论文部分内容阅读
目的探讨超低出生体质量儿(ELBWI)最佳胃肠内喂养(EN)启动时间,以促进ELBWI体质量增长,减少并发症。方法选择2009年11月-2011年9月在北京军区总医院附属八一儿童医院新生儿重症监护中心116例ELBWI,随机分为24 h开奶组和延迟开奶组,每组各58例。24 h开奶组出生24 h内启动EN,延迟开奶组禁食3 d后启动EN。2组均接受“全合一”胃肠外营养(PN),EN 0.5～1.0 mL,2～4次.d-1,梯度增加喂养次数及奶量,至150～160 mL.kg-1.d-1,过渡为全肠内营养。观察2组患儿生化指标、体格发育指标及并发症。结果 24 h开奶组与延迟开奶组性别、胎龄、分娩方式、出生时窒息史及分娩前用药、出生体质量比较差异均无统计学意义(Pa>0.05),纳入条件相同;出院时NEC发生率、住院时间、宫外发育迟缓、喂养不耐受、总胆红素、结合胆红素、γ-谷氨酰转移酶、光疗时间、使用布洛芬在2组间比较差异均无统计学意义(Pa>0.05)。与延迟开奶组相比,24 h开奶组矫正胎龄32周时体质量较高[(1 300.6±161.2)g vs(1 174.8±192.3)g,P=0.000],恢复出生体质量时间短[(13.5±3.7)d vs(15.1±3.2)d,P=0.014],PN时间较短[(45.7±6.7)d vs(54.8±10.6)d,P=0.000],ALT[12.0(3.5,45.0)U.L-1 vs 72.0(30.0,89.3)U.L-1,P=0.000]、ALP[334.5(157.0,378.0)U.L-1 vs 560.0(409.0,997.0)U.L-1,P=0.000]、总胆汁酸[11.4(6.0,13.5)μmol.L-1vs 14.6(9.2,22.3)μmol.L-1,P=0.000]均较低。24 h开奶组胃肠外营养相关胆汁淤积(5%vs 19%,P=0.023)、脓毒症(7%vs 21%,P=0.031)的发生率低于延迟开奶组。结论 ELBWI 24 h内开奶较延迟开奶安全、有效。
Objective To investigate the optimal time of starting gastrointestinal feeding for ELBWI in order to promote the growth of ELBWI and reduce the complications. Methods Selective ELBWI was performed in 116 Neonatal Intensive Care Centers of Bayi Children’s Hospital Affiliated to Beijing Military Region General Hospital from November 2009 to September 2011. The ELBWI patients were randomly divided into 24-hour open milk group and delayed-open milk group, 58 cases in each group. EN was started within 24 h in 24 h milk group, and EN was delayed after 3 d in fasting milk group. The rats in both groups received “all in one” parenteral nutrition (PN), EN 0.5-1.0 mL, 2-4 times .d-1, increasing the feeding frequency and milk volume to 150-160 mL.kg- 1.d-1, transition to full enteral nutrition. The biochemical indexes, physical development indexes and complications of two groups were observed. Results There was no significant difference in sex, birth weight and birth weight between 24-h Kai milk group and delayed-Kai milk group (P> 0.05) The incidence of NEC, hospital stay, extrauterine stunting, feeding intolerance, total bilirubin, conjugated bilirubin, γ-glutamyl transferase, phototherapy time, the use of ibuprofen in the two groups were no significant differences Statistical significance (Pa> 0.05). Compared with the delayed open milk group, the body weight of the 24 h Kai milk group corrected for gestational age was significantly higher at 32 weeks [(1 300.6 ± 161.2) g vs (1 174.8 ± 192.3) g, P = 0.000] (45.7 ± 6.7) d vs (54.8 ± 10.6) d, P = 0.000], ALT [12.0 (3.5) , UL-1 45.0) UL-1 vs 72.0 (30.0,89.3) UL-1, P = 0.000], ALP [334.5 (157.0,378.0) UL-1 vs 560.0 (409.0,997.0) Bile acids [11.4 (6.0, 13.5) μmol.L-1 vs 14.6 (9.2, 22.3) μmol.L-1, P = 0.000] were lower. The incidence of parenteral nutrition-related cholestasis (5% vs 19%, P = 0.023) and sepsis (7% vs 21%, P = 0.031) in the 24-h Kai milk group was lower than in the delayed Kai milk group. Conclusion ELBWI milk within 24 h is more safe and effective than delayed opening of milk.