目的 评价早产儿经胃管喂养后采用空气冲管的应用效果。方法 选择2021年1月–2021年12月广州市第一人民医院收治的经胃管喂养后采用温水冲管的60例早产儿为对照组,选择2022年1月–2022年12月收治的经胃管喂养后采用空气冲管的57例早产儿为研究组。喂养1周后,比较两组患儿体质量增加量、血清白蛋白浓度增加量、大便量、喂养不耐受发生率、胃管堵塞率等指标的差异。结果 无患儿发生胃管堵塞。研究组的血清白蛋白浓度增加量[（2.86±5.61）g/L]高于对照组[（0.84±5.27）g/L]（P<0.05）,而两组患儿在体质量增加量、大便量、喂养不耐受发生率等方面比较差异无统计学意义（P>0.05）。多元线性回归分析结果显示空气冲管为血清白蛋白浓度增加量的影响因素（P<0.05）。结论 采用空气进行胃管冲管的方法可改善早产儿的营养状态。

Objective To evaluate the effects of flushing gastric tube by air after feeding in premature infants．Methods A total of 60 premature infants admitted to Guangzhou First People's Hospital from January 2021 to December 2021 whose gastric tube were flushed with water after feeding were selected as the control group,while 57 admitted from January 2022 to December 2022 whose gastric tube were flushed with air after feeding were selected as the study group．After 1 week of feeding,the differences of weight increase,serum albumin concentration increase,stool volume,feeding intolerance incidence and gastric tube blockage rate were compared between the 2 groups．Results No gastric tube blockage occurred．The increase of serum albumin concentration in the study group[（2.86±5.61）g/L] was significantly higher than that in the control group[（0.84±5.27）g/L]（P<0.05）,but there were no significant differences in weight increase,stool volume and feeding intolerance incidence between the 2 groups．Multiple linear regression analysis showed that the flushing gastric tube with air was an independent influencing factor for the increase of serum albumin（P<0.05）．Conclusions Flushing gastric tube with air can improve the nutritional status of premature infants,which is worthy of clinical application．

目的 分析早产儿发生新生儿坏死性小肠结肠炎（NEC）的临床特点及危险因素。方法 选取2021年3月—2023年3月在濮阳市人民医院出生的早产儿160例,根据有无NEC分为NEC组（40例）和非NEC组（120例）,总结和比较两组患儿的临床资料,分析早产儿NEC的危险因素。结果 NEC组早产儿的发病时间主要集中在出生后的3~21 d,平均发病时间为（12.84±3.5）d。主要临床症状包括肉眼便血23例（57.5%）、腹胀31例（77.5%）、呕吐18例（45.0%）、呼吸暂停7例（17.5%）、肠穿孔9例（22.5%）。Logistic回归分析发现,败血症、输血、呼吸窘迫综合征及新生儿窒息是早产儿发生NEC的危险因素（P<0.05）,而预防应用益生菌以及母乳喂养是NEC的保护因素（P<0.05）。结论 NEC的主要临床表现包括肉眼便血、腹胀、呕吐、呼吸暂停、肠穿孔等;患儿出现NEC与败血症、输血、呼吸窘迫综合征及新生儿窒息等因素相关;母乳喂养和益生菌的应用是其保护因素。

Objective To analyze the clinical characteristics and risk factors of necrotizing enterocolitis（NEC）in premature infants. Methods A total of 160 premature infants born in Puyang People's Hospital from March 2021 to March 2023 were selected and divided into NEC group（40 cases）and non-NEC group（120 cases）according to the presence or absence of NEC．The clinical data were obtained and compared between the two groups．The clinical data of two groups were compared,and the related risk factors of NEC in premature infants were analyzed and summarized. Results The onset time of NEC premature infants is mainly between 3-21 days after birth,with an average onset time of（12.84±3.5）days．The main clinical symptoms included 23 cases（57.5%）of bloody stool,31 cases（77.5%）of abdominal distension,18 cases（45.0%）of vomiting,7 cases（17.5%）of apnea,and 9 cases（22.5%）of intestinal perforation．Logistic regression analysis found that sepsis,blood transfusion,respiratory distress syndrome,and neonatal asphyxia were risk factors for NEC in premature infants（P<0.05）,while prophylactic use of probiotics and breastfeeding were protective factors for NEC（P<0.05）. Conclusions The main clinical manifestations of NEC include bloody stool,abdominal distension,vomiting,apnea,intestinal perforation,etc．NEC in infants is related to sepsis,blood transfusion,respiratory distress syndrome and neonatal asphyxia．Breastfeeding and the application of probiotics are its protective factors．

