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目的探讨早期营养支持策略对早产儿生长和代谢的影响。方法回顾性分析我院2005—2007年(A组82例)和2008—2010年(B组82例)出生体重≤1800g、无先天畸形、住院2周以上、存活出院早产儿的临床资料,比较两组出生时一般情况、肠内外营养摄入、体格增长及血生化指标。结果与A组相比,B组早产儿应用氨基酸、脂肪乳剂更早[氨基酸:(1.8±0.4)天比(2.1±0.9)天,脂肪乳:(2.2±0.6)天比(2.6±1.6)天],起始剂量更高[氨基酸:(1.4±0.5)g/(kg·d)比(0.8±0.3)g/(kg·d),脂肪乳:(0.9±0.2)g/(kg·d)比(0.6±0.3)g/(kg·d)],且开奶时间早(1天比2天),肠内热卡达到100kcal/(kg·d)的日龄更早(20天比25天),第7天摄入奶量明显增多(45ml/天比22ml/天),母乳喂养及混合喂养率明显增加(56.1%比40.0%),肠外营养时间缩短(24天比27天),体重和身长增长速度更快[体重:(22.6±3.3)g/(kg·d)比(18.6±4.4)g/(kg·d),身长:(1.1±0.6)cm/周比(0.8±0.4)cm/周],出院时宫外生长迟缓发生率降低(58.5%比72.0%),住院时间缩短(30天比35天),血白蛋白、前白蛋白、尿素氮、血磷水平明显增高[白蛋白:(34.2±2.8)g/L比(31.8±2.9)g/L,前白蛋白:(112.0±25.0)mg/L比(89.0±19.0)mg/L,尿素氮:(4.1±2.1)mmol/L比(3.3±1.8)mmol/L,血磷:(2.0±0.5)mmol/L比(1.8±0.5)mmol/L],总胆汁酸和碱性磷酸酶明显降低[总胆汁酸:(25.1±19.7)μmol/L比(38.6±25.2)μmol/L,碱性磷酸酶:(315.4±120.0)U/L比(471.1±202.3)U/L],差异均有统计学意义(P<0.05)。结论早期更积极的营养支持策略能促进早产儿的生长,减少宫外生长迟缓的发生,缩短住院时间,改善营养状况。
Objective To investigate the effect of early nutritional support on the growth and metabolism of premature infants. Methods The clinical data of 82 preterm infants discharged from our hospital from 2005 to 2007 (group A, 82 cases) and 2008-2010 (group B, 82 cases) with birth weight ≤ 1800g without congenital malformations and hospitalization for more than 2 weeks were retrospectively analyzed. The two groups were born at the general situation, enteral nutrition, body growth and blood biochemical indicators. Results Compared with group A, the amino acids were used in preterm infants in group B, with the earlier fat emulsion [amino acid: (1.8 ± 0.4) days vs. (2.1 ± 0.9) days) and fat emulsion: (2.2 ± 0.6) Day] and higher initial dose [amino acid: (1.4 ± 0.5) g / (kg · d)) (0.8 ± 0.3) g / (kg · d) (0.6 ± 0.3) g / (kg · d)], and the earlier the milk was taken (1 day vs. 2 days), the earlier the age of enteral heat card reached 100 kcal / (kg · d) 25 days), significantly increased milk intake (45ml / day vs. 22ml / day) on day 7, significantly increased breastfeeding and mixed feeding rates (56.1% vs 40.0%), shorter parenteral nutrition time (24 days vs 27 days (Body weight: (22.6 ± 3.3) g / (kg · d) vs (18.6 ± 4.4) g / (kg · d), body length: (1.1 ± 0.6) cm / week 0.8 ± 0.4 cm / week]. The incidence of eutopic delayed growth (58.5% vs. 72.0%), hospital stay (30 days vs 35 days), serum albumin, prealbumin, urea nitrogen, (34.2 ± 2.8) g / L (31.8 ± 2.9) g / L, prealbumin (112.0 ± 25.0) mg / L (89.0 ± 19.0) mg / L, (4.1 ± 2.1) mmol / L (3.3 ± 1.8) mmol / L, and phosphorus 2.0 ± 0.5 mmol / L (1.8 ± 0.5) mmol / L] Acid and alkaline phosphatase were significantly lower (total bile acid: (25.1 ± 19.7) μmol / L (38.6 ± 25.2) μmol / L, alkaline phosphatase: (315.4 ± 120.0) U / L ratio U / L], the differences were statistically significant (P <0.05). Conclusion Early, more aggressive nutritional support strategies can promote the growth of premature children, reduce the incidence of extra-uterine growth retardation, shorten the length of hospital stay, and improve nutritional status.