极低出生体质量儿的早期积极营养支持  

Early nutritional support for very low birth weight infants

作　　者：顾谦学[1] 顾红兵[1] 李双双[1] 陆超[2] 胡毓华[2] 

机构地区：[1]南通大学附属南通妇幼保健院儿科,江苏南通226018 [2]南京医科大学第一附属医院儿科,210029

出　　处：《中华实用儿科临床杂志》2016年第7期499-502,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81170487）;江苏省卫生厅妇幼重点学科项目（FXK201212）

摘　　要：目的观察早期积极的静脉营养联合早期微量喂养对极低出生体质量儿（VLBWI）的影响，并评价肠道屏障蛋白和感染相关MicroRNA的临床检测价值。方法选择2006年1月至2014年6月入住南通大学附属南通妇幼保健院新生儿重症监护病房的VLBWI62例。其中A组30例采用传统的静脉营养策略；B组32例采用早期积极的静脉营养联合早期微量喂养策略。比较恢复出生体质量时间、恢复出生体质量后每天增长克数、静脉营养时间、住院时间；记录并发症情况；住院期间监测肝肾功能、电解质、血脂分析、血气分析等。酶联免疫吸附法检测血浆中肠道屏障蛋白肠脂肪酸结合蛋白（I-FABP）。实时定量PCR（RT—PCR）检测感染相关MicroRNA155。结果2组患儿出生后体质量下降幅度[A组（13．70±3．10）％、B组（5．46±2．64）％]、恢复出生体质量时间[A组（12．20±3．38）d、B组（6．82±3．20）d]、静脉营养时间[A组（29．62±4．16）d、B组（20．80±3．20）d]、平均住院天数[A组（44．60±6．32）d、B组（28．91±4．36）d]比较，B组均优于A组（P均〈0．05）。住院期间高胆红素血症发生率（B组31．2％、A组56．7％）、宫外生长迟缓发生率（B组34．3％、A组73．3％）、胆汁淤积发生率（B组6．2％、A组23．3％）、喂养不耐受发生率（B组15．6％、A组53．3％）、坏死性小肠结肠炎发生率（B组0、A组16．7％），B组较A组显著减少，差异均有统计学意义（P均〈0．05）。A组肠道屏障蛋白I-FABP的血浆水平[（9．083±1．059）μg／L]高于B组[（7．563±0．739）μg／L]，但差异无统计学意义（t=1．190，P=0．0764）。A组中坏死性小肠结肠炎患者I-FABP的血浆水平[（19．500±3．510）μg／L]高于B组[（7．563±0．739）μg／L]，差异有统计学意义（t=5．231，P=0．0350）。A组的MicroRNA155基因表达量2也Ac‘为0．81±0。12，显著高于B�Objective To study the role of early intravenous nutrition given aggressively combined with early minimal feeding on very low birth weight infants （ VLBWI）, and to evaluate the clinical value of intestinal barrier protein and MicroRNA. Methods All of 62 cases of VLBWI admitted in NICU, the Maternal and Child Health Hospital of Nantong Affiliated to Nantong University from January 2006 to June 2014 were recruited. Sixty - two VLBWI were randomly divided into group A and group B. Thirty infants in group A were exposed to conventional intravenous nutrition. Thirty- two infants in group B were treated with early intravenous nutrition aggressively combined with early minimal feeding. The time of birth weight recovery, days with intravenous nutrition, hospital stay and complications were recorded. The liver and kidney functions, electrolytes, blood gas analysis were monitored. Enzyme - linked immunosorbent method was used to detect intestinal fatty acid binding protein （I - FABP）, an intestinal barrier protein in plasma. Infection related MicroRNA155 was detected with fluorescent quantitative polymerase chain reaction （RT- PCR）. Results Group B was superior to group A in weight loss after birth [ （ 13.70 ±3.10 ） % vs （5.46±2.64 ） %, P 〈 0. 05 ], shorter recovery time of body weight [ （ 12.20 ±3.38 ） d vs （ 6. 82 ±3.20） d, P 〈 0. 05 ], fewer days with intra- venous nutrition [ （29.62±4.16） d vs（20.80±3.20） d,P 〈0.05] and shorter hospital stays [ （44. 60 ±6.32） d vs （28.91 ± 4.36） d, P 〈 0.05 ]. Compared with group A, the infants in group B had less complications,including hyper- bilirubinemia （31.2% vs 56. 7% ）, extrauterine growth retardation （34. 3% vs 73.3% ）, cholestasis （6. 2% vs 23.3% ） ,feeding intolerance （ 15.6% vs 53.3% ） and necrotizing enterocolitis （0 vs 16.7% ） （ all P 〈 0.05 ）. Although I - FABP had a higher plasma concentration in group A than that of group B [ （9. 083 ± 1. 059） μg/L vs （7. 563± 0.739） μg/L

关 键 词：婴儿 极低出生体质量 静脉营养 微量喂养 

分 类 号：R722.6[医药卫生—儿科]