早期营养策略变化对极早产儿宫外生长发育迟缓发生率的影响及高危因素分析  

Effects of early nutritional strategy changes on the incidence of extrauterine growth retardation in extremely premature infants and risk factors

作　　者：邹静静[1] 黄咏欣 龙芳[1] 王俊平[1] Zou Jingjing;Huang Yongxin;Long Fang;Wang Junping(Department of Neonatology,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州510010

出　　处：《国际医药卫生导报》2022年第24期3539-3543,共5页International Medicine and Health Guidance News

摘　　要：目的比较早期营养策略调整对极早产儿宫外生长发育迟缓(EUGR)发生率的影响并分析其高危因素。方法本研究为前瞻观察性队列研究,纳入2018年1月1日至2019年12月31日在广东省妇幼保健院产科娩出的胎龄在32周以下的早产儿,按营养策略调整前后分对照组和干预组,收集两组一般情况、肠内外营养情况、并发症等临床资料,比较两组EUGR发生率差异,并采用多因素logistic回归分析分析极早产儿发生EUGR的高危因素。采用独立样本t检验、χ^(2)检验、秩和检验进行比较。结果两组共纳入符合研究条件的早产儿356例,对照组177例,干预组179例。对照组男114例、女63例,胎龄(30.15±1.39)周;干预组男110例、女69例,胎龄(29.83±1.33)周。两组性别、出生体质量、剖宫产率、小于胎龄儿率、窒息率、产前糖皮质激素使用率、多胎妊娠率、母亲妊娠期高血压率比较,差异均无统计学意义(均P>0.05);干预组胎龄[(29.83±1.33)周]与对照组[(30.15±1.39)周]比较,差异有统计学意义(P<0.05)。干预组开始肠内喂养时间[0.5(0.5,28.0)h]、全肠内喂养时间[(28.12±11.76)d]、静脉营养天数[22(14,30)d]、恢复出生体质量时间[(7.58±5.76)d]、达到足量肠内热卡时间[(22.59±9.23)d]均短于对照组[18.0(0.5,68.0)h、(32.29±14.02)d、26(18,35)d、(10.73±7.35)d、(28.64±12.17)d],差异均有统计学意义(均P<0.05);干预组禁食天数[(6.16±6.02)d]少于对照组[(8.19±6.98)d],干预组生后1周氨基酸量和住院期间氨基酸总量、1周热卡量、体质量增长速度[(11.74±3.67)g/kg、(45.40±34.99)g/kg、(360.03±124.31)kcal/kg、(21.04±5.71)g/d]均高于对照组[(10.72±2.81)g/kg、(39.22±18.00)g/kg、(312.51±79.82)kcal/kg、(19.12±5.52)g/d],差异均有统计学意义(均P<0.05)。干预组极早产儿EUGR发生率为69.3%(124/179),低于对照组81.4%(144/177),差异有统计学意义(P<0.05)。多因素回归分析模型显示出生体质量(OR=1.980,95%CI Objective To investigate the effect of early nutritional strategy adjustment on the incidence of extrauterine growth retardation(EUGR)in extremely premature infants and analyze its risk factors.Methods It was a prospective observational cohort study.Extremely premature infants under 32 weeks of gestational age who were delivered in the obstetric department of Guangdong Women and Children Hospital between January 1,2018 and December 31,2019 were selected.They were divided into a control group and an intervention group before and after adjustment of nutrition strategies.The clinical data of the two groups were collected,including general information,enteral nutrition,and complications.The difference in the incidence of EUGR was compared between the two groups.Multivariate logistic regression analysis was used to analyze the high-risk factors of EUGR in extremely premature infants.Independent sample t test,χ^(2) test,and rank sum test were used for comparison.Results A total of 356 premature infants eligible for the study were included in the two groups,including 177 cases in the control group and 179 cases in the intervention group.In the control group,there were 114 males and 63 females,with a gestational age of(30.15±1.39)weeks;in the intervention group,there were 110 males and 69 females,with a gestational age of(29.83±1.33)weeks.There were no statistically significant differences in the gender,birth weight,cesarean section rate,small for gestational age rate,asphyxia rate,prenatal glucocorticoid use rate,multiple pregnancy rate,and maternal hypertension rate during pregnancy between the two groups(all P>0.05).The gestational age of the intervention group[(29.83±1.33)weeks]and the control group[(30.15±1.39)weeks]were significantly different(P<0.05).The time of starting enteral feeding[0.5(0.5,28.0)h],total enteral feeding time[(28.12±11.76)d],intravenous nutrition time[22(14,30)d],time of birth weight recovery[(7.58±5.76)d],and time of achieving sufficient intestinal heat accumulation[(22.59±9.23)d]in th

关 键 词：早期营养策略 极早产儿 宫外发育生长迟缓 高危因素 

分 类 号：R722.6[医药卫生—儿科]