目的 探讨在早期早产儿配方奶(PF)喂养失败下,更换母乳(HM)或深度水解奶(eHF)对极低出生体质量儿喂养不耐受(FI)的改善情况。方法 选择2016年1月—2018年1月在广州市妇女儿童医疗中心出生、生后PF喂养失败、出现FI的极低出生体质量儿84例,根据家长HM喂养意愿及条件,分为HM喂养组38例和eHF喂养组46例,比较2组患儿更换喂养配方后FI消失时间、FI改善率、达全肠内喂养时间及体质量增长情况等喂养结局。结果 相对于eHF喂养组,HM喂养组FI消失时间更快,FI改善率更高,达全肠内喂养时间更快,差异有统计学意义。HM喂养组平均每日体质量增长量、出院时体质量均明显大于eHF喂养组,住院时间更短,出院时宫外发育迟缓(EUGR)发生率更低,差异有统计学意义。2组患儿坏死性小肠结肠炎、胆汁淤积症、院内感染发生率比较无统计学差异。结论 当极低出生体质量儿PF喂养失败、出现FI时,选择HM或eHF均可改善FI,但HM效果更好,达全肠内喂养时间更快且体质量增长更理想,出院时EUGR发生率较低。

Objective To investigate the improvement of feeding intolerance (FI) by changing human milk (HM) or extensively hydrolyzed formula(eHF) after failure of preterm formula (PF) feeding in very low birth weight (VLBW) infants. Methods Eighty-four VLBW infants who were born in Guangzhou Women and Children's Medical Center from January 2016 to January 2018 with PF feeding failure and FI were divided into HM feeding group (n=38) and eHF feeding group (n=46) according to their parents' HM feeding willingness and conditions.The time of FI disappearance, FI improvement rate, total enteral feeding time and weight gain were compared between the two groups after changing feeding formula. Results Compared with the eHF feeding group, the disappearance time of FI, the time of getting total intestinal feeding in the HM feeding group were shorter, and the improvement rate of FI was higher,the differences were statistically significant.The average daily weight increase and discharge weight of the HM feeding group were significantly more than those of the eHF feeding group, and the length of hospital stay, the incidence of extrauterine growth retardation(EUGR) at discharge were lower, the differences were statistically significant.There was no significant difference in the incidence of necrotizing enterocolitis, cholestasis and nosocomial infection between the two groups. Conclusions In the case of failure of PF feeding and FI in VLBW infants, both HM and eHF could ameliorate FI, but HM had a better effect, with a shorter time of getting total intestinal feeding, better weight gain and a lower incidence of EUGR at discharge.

目的 研究低Apgar评分新生儿外周动脉(非脐动脉,以下同)血pH对新生儿窒息诊断的作用。方法 选取本院出生Apgar评分1min≤7分活产婴儿158例,复苏后1 h内,平均(33±3.9)min,抽取外周动脉血气,分析其pH与Apgar评分及多器官损害关系,以探讨它们之间作为窒息诊断的互补性。结果 复苏后的外周动脉血pH值比脐动脉血pH值高,动脉血pH与Apgar 评分呈正相关。1min Apgar评分4～7分组中pH＞7.25者占67%(109/158),且几乎在5min时Apgar评分转至8分以上,提示可能没酸中毒或窒息。动脉血pH在7.25以下或1min Apgar评分0～3分者发生多器官损害率较高,而4～7分者且pH＞7.25时多器官损害率较低。与目前窒息的诊断标准对比,本组符合率降低,可能与采用复苏后的外周动脉而非脐动脉血pH有关。结论 外周动脉血pH一定程度上可反映窒息情况,低Apgar评分不等同窒息,动脉血pH及多器官损害是判断低Apgar评分新生儿是否窒息的重要互补因素,采用复苏后才抽取的外周动脉血pH判断窒息时,如果仍以pH＜7.20为标准,可能会造成漏诊。