目的 了解早产儿母亲群体的知识需求和情感特征,为延续性护理提供证据支持。方法 创建早产儿妈妈群,群成员共43人,通过整理并计量分析2018年9月—2019年1月的该微信群群聊记录,对群聊记录进行主题分类,归纳出对话频次最多及参与人数过半的聊天主题,并统计分析不同孕妇情况不同早产儿情况下早产儿母亲的关注内容。结果 早产儿母亲对早产儿照护相关知识需求较大,尤其在早产儿生长发育管理及疾病管理知识方面。此外,不同家庭月均收入水平、不同文化程度、不同分娩孕周、新生儿出生体质量不同、新生儿住院天数不同,其对话主题明显不同,对比有统计学意义(P<0.05)。结论 延续性护理工作中应加强早产儿照护相关知识宣教,根据孕妇和早产儿情况给予更加针对性的指导,同时不能忽视早产儿母亲的心身需求。此外,对群聊记录进行资料分析的方法可靠,建议在未来的研究中应用。

Objective To investigate the knowledge needs and psychological characters of the mothers of premature infants, providing the basis for continuous nursing. Methods WeChat group of mothers of premature infants was established and 43 group members were included. Chatting records of the WeChat group from September 2018 to January 2019 were extracted and classified into relevant topics. The topics with the most conversations or more than half of the participants and the topic related to the psychological experiences of mothers of premature infants were further analyzed. Results Mothers of premature infants had a large knowledge need for the care for premature infants, especially the knowledge about the growth and development management of premature infants and disease management of premature infants. Moreover, some mothers of premature infants had negative psychological feelings. Mothers with different family monthly income, educational levels, pregnancy duration, different weight and hospitalization cycles of their infants, had different chatting topics, which differences were significant (P<0.05). Conclusion In continuous nursing for mothers of premature infants, education on the care for premature infants should be strengthened and comprehensive measures of mental health should be undertaken. Additionally, the method of analyzing chatting records seems reliable and can be applied in future studies.

目的 分析某院中期早产儿体格发育及肠外营养状况,为中期早产儿制定合理的肠外营养方案提供参考。方法 收集某院2017年10月—2018年12月50例(32～33⁺⁶)周早产儿的病例进行回顾分析。结果 50例患儿出生平均体质量、身长、头围各为(1.84±0.24) kg、(42.92±2.16) cm、(29.77±1.20) cm,生后 1周和生后2周的平均体质量、身长、头围分别为(1.83±0.24) kg、(43.28±1.95) cm、(29.97±1.32) cm和(2.07±0.23) kg、(43.91±1.79) cm、(30.62±1.13) cm。营养素的起始剂量各为:氨基酸(1.11±0.37)g·kg^-1·d ^-1,脂肪乳(0.78±0.22)g·kg^-1·d ^-1,葡萄糖(5.86±1.51)mg·kg^-1·min^-1,肠外营养平均天数(22.8±6.46)天,体质量平均下降幅度(7.22±3.82)%,恢复至出生体质量平均天数(8.3±2.72)天。结论 该院中期早产儿肠外营养设计需完善,以控制生理性体质量下降程度及持续时间,更适于体格发育。

Objective To analyze the physical development and parenteral nutrition status of preterm infant in a hospital in order to provide reference for the formulation of reasonable parenteral nutrition treatment plan for medium preterm infants. Methods The clinical data of 50 preterm infants aged 32～33⁺⁶ weeks from October 2017 to December 2018 were collected and analyzed retrospectively. Results The average birth weight, body length and head circumference of the child patients were (1.84±0.24) kg, (42.92 ±2.16) cm, (29.77±1.20) cm respectively. After one week and After two weeks,the average birth weight, body length and head circumference were(1.83±0.24) kg, (43.28±1.95) cm, (29.97±1.32) cm respectively and (2.07±0.23) kg, (43.91±1.79) cm, (30.62±1.13) cm respectively. The initial dose of amino acid(1.11±0.37)g·kg^-1·d^-1, fat emulsion(0.78±0.22)g·kg^-1·d^-1, glucose(5.86±1.51)mg·kg^-1·min^-1. The average days of parenteral nutrition treatment were(22.8±6.46)d, the average weight loss was(7.22±3.82)% and the average days of recovery to birth weight were (8.3±2.72)d. Conclusion The design of parenteral nutrition for preterm infants still needs to be improved in order to control the degree and duration of physiological weight loss of preterm infants in the mid-term, which is conducive to the physical development of preterm infants in the mid-term.

