超低出生体质量儿早期微量肠内营养喂养间隔的对照研究  

A comparative study of different interval schedules of early minimal enteral feeding in extremely-low-birth weight infants

作　　者：许靖[1,2] 张小英[2] 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 [2]北京军区总医院附属八一儿童医院,北京100700

出　　处：《临床儿科杂志》2012年第9期809-813,共5页Journal of Clinical Pediatrics

基　　金：国家自然科学基金项目(No.30973210;No.81070524);首都特色临床医学技术发展研究项目(No.Z090507017709001)

摘　　要：目的探讨超低出生体质量儿早期微量肠内营养的最佳喂养间隔,以制订早期肠内营养方案。方法将符合纳入标准的181例婴儿随机分为3组,以0.5 ml为起始剂量,分为间隔12 h喂养1次的A组(51例)、间隔6 h的B组(63例)、间隔3 h的C组(67例),梯度增加奶量至150～160 ml/(kg.d),达到全肠道营养。结果 A、B、C组婴儿恢复出生体质量的时间分别为(13.4±3.8)d、(16.0±3.3)d、(15.2±3.2)d,差异有统计学意义(P<0.05),A组比B、C组时间短,差异有统计学意义(P<0.05);A、B、C组婴儿矫正胎龄32周的体质量分别为(1289.9±158.6)g、(1184.4±189.8)g、(1197.6±205.1)g,差异有统计学意义(P<0.05),A组婴儿高于B组,差异有统计学意义(P<0.05)。三组婴儿的宫外发育迟缓发生率、胃肠外营养天数、住院天数差异均无统计学意义(P均>0.05);但三组婴儿的喂养不耐受累计时间、胃肠外营养相关胆汁淤积、坏死性小肠结肠炎及败血症的差异均有统计学意义(P均<0.05),且均以A组发生率最低。结论以0.5 ml、间隔12 h启动超低出生体质量儿肠内营养,能减少并发症,促进体质量较快增长,喂养效果理想。Objective To explore the optimal feeding interval schedule for extremely-low-birth weight infants and find the best early enteral nutrition protocol. Methods A total of 181 neonates who met the inclusion criteria were divided into 3 groups. Group A （n=51） initiated feeding at 0.5 ml/12 h, group B （n=63） at 0.5 ml/6 h and group C （n=67） at 0.5 ml/3 h. Milk volume was increased gradually. Upon reaching 150 - 160 ml/（kg·d）, infants were fed fully enterally. Results Group A took （13.4±3.8） d to regain birth weight; group B took （16.0±3.3） d; group C took （15.2±3.2） d. The differences between groups A and B and groups A and C were statistically significant （P〈0.05） while the difference between groups B and C was not statistically significant （P〉0.05）. The weight at corrected gestational age 32 w was （1289.9±158.6） g in group A, （1184.4±189.8） g in group B and （1197.6±205.1） g in group C. There was statistical difference only between groups A and B （P〈0.05）. Group A had received parenteral nutrition for （46.3±16.9） d, group B for （51.8±18.3） d and group C for （53.8±23.7） d. The length of hospital stay was （76.4±37.4） d in group A, （87.2±37.2） d in group B and （84.8±35.8） d in group C. The difference was not statistically significant. The incidence of extrauterus-growth-retardation also did not have statistical difference among groups. The incidence of the complications, such as feed intolerance, parenteral nutrition associated cholestasis, necrotising enterocolitis and sepsis had statistical difference among groups. Group A had the lowest incidence of complications. Conclusions If initiating feeding at 0.5 ml/12 h, the extremely-low-birth weight infants grow fast and have less chance of developing complications. This study showed that 0.5 ml/12 h is the optimal feeding protocol for extremely-low-birth weight infants.

关 键 词：喂养 营养 早产儿 

分 类 号：R722[医药卫生—儿科]