论文部分内容阅读
目的探讨早期营养支持策略对极低出生体重儿生长代谢及并发症的影响。方法回顾性分析我院2009—2012年出生体重<1500 g、无先天消化道畸形、住院2周以上、存活出院的极低出生体重儿临床资料,2009—2010年为A组,2011—2012年为B组。比较两组出生时一般情况、肠内外营养摄入、体格增长及血生化指标。结果与A组(118例)相比,B组(130例)早产儿应用氨基酸、脂肪乳剂更早[氨基酸:21.0(17.0,31.5)h比28.0(22.5,41.8)h,脂肪乳:40.0(28.0,46.0)h比45.0(30.0,75.8)h],起始剂量更高[氨基酸:(1.21±0.40)g/(kg·d)比(1.07±0.33)g/(kg·d),脂肪乳:(0.86±0.35)g/(kg·d)比(0.66±0.24)g/(kg·d)],热卡达到120kcal/(kg·d)时间更短[(24.9±9.2)天比(28.4±9.9)天],开奶时间更早[48.0(36.0,71.5)h比56.5(37.0,88.0)h],禁食时间缩短[4.5(2.5,7.5)天比5.0(2.9,8.0)天],体重增长速度更快[(17.0±3.7)g/(kg·d)比(14.5±4.6)g/(kg·d)],出院时宫外生长迟缓发生率降低(59.2%比82.2%),体重最大下降值减少[70.0(40.0,110.0)g比80.0(50.0,117.5)g],差异均有统计学意义(P<0.05)。两组坏死性小肠结肠炎、胆汁淤积症、医院感染、早产儿视网膜病变、支气管肺发育不良、呼吸窘迫综合征发生率、氧疗及机械通气时间差异无统计学意义(P>0.05)。结论早期更积极的营养支持策略能促进早产儿生长,减少宫外生长迟缓的发生,缩短住院时间,不会增加坏死性小肠结肠炎、胆汁淤积症、支气管肺发育不良、早产儿视网膜病变、呼吸窘迫综合征的发生率以及氧疗、机械通气的时间。
Objective To investigate the effects of early nutritional support on growth, metabolism and complications of very low birth weight infants. Methods A retrospective analysis of our hospital from 2009 to 2012 birth weight <1500 g, no congenital digestive tract malformations, hospital stay for more than 2 weeks, survival and discharge of very low birth weight children clinical data, 2009-2010 for Group A, 2011-2012 For the B group. The general conditions of birth, enteral nutrition, physical growth and blood biochemical indexes were compared between the two groups. Results Compared with group A (n = 118), group B (n = 130) preterm infants had earlier application of amino acids (amino acids: 21.0 (17.0, 31.5) h vs. 28.0 (1.21 ± 0.40) g / (kg · d), (1.07 ± 0.33) g / (kg · d), fat (0.96 ± 0.24) g / (kg · d)] in milk: (24.9 ± 9.2) days after heat card reached 120 kcal / (kg · d) (28.4 ± 9.9 days), earlier milk opening time (48.0 (36.0, 71.5) h vs. 56.5 (37.0, 88.0) h], shortened fasting time (4.5, 2.5, (17.0 ± 3.7) g / (kg · d) vs (14.5 ± 4.6) g / (kg · d)], and the rate of ectopic growth retardation at discharge was lower (59.2% vs 82.2 %), And the maximum weight loss decreased [70.0 (40.0,110.0) g vs 80.0 (50.0,117.5) g]. The difference was statistically significant (P <0.05). There was no significant difference between the two groups in necrotizing enterocolitis, cholestasis, nosocomial infection, retinopathy of prematurity, bronchopulmonary dysplasia, incidence of respiratory distress syndrome, duration of oxygen therapy and mechanical ventilation (P> 0.05). Conclusions Early, more aggressive nutritional support strategies can promote the growth of premature infants, reduce the incidence of extrauterine growth retardation, shorten the length of hospital stay, and do not increase necrotizing enterocolitis, cholestasis, bronchopulmonary dysplasia, retinopathy of prematurity, respiratory The incidence of distress syndrome and oxygen therapy, mechanical ventilation time.