目的 探讨四磨汤联合穴位按摩对早产儿喂养不耐受的影响。方法 将165例出现喂养不耐受的早产儿分组,82例于常规治疗基础上予四磨汤加穴位按摩为研究组,另83例予常规治疗为对照组,观察两组早产儿发生呕吐、胃潴留、腹胀等情况,并在喂养2周后作胃泌素和胰岛素的测定。结果 研究组早产儿发生呕吐、腹胀、胃潴留例数及所占比例分别为 12(14.6%) 、13(15.9%) 、18(22.0),发生率低于对照组(P<0.05);研究组早产儿喂养前和喂养后血清胃泌素分别是(250.41±73.76)ng/L 和(308.27±70.67)ng/L,血清胰岛素是(7.63±2.12)ng/L和(9.43±3.13)ng/L,与对照组相比,2周后的血清胃泌素和胰岛素水平增高(P<0.05)。结论 健脾导滞法可减少早产儿呕吐、腹胀、胃潴留等症状的发生,促进血清胃泌素和胰岛素的分泌,减少早产儿的喂养不耐受的发生。

早期干预是预防和减少早产儿神经系统损伤的有效措施,可以促进早产儿的正常发育并减轻神经系统伤残的发生,对提高儿童综合素质和家庭幸福都至关重要。在早产儿早期干预过程中存在与医学伦理原则不相适应的方面,如医疗设施不足、医疗措施不当、专业人员不足,早产儿干预预后的不确定性,治疗时机与家长经济及遵医行为之间的冲突,家长知情选择和知情同意不足等,本文结合医学伦理学的观点对0~3岁早产儿在早期干预中存在的问题进行分析并提出相应的建议。

Early intervention is an effective measure to prevent and reduce the nervous system injury in preterm infants,It can promote the normal development of preterm infants and reduce the occurrence of the nervous system disability.It is vital to improve the comprehensive quality of children and family quality of life. In the stage of premature infant intervention,there are some aspects that are incompatible with the medical ethics principle,i.e. inadequate medical facilities,improper medical measures,lack of professionals,premature infants intervention prognosis uncertainty,the conflict between the timing of treatment and the parents' economic and compliance behaviors,parents' informed choice and informed consent. etc. This paper analyzes the problems in early intervention of 0~3 year old preterm infants and puts forward corresponding suggestions according to the viewpoint of medical ethics.

        目的   探讨出生胎龄＜37周早产儿发生败血症时的临床特征及其不良结局的危险因素。方法   收集2020年1月—2023年12月安徽医科大学第一附属医院本部新生儿科收治出生胎龄＜37周且发生败血症早产儿的临床资料；根据败血症发生时间分为早发型败血症（EOS）49例，晚发型败血症（LOS）150例；根据是否出现不良结局，分为结局不良组90例，结局良好组109例。分析EOS和LOS败血症的临床特征，并采用多因素Logistic回归分析早产儿败血症出现不良结局的危险因素。结果  早产儿败血症中EOS患儿出生胎龄更小，生后1 min Apgar评分更低，孕母羊水污染、胎膜早破≥18 h发生率较LOS更高（P＜0.05）；早产儿败血症临床表现无特异性，但LOS患儿休克发生率更高（P＜0.05）；早产儿易发生革兰阴性菌感染，合并先天性心脏病（OR=2.490，P＜0.05）、出生胎龄＜30周（OR=4.851，P＜0.05）、出生体质量小于1 500 g（OR=4.169，P＜0.05）是早产儿败血症发生不良结局的危险因素。结论  早产儿败血症临床表现无特异性，更易发生革兰阴性菌感染，出生胎龄越小、体质量越低发生不良结局的风险更高。

       Objective  To analyze the clinical characteristics and  risk factors of adverse outcomes of  sepsis in premature infants with gestational age ＜ 37 weeks．Methods  Clinical data of preterm infants ＜ 37 weeksof gestational age admitted to the Department of Neonatology of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2023 were collected．According to the timing of sepsis，49 cases with early-onset sepsis（EOS）and 150 cases with late-onset sepsis（LOS）were diagnosed．According to the outcome，90 cases were divided into the adverse outcome group and 109 cases were good outcome group．The clinical characteristics of EOS and LOS were analyzed，and the risk factors of adverse outcomes were analyzed by multivariate logistic regression．Results The gestational age of EOS infants was smaller at birth，the 1 minute Apgar score was lower ，and the incidence of amniotic fluid contamination and premature rupture of membranes ≥18h were higher than those in LOS infants（P＜0.05）．The clinical manifestations of sepsis in premature infants were not specific，but the incidence of shock was higher in LOS children（P＜0.05）．Preterm infants were more likely to develop gram-negative bacterial infection，congenital heart disease（OR=2.490，P＜0.05），gestational age ＜30 weeks（OR=4.851，P＜0.05），and birth weight ＜ 1 500 g（OR=4.169，P＜0.05）were identified as significant risk factors for adverse sepsis outcomes in preterm infants．Conclusions The clinical manifestations of septicemia in preterm infants are non-specific，and they are more likely to suffer from gram-negative bacterial infection．The younger the gestational age and lower the birth weight of preterm infants，the higher the risk of adverse outcomes after sepsis．