2020 年第 4 期 第 15 卷

初乳舌下黏膜涂抹对极低出生体质量儿康复的影响

Effect of sublingual mucosal application of colostrum on very low birth weight infants

作者：李玲玉于平董晶晶

英文作者：Li Lingyu Yu Ping Dong Jingjing

单位：哈尔滨医科大学附属第一医院儿科三病房150001 

英文单位：The Third Ward of Pediatrics the First Affiliated Hospital of Harbin Medical University Harbin 150001 China

关键词：极低出生体质量儿；初乳；舌下黏膜；喂养不耐受；免疫力

英文关键词：Verylowbirthweightinfants；Colostrum；Sublingualmucosa；Feedingintolerance；Immunity

• 摘要：

• 【摘要】目的    探讨舌下黏膜涂抹亲生母亲初乳对极低出生体质量儿(VLBWI)消化功能、免疫功能及临床预后的作用。方法    选取2017年3月至2019年2月哈尔滨医科大学附属第一医院新生儿重症监护病房治疗的VLBWI 96例，选取其中2017年3月至2018年2月出生的48例为对照组，2018年3月至2019年2月出生的48例为观察组。观察组舌下黏膜涂抹亲生母亲初乳连续7 d，对照组舌下黏膜涂抹等量0.9%氯化钠注射液。比较2组出生第7天免疫球蛋白（Ig）及T淋巴细胞水平；比较2组胃潴留次数、潴留量、完全不潴留时间、达全胃肠道营养时间及并发症发生情况和临床转归，多因素Logistic回归分析舌下黏膜涂抹初乳对患儿临床结局的影响。结果    出生7 d时，观察组胃潴留次数、潴留量均明显少于对照组［(1.5±0.3)次比(3.2±0.4)次、(4.4±0.5)ml比(10.6±1.2)ml］，完全不潴留时间及达全胃肠道营养时间均早于对照组［（14.2±1.0）d比（26.7±2.8）d、（19±3）d比（30±5）d］（均P＜0.001）。出生7 d时，观察组IgA、CD+4水平和CD+4/CD+8比值高于对照组（均P＜0.05）。观察组临床败血症、院内感染发生率均低于对照组（均P＜0.05），2组其余并发症发生率及病死率比较差异均无统计学意义（均P＞0.05）。多因素Logistic回归分析结果显示，在调整出生体质量、出生胎龄等变量后，舌下黏膜涂抹初乳是VLBWI发生临床败血症（比值比=0.53，95%置信区间：0.32～0.67，P＜0.001）、院内感染（比值比=0.76，95%置信区间：0.55～0.87，P=0.023）的抑制因素。结论    舌下黏膜涂抹初乳可通过减少VLBWI胃潴留，加快肠内营养进程来提高消化系统功能，通过提高血清IgA、CD+4 T淋巴细胞水平，来增强免疫力，进而降低院内感染、临床败血症发生率，改善患儿预后。

• 【Abstract】Objective    To investigate the effect of sublingual mucosal application of colostrum on digestive function, immune function and prognosis of very low birth weight infants(VLBWI). Methods    Ninety-six cases of VLBWI admitted to neonatal intensive care unit in the First Affiliated Hospital of Harbin Medical University from March 2017 to February 2019 were enrolled; 48 infants born between March 2017 and February 2018 were included in control group and 48 infants born between March 2018 and February 2019 were included in observation group. The observation group was treated with sublingual mucosal application of colostrum for 7 days and the control group was treated with 0.9% sodium chloride. Immunoglobulin(Ig) and T lymphocytes were detected on the 7th day after birth. Occurrence of gastric retention, retention volume, length of non-retention, length of recovering to total gastrointestinal nutrition, complications and outcomes were recorded. Influence of sublingual use of colostrum on clinical outcomes of VLBWI was analyzed by multivariate logistic regression. Results    On the 7th day after birth, times and volume of gastric retention in observation group were significantly less than those in control group［(1.5±0.3) vs (3.2±0.4), (4.4±0.5)ml vs (10.6±1.2)ml］; lengths of non-retention and total gastrointestinal nutrition recovering in observation group were significantly shorter than those in control group［（14.2±1.0）d vs （26.7±2.8）d, （19±3）d vs （30±5）d］(all P＜0.001). On the 7th day after birth, levels of IgA, CD+4 and CD+4/CD+8 ratio in observation group were significantly higher than those in control group(all P＜0.05). Incidences of sepsis and nosocomial infection in observation group were significantly lower than those in control group(all P＜0.05). There were no statistical differences in complications and mortality between groups(all P＞0.05). With adjustment of confounding factors such as birth weight and gestational age, multivariate logistic regression showed that sublingual mucosal application of colostrum was the restraining factor of sepsis(odds ratio=0.53, 95% confidence interval: 0.32-0.67, P＜0.001) and nosocomial infection(odds ratio=0.76, 95% confidence interval: 0.55-0.87, P=0.023) in VLBWI. Conclusion    Sublingual mucosal application of colostrum can improve digestive function by reducing gastric retention and accelerating the progress of enteral nutrition, enhance immunity by increasing serum IgA and CD+4 T lymphocyte levels, reduce nosocomial infection and sepsis, and improve the prognosis of VLBWI.