林星光,刘伟,李伟,乌剑利,肖娟,刘燕燕
LIN Xingguang,LIU Wei,LI Wei,WU Jianli,XIAO Juan,LIU Yanyan

• 1:华中科技大学同济医学院附属同济医院妇产科
• 2:华中科技大学同济医学院附属同济医院新生儿重症监护病房

摘要(Abstract)：

目的:探讨母乳喂养质量改进(QI)对产妇泌乳情况及其分娩的极低出生体重儿健康的影响。方法:将母乳喂养QI前后的住院产妇及其分娩的极低出生体重儿分为母乳喂养质量改进前组(BQI组,111例)和母乳喂养质量改进组(QI组,136例)。收集2组产妇的每日泌乳情况(挤奶次数、挤奶量、挤奶量达到350 mL/d的时间、7 d内挤奶量≥350 mL/d的人数),极低出生体重儿的出生孕周、体质量、分娩方式、性别、Apgar评分及消化系统情况(母乳喂养量、静脉营养持续时间、达到全肠道喂养时间及喂养不耐受发生率)等指标并比较分析。结果:两组极低出生体重儿的出生孕周、出生体质量、1min和5 min Apgar评分、分娩方式及性别的差异均无统计学意义(P>0.05);与BQI组产妇相比,QI组产妇第3天、第7天和第14天的挤奶次数及挤奶量均增加(P<0.05或P<0.01);QI组产妇挤奶量达到350 mL/d的时间比BQI组产妇缩短,7 d内挤奶量≥350 mL/d的人数较BQI组产妇增加(P<0.05或P<0.01);与BQI组极低出生体重儿相比,QI组极低出生体重儿的母乳强化剂添加时间、静脉营养持续时间和达到全肠道喂养时间均有减少(P<0.05),喂养不耐受发生率也较BQI组减少(P<0.05);QI组极低出生体重儿第7天体质量丢失量较BQI组明显减少(P<0.01),QI组极低出生体重儿第14天体质量增长量高于BQI组(P<0.05);第21天和第28天时2组极低出生体重儿体重增长量的差异无统计学意义(P>0.05)。结论:实行母乳喂养QI措施,可有效地提高极低出生体重儿母亲的泌乳量,还可减少极低出生体重儿的消化系统并发症,促进母乳喂养耐受,提高极低出生体重儿生存率和生存质量。
Objective: To investigate the effects of quality improvement(QI) measures of breastfeeding on maternal lactation and the health status of infants with very low birth weights. Methods: Hospitalized women whose infants with very low birth weight were divided into two groups based on whether or not given QI: without given QI group(BQI, 111 cases), with given QI served as QI group(136 cases). We collected daily lactation status(number of milking, milking amount, milking time of milking amount around 350 mL/d, the number of women whose milking amount ≥350 mL/d within 7 days). We also collected clinical information for the infants with very low birth weight, including birth gestational weeks, body weight, mode of delivery, gender, Apgar score and digestive system(the amount of breastfeeding, duration of intravenous nutrition, total intestinal feeding time and incidence of feeding intolerance) were anaylzed. Results: There were no significant differences in the gestational age, birth weight, Apgar scores at both 1 min and 5 min, mode of delivery and gender of infants with very low birth weight between BQI and QI groups(P>0.05). Compared with the BQI group, the number of milking on the 3 rd, 7 th and 14 th day were significantly increased in QI group(P<0.05 or P<0.01). In addition, the time needed for the milking amount reaching 350 mL/d was less in QI group than BQI group(P<0.05), and the number of milking ≥350 mL/d in 7 days was higher in QI group than that in BQI group(P<0.01). Moreover, the time points for adding the breast milk fortifier, intravenous nutrition, and feeding the whole intestine were all earlier in QI group than those in BQI group. The incidence of feeding intolerance in QI group was less than BQI group(P<0.05). The infant body weight losses on 7~(th) day birth was significantly lower in QI group than those in BQI group(P<0.01), and the infant body weight increases on 14~(th) day birth was significantly higher in QI group than those in BQI group(P<0.05). On day 21 and 28 after birth, the infant body weights were similar(P>0.05). Conclusion: Breastfeeding QI effectively increases the lactation of mothers and reduces incidence rates of the digestive system complications of infants, and improves infant survival and health.

关键词(KeyWords)： 母乳喂养;泌乳;消化系统疾病;婴儿,极低出生体重;质量改进;喂养不耐受
breast feeding;lactation;digestive system diseases;infants with very low birth weight;quality improvement;feeding intolerance

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81701476);; 湖北省卫生健康科研基金(WJ2019M138)

作者(Author): 林星光,刘伟,李伟,乌剑利,肖娟,刘燕燕
LIN Xingguang,LIU Wei,LI Wei,WU Jianli,XIAO Juan,LIU Yanyan

DOI: 10.19367/j.cnki.1000-2707.2019.09.015

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