超低出生体质量儿早期胃肠内微量喂养的临床研究  

Clinical Study of Earlier Micronutrient Enteral Feeding in Extremely Low Birth Weight Infants

作　　者：许靖[1,2] 张小英[3] 李秋平[2] 王自珍[2] 周丽[2] 杨璐[2] 马兴娜[2] 封志纯[2] 

机构地区：[1]南方医科大学八一临床医学院附属八一儿童医院新生儿重症监护中心,北京100007 [2]北京军区总医院附属八一儿童医院新生儿重症监护中心,北京100007 [3]北京军区总医院附属八一儿童医院临床遗传中心,北京100007

出　　处：《实用儿科临床杂志》2012年第7期486-488,518,共4页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(30973210;81070524);首都特色临床医学技术发展研究项目(Z090507017709001)

摘　　要：目的探讨超低出生体质量儿(ELBWI)最佳胃肠内喂养(EN)启动时间,以促进ELBWI体质量增长,减少并发症。方法选择2009年11月-2011年9月在北京军区总医院附属八一儿童医院新生儿重症监护中心116例ELBWI,随机分为24 h开奶组和延迟开奶组,每组各58例。24 h开奶组出生24 h内启动EN,延迟开奶组禁食3 d后启动EN。2组均接受"全合一"胃肠外营养(PN),EN 0.5～1.0 mL,2～4次.d-1,梯度增加喂养次数及奶量,至150～160 mL.kg-1.d-1,过渡为全肠内营养。观察2组患儿生化指标、体格发育指标及并发症。结果 24 h开奶组与延迟开奶组性别、胎龄、分娩方式、出生时窒息史及分娩前用药、出生体质量比较差异均无统计学意义(Pa>0.05),纳入条件相同;出院时NEC发生率、住院时间、宫外发育迟缓、喂养不耐受、总胆红素、结合胆红素、γ-谷氨酰转移酶、光疗时间、使用布洛芬在2组间比较差异均无统计学意义(Pa>0.05)。与延迟开奶组相比,24 h开奶组矫正胎龄32周时体质量较高[(1 300.6±161.2)g vs(1 174.8±192.3)g,P=0.000],恢复出生体质量时间短[(13.5±3.7)d vs(15.1±3.2)d,P=0.014],PN时间较短[(45.7±6.7)d vs(54.8±10.6)d,P=0.000],ALT[12.0(3.5,45.0)U.L-1 vs 72.0(30.0,89.3)U.L-1,P=0.000]、ALP[334.5(157.0,378.0)U.L-1 vs 560.0(409.0,997.0)U.L-1,P=0.000]、总胆汁酸[11.4(6.0,13.5)μmol.L-1vs 14.6(9.2,22.3)μmol.L-1,P=0.000]均较低。24 h开奶组胃肠外营养相关胆汁淤积(5%vs 19%,P=0.023)、脓毒症(7%vs 21%,P=0.031)的发生率低于延迟开奶组。结论 ELBWI 24 h内开奶较延迟开奶安全、有效。Objective To investigate the optimal time for commencing enteral nutrient（EN） in the extremely low birth weight infants （ELBWI） ,in order to promote ELBWI body quality growth and reduce complications in ELBWI. Methods From Nov. 2009 to Sep. 2011, 116 cases of ELBWI were included in the study admitted to the Neonatal Intensive Care Unit in Bayi Children＇s Hospital Affiliated to General Hospital of Beijing Military Command of People＇s Liberation Army were enrolled. They were randomly allocated in to 2 groups which included 58 cases equally（group A and group B）. In group A,EN was initiated in 24 hours for neonates＇ ; in group B,the neonates were fasted for 3 days before the start of EN. In both groups, milk was given with a dose of 0.5 - 1.0 mL,2 -4 times every day, and increased gradually,till the milk volume reached 150 -160 mL · kg^-1 . d^-1, then total EN were performed. Biochemical indicators, complications and physique indexes were observed and recorded. Results No statistically significant difference was found in gender,gestational ages,labor mode,labor asphyxia, dexamethasone utility and birth weight between the 2 groups （ Pa 〉 0.05 ）. Also no significant difference between the 2 groups was found in extrauterine growth retardation at discharge, feeding intolerance, total bilirubin, direct bilirubin, γ - glutamyl transpeptidase, phototherapy duration, utilizing ibuprofen and ventilation support, neerotizing enteroeolitis ratio and hospital stay （ Pa〉 0.05 ）. Compared with group B, patients in group A had a heavier weight at 32 weeks in correcting gestational ages [ （ 1 300.6 ± 161.2 ） g vs （ 1 174.8 ± 192.3 ） g, P = 0. 000 ] , shorter time to regain birth weight [（13.5±3.7） dvs （15.1 ±3.2） d,P =0.014] ,shorter time to accomplish PN [（45.7±6.7） dvs （54.8± 10. 6 ） d, P = 0.000 ] ,less peak value of alanine transaminase [ 12.0 （3.5,45.0） U ·L^-1 vs 72.0 （ 30.0,89.3 ） U · L ^-1, P = 0. 000 ], alkaline phosphatase[ 334.5（157.0,378.0） U ·

关 键 词：超低出生体质量儿 微量喂养 胃肠外营养 并发症 

分 类 号：R722[医药卫生—儿科]