012,36(5):506-523
[32]Senterre T.Practice of enteral nutrition in very low birth weight and extremely low birth weight infants[J].See comment in Pub Med Common2s below World Rev Nutr Diet,2014,110:201-214
[33]De Nisi G,Berti M,De Nisi M,et al.Early enteral feeding with human milk for VLBW infants[J].J Biol Regul Homeost Agents,2012,26(3Suppl):69-73