非营养性吸吮对早产儿营养胰岛素及生长抑素水平的影响

Effects of non-nutritive sucking on nutrient and plasma insulin and somatostatin levels in premature infants

摘要:

目的：非营养性吸吮(NNS)对早产儿的有益作用尚存在不同意见，该文探讨了NNS对早产儿营养、血浆胰岛素(INS)及生长抑素(SS)水平的影响。方法：将38例需经鼻胃管喂养的健康早产适于胎龄儿，随机分成NNS和无非营养性吸吮组(N-NNS)两组，用同一种配方乳喂养，并用放射免疫法测定INS、SS水平。结果：NNS组恢复出生体重时间 8.8 ±3.7 d 较N-NNS组11.1±3.0 d缩短，差异有显著性(P<0.05)，1周、2周时体重、身长、头围的变化无差异(均P>0.05)；NNS组肠道营养热能达每日418.4 kJ/kg 的时间为 12.3±5.1 d 较N-NNS组15.7±5.2 d 缩短，差异有显著性(P<0.05)；鼻胃管留置时间NNS组为13±10 d，N-NNS组为17±12 d，差异无显著性(P>0.05)。NNS组胃残留的发生率(16.7%)较N-NNS组(50%)减少(P<0.05)。早产儿喂奶后1，2周INS水平NNS组为 37.1±11.3 μU/ml、50.3±18.4 μU/ml高于N-NNS组29.6±8.8 μU/ml、40±9.9 μU/ml，而SS水平NNS组 454.6±136.4 pg/ml，595.6±172.1 pg/ml 低于N-NNS组 595.3±260.1 pg/ml，727.2±220.8 pg/ml，差异均有显著性意义(均P<0.05)。结论：NNS可促进INS的分泌，抑制SS的分泌，NNS有利于早产儿生后胃肠道的继续发育，加速体格生长，提高经肠道喂养的耐受性。

Abstract:

OBJECTIVE: In view of the different opinions on the effects of non-nutritive sucking (NNS) on premature infants, this paper aims at evaluating the effects of NNS on nutrient and gastrointestinal hormones insulin (INS) and somatostatin (SS) levels in premature infants. METHODS: Thirty-eight healthy, appropriate for gestational age, premature infants who accepted intermittent nasogastric feeding (INGF) were randomly assigned into a NNS group and a non-NNS group according to INGF with and without NNS. They were fed with the same milk formula. Plasma INS and SS levels were detected by radioimmunoassay (RIA). RESULTS: The birth-weight regaining time in the NNS group was significantly shorter than that in the N-NNS group ( 8.8± 3.7 d vs 11.1± 3.0 d; P< 0.05). Within two weeks after feeding, there were no significant differences in the increase of body weight, length and head circumference between the two groups. The time of reaching 418.4 kJ/kg of caloric intake daily by enteral feeding in the NNS group was significantly shorter than that in the N-NNS group ( 12.3± 5.1 d vs 15.7± 5.2 d; P< 0.05); while the feeding time through the nasogastric tube was the same for both groups. There was a lower incidence of gastric residue in the NNS group ( 16.7%) compared with that in the N-NNS group (50%) (P< 0.05). After a week of initial feeding, the plasma INS level in the NNS group was significantly higher than that in the N-NNS group ( 37.1± 11.3 μU/ml vs 29.6± 8.8 μU/ml; P< 0.05). By the end of the second week the plasma INS level in the NNS group was also higher than that in the N-NNS group ( 50.3± 18.4 μU/ml vs 40.0± 9.9 μU/ml; P< 0.05). The plasma SS level in the NNS group was significantly lower than that in the N-NNS group by the end of both the first and second weeks ( 454.6± 136.4 pg/ml vs 595.3± 260.1 pg/ml and 595.6± 172.1 pg/ml vs 727.2± 220.8 pg/ml; both P< 0.05). CONCLUSIONS: NNS can promote INS secretion and suppress SS secretion, which is of benefit to gastrointestinal development and growth, and to improving the tolerance of enteral feeding.