液体摄入量对早产儿死亡率与并发症发生率的影响  

Effect of different water intake on mortality and frequency of complication in preterm infants

作　　者：陶晔璇[1] 蔡威[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海市儿科医学研究所,上海200092

出　　处：《临床儿科杂志》2007年第3期229-231,共3页Journal of Clinical Pediatrics

基　　金：国家"十五"科技攻关项目(No.2004BA709B09)

摘　　要：目的系统评价早产儿及低出生体重儿应用不同补液量的疗效及安全性,为临床早产儿合理补液提供依据。方法以生后早期补液量为干预措施,早产儿/低出生体重儿为纳入对象,按Cochrane系统评价方法,评价纳入研究的方法学质量并提取有效数据进行Meta分析。结果共纳入3个随机对照研究,纳入总病例数438例。生后1周时补液量>150ml/(kg·d)的亚组患儿,动脉导管重新开放率、新生儿坏死性小肠炎发病率显著高于对照组(OR:2.86,95%CI:1.25～6.51;OR:8.32,95%CI:1.56～44.52),与生后1周时补液量在130～150ml/(kg·d)的亚组分析结果显示差异无统计学意义。高补液量组最大体重下降百分比显著低于对照组(WMD=-2.54,95%CI:-3.95～-1.19);两组死亡率、支气管肺发育不良发病率、颅内出血发病率差异无统计学意义。结论过高补液总量摄入[>150ml/(kg·d)]给临床转归带来不利影响,而生后1周时130～150ml/(kg·d)的补液量是安全的。Objectives To assess the effects and safety of different water intake on premature and low birth weight infants, and provide the basis for rational fluid therapy. Methods Water intake is the intervention management for infants in early neonatal stage. Randomized clinical trials were sought and the comparison of the outcomes in premature infants with different levels of water intake was made. Indicies evaluated including the highest percentage of postnatal weight loss, mortality, morbidity; the incidence of reopened patent ductus arteriosus, necrotizing enterocolitis, bronchus-pulmonary hypoplasia, and intracranial hemorrhage. The treatment group had higher water intake while the control group had routine water intake. Results The study involved three RCT and included 438 cases. Subgroup analysis was conducted in the higher water intake groups if the fluid amount was more than 150 mt/（kg·d） . The incidences of reopened patent ductus arteriosus and necrotizing enterocolitis were significantly higher in the higher intake subgroup （150 ml/（kg·d）） than that of the control（OR：2.86, 95%CI： 1.25 - 6.51; OR： 8.32,95%CI： 1.56 - 44.52）. While the difference on incidences of reopened patent ductus arteriosus and necrotizing enterocolitis were not significant between median intake subgroup （130 - 150 ml/（kg·d）） and the control. The maximal percentage weight loss was significantly lower in higher water intake group than that of the control （WMD = -2.54, 95%CI： -3.95 - -1.19） . The differences on mortality, incidence of bronchus-pulmonary hypoplasia, and intracranial hemorrhage were not significant between two groups. Conclusions Too high water intake （ 〉 150 ml/（kg.d） on the 7th day postnatal） will impart negative effect on the outcomes of preterm neonate, while 130- 150 mt/（kg·d）water intake is appropriate.

关 键 词：液体治疗 早产儿 META分析 

分 类 号：R722.6[医药卫生—儿科]