目的 探讨早产极低出生体重儿(very low birth weight infant,VLBWI)早期生长与肠外肠内营养的关系,为早产VLBWI肠外营养(parenteral nutrition,PN)和肠内营养(enteral nutrition,EN)实践管理提供科学依据。方法 根据早产VLBWI出院校正胎龄与出生胎龄的体重Z-评分(Z-score)改变(ΔWt SDS)分为两组:非生长减速(non-catch-down,NCD)组,ΔWt SDS≥-0.67;生长减速(catch-down,CD)组,ΔWt SDS＜-0.67。两组临床资料行回顾性分析。结果 NCD组92例、CD组85例早产VIBWI。两组母亲孕期主要并发症发生率、出生胎龄、出生体格指标(体重、身长、头围)及相应Z-score差异无统计学意义(P＞0.05)。NCD组出院体格指标及相应Z-score显著高于CD组(P＜0.05或＜0.01)。NCD组支气管肺发育不良和静脉营养相关性胆汁淤积症发生率显著低于CD组(P＜0.05)。NCD组PN时间显著低于CD组(P＜0.01)。出生5~7 d NCD组PN脂肪乳摄入量和PN能量摄入量均显著高于CD组(P均＜0.05),而出生2~6周NCD组PN能量摄入量显著低于CD组(P＜0.05);出生5 d~6周NCD组EN摄入奶量则显著高于CD组(P＜0.05或＜0.01);出生5 d~5周NCD组PN和EN总蛋白质摄入量显著高于CD组(P＜0.05)。结论 早产VLBWI出生1周内充足PN脂肪乳和能量摄入,EN喂养量增加,可降低PN时间,获早期生长改善。
Abstract
Objective To investigate the relationship between early growth of preterm very low birth weight infant (VLBWI) and parenteral and enteral nutrition,so as to provide scientific basis for parenteral nutrition (PN) and enteral nutrition (EN) regimen in clinical practice. Methods All eligible VLBWIs were divided into two groups according to the change of Z-score (ΔWt SDS) between birth and correct gestational age at discharge for body weight:non-catch-down (NCD) group,ΔWt SDS≥-0.67;catch-down (CD) group:ΔWt SDS＜-0.67.Clinical data were analyzed between the two groups. Results There were 92 cases in NCD group and 85 cases in CD group.No significant differences were found in incidence of maternal complications,birth anthropometric parameters (weight,length,head circumference) and relative anthropometric parameters Z-score between the two groups (P＞0.05).The NCD group had better anthropometric parameters and relative anthropometric parameters Z-score than the CD group at discharge (P＜0.05 or ＜0.01).The NCD group had lower incidence of bronchopulmonary dysplasia and parenteral nutrition associated cholestasis than the CD group (P＜0.05).The NCD group had significant lower PN duration than the CD group (P＜0.01).The NCD group had higher PN energy intake than the CD group from day 5 to day 7 (P＜0.05).However,the NCD group had lower PN energy intake than the CD group from week 2 to week 6 (P＜0.05).The NCD group had higher EN feeding volume from day 5 to week 6 (P＜0.05 or ＜0.01).The NCD group had higher EN and PN total protein intake from day 5 to week 5 (P＜0.05). Conclusion Adequate PN lipid and energy intake during the first week of life,enhanced EN feeding volume could shorten PN duration and improve early growth of VLBWI.
关键词
早产极低出生体重儿 /
早期生长 /
肠外营养 /
肠内营养
Key words
preterm very low birth weight infant /
early growth /
parenteral nutrition /
enteral nutrition
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基金
广东省自然科学基金(2015A030313148);国家级大学生创新训练计划的项目(201601069)
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