不同营养支持方案在极低出生体重儿中的应用效果比较

Effect of different nutritional support programs on very low birth weight infant

摘要:

探讨不同营养支持方案在极低出生体重儿（VLBWI）中的应用效果。方法选取2014 年3 月-2015 年12 月该院收治的行早期积极营养支持方案的45 例VLBWI 归为早期组，然后选取2013 年1 月-2014 年2 月收治的行传统滞后静脉营养支持方案的40 例VLBWI为滞后组。比较两组的临床资料、并发症发生状况及实验室检查结果。结果体重的下降幅度、恢复出生体重的时间、体重达到2 000 g的日龄、静脉营养支持的持续天数、总住院时间等均早期组< 滞后组，恢复出生体重后的体重平均增长速度、出生后第7 天的热卡总量等早期组> 滞后组，差异有统计学意义（p <0.05）。所有患儿均未出现氮质血症、静脉炎、血栓形成等并发症，早期组的喂养不耐受（FI）、宫外生长迟缓（EUGR）等并发症发生率低于滞后组，差异有统计学意义（p <0.05）。两组的高胆红素血症、胆汁淤积、坏死性小肠结肠炎（NEC）等并发症发生率比较，差异无统计学意义（p >0.05）。两组的血总胆红素（TB）、结合胆红素（CB）、血肌酐（Scr）、尿素氮（BUN）、丙氨酸氨基转移酶（ALT）等指标比较，差异无统计学意义（p >0.05）。结论对VLBWI 而言，早期给予积极营养支持能促进患儿的生长发育，降低FI和EUGR 的发生风险，安全可行，值得临床推广应用。

Abstract:

To compare the effect of different nutritional support programs on very low birth weight infant (VLBWI). Methods Forty-five very low birth weight infants (VLBWI) received early positive nutritional support between March 2014 and December 2015 were enrolled into early group, and 40 VLBWI received conventional conservative delayed nutritional support between January 2013 and February 2014 were selected as delayed group. The clinical data, incidences of complications and laboratory test results were compared between the two groups. Results The weight loss after birth was less, the recovery time of body weight, the time of weight reaching 2000 g, the duration of intravenous nutrition and the hospital stay were significantly shorter in the early group compared to the delayed group; and the average growth rate of weight after recovery of birth weight and the total calories on the 7th d in the early group were significantly higher than those in the delayed group (p < 0.05).There was no azotemia, phlebitis or thrombosis in any case. The incidences of feeding intolerance (FI) and extrauterine growth retardation (EUGR) in the early group were significantly lower than those in the delayed group (p< 0.05). There was no significant difference in the incidence of hyperbilirubinemia, cholestasis or necrotizingenterocolitis between the two groups (p > 0.05). There was no significant difference in serum total bilirubin,conjugated bilirubin, serum creatinine, blood urea nitrogen or alanine transaminase between the two groups (p >0.05). Conclusions For VLBWI, early positive nutritional support could significantly promote the growth and development, reduce the risk of FI and EUGR, hence it is safe, feasible and worth clinical application.