早产儿呼吸支持模式与喂养不耐受的关系：一项回顾性队列研究

张婷; 冯艺; 胡勇; 应俊杰; 王少璞; 王华

doi:10.12182/20231160104

早产儿呼吸支持模式与喂养不耐受的关系：一项回顾性队列研究

Association Between Different Modes of Respiratory Support and Feeding Intolerance in Preterm Infants: A Retrospective Cohort Study

摘要

摘要:
目的探讨早产儿住院期间使用的各种呼吸支持模式与早产儿喂养不耐受（feeding intolerance, FI）的关系，为需要呼吸支持的早产儿肠内喂养管理提供参考。
方法对四川大学华西第二医院新生儿科2015年6月–2018年11月期间住院的符合纳入、排除标准的早产儿进行回顾性分析，将使用的呼吸支持模式作为自变量，以FI为结局指标。按照早产儿住院期间使用的呼吸支持模式进行分组，对比各呼吸支持模式与FI之间的关系。
结果共有272例早产儿被纳入研究，logistic回归分析提示与常压吸氧相比，调整混杂因素后经鼻高流量（high flow nasal cannula, HFNC）可能减少FI的发生〔比值比（odds ratio, OR）=0.53，95%置信区间（confidence interval, CI）：0.06～4.77〕，其余通气模式可能增加FI的发生；与经鼻持续气道正压通气（nasal continuous positive airway pressure, NCPAP）相比，双水平气道正压通气（bilevel positive airway pressure, BIPAP）和有创通气可能增加FI发生（调整后OR值分别为1.31、1.69，95%CI分别为0.67～2.55、0.65～4.41）；而BIPAP和有创通气发生FI的概率可能相当（调整后OR=1.00, 95%CI：0.41～2.42）。但上述结果P值均大于0.05。
结论在本研究的呼吸支持模式中，使用HFNC发生FI的概率可能最低，使用NCPAP、BIPAP和有创通气时需关注肠内喂养管理，警惕FI的发生。因受限于样本量，此结论需进一步证实。

Abstract:
Objective To explore the relationship between different modes of respiratory support and feeding intolerance (FI) in preterm infants over the course of their hospitalization and to provide recommendations for the management of enteral feeding in preterm infants requiring respiratory support.
Methods A retrospective analysis was performed with the preterm infants admitted to the Neonatal Intensive Care Unit (NICU), West China Second University Hospital, Sichuan University between June 2015 and November 2018. The modes of respiratory support were used as independent variables and FI was used as the outcome indicator. The preterm infants were grouped according to the specific modes of respiratory support they were on over the course of their hospitalization and the relationship between each mode of respiratory support and FI was compared.
Results A total of 272 preterm infants were enrolled in the study. After adjusting for confounding factors, findings from logistics regression suggested that, compared with normobaric oxygen, high flow nasal cannula (HFNC) might reduce the incidence of FI (odds ratio OR=0.53, 95% confidence interval CI: 0.06-4.77), while other modes of respiratory support might increase the incidence of FI. Compared with nasal continuous positive airway pressure (NCPAP), bilevel positive airway pressure (BIPAP) and invasive ventilation might increase the incidence of FI, with the adjusted OR being 1.31 and 1.69, and 95% CI being 0.67-2.55 and 0.65-4.41, respectively. The incidence of FI in BIPAP and invasive ventilation was similar (adjusted OR=1.00, 95% CI: 0.41-2.42). However, the P-values of the above results were all greater than 0.05.
Conclusion HFNC has the lowest incidence of FI in the respiratory support modes examined in this study. Attention should be paid to enteral feeding management when using NCPAP, BIPAP, and invasive ventilation to avoid the occurrence of FI. Given the limited sample size, further research is warranted to confirm the conclusion.

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