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目的探讨早期个体化外周静脉营养方案对极低出生体重儿(VLBWIs)的耐受性和临床效果。方法将湖南省浏阳市妇幼保健院2005年8月至2010年7月收治的不能耐受全胃肠道营养的早产VLBWIs115例随机分为2组。实验组58例,于生后12h开始应用个体化外周静脉营养方案;对照组57例,于生后48h开始应用传统外周静脉营养方案。每天计算供给2组患儿公斤体重热卡、观察恢复出生体重时间、恢复出生体重后静脉营养期间每日体重增长情况,每天测量体重、监测血糖,每周测头围、身长各1次,在入院时、住院期间定期抽血了解肝功能、肾功能、血脂、血糖、电解质、血常规、碱性磷酸酶(ALP)的情况。观察静脉营养相关并发症发生情况,并进行统计学分析。结果 1周内相同日龄实验组所供热卡明显高于对照组,差异有统计学意义(P<0.05);实验组恢复出生体重时间明显短于对照组,差异有统计学意义(P<0.05);实验组住院14d时白蛋白分别与同期对照组和住院72h比较差异均有统计学意义(P<0.05);实验组头围、身长增长较对照组快,差异有统计学意义(P<0.05);实验组较对照组长至2kg所需住院时间明显缩短,差异有统计学意义(P<0.05);两组间比较均未增加代谢性酸中毒、胃肠外营养相关性胆汁淤积(PNAC)、脂质代谢紊乱、高胆红素血症以及肾功能损害;两组间比较ALP差异无统计学意义(P<0.05);但VLBWIs的ALP在住院14d与住院72h比较差异有统计学意义(P<0.05)。结论 VLBWIs早期个体化外周静脉营养耐受性好,体重增长快,达全胃肠喂养时间缩短,没有增加肠外营养相关并发症。生长发育
Objective To investigate the tolerability and clinical efficacy of early individualized peripheral venous nutrition regimens for very low birth weight infants (VLBWIs). Methods One hundred and fifteen cases of preterm VLBWIs that could not tolerate total gastrointestinal nutrition admitted to Liuyang Maternal and Child Health Hospital of Hunan Province from August 2005 to July 2010 were randomly divided into two groups. Fifty-eight patients in experiment group received individualized peripheral vein nutrition program 12h after birth. In control group, 57 patients received traditional peripheral vein nutrition program 48h after birth. Calculated daily supply of 2 kg of body weight in children with heat card to observe the recovery of birth weight time, weight gain after birth to restore daily weight gain during intravenous nutrition, daily measurement of body weight, blood sugar monitoring, circumference per week circumference, length of 1 each in the At admission, blood was drawn regularly during hospitalization to understand liver function, renal function, blood lipids, blood glucose, electrolytes, blood, and alkaline phosphatase (ALP). Observed the incidence of complications related to parenteral nutrition, and statistical analysis. Results The heat card supplied by the experimental group of the same age within 1 week was significantly higher than that of the control group (P <0.05), and the weight of the experimental group was significantly shorter than that of the control group (P < 0.05). The albumin in the experimental group was significantly higher than that in the control group and hospitalized for 72h (P <0.05) on the 14th day of hospitalization. The head circumference and length of the experimental group were faster than the control group (P <0.05). Compared with the control group, the length of hospital stay required in the experimental group was significantly shorter than that of the control group (P <0.05). Metabolic acidosis, parenteral nutrition-related cholestasis (PNAC), dyslipidemia, hyperbilirubinemia and renal dysfunction. There was no significant difference in the ALP between the two groups (P <0.05). However, there was statistical difference between the ALP of VLBWIs in hospital for 14 days and in hospital for 72 hours Significance (P <0.05). Conclusion Early individualized peripheral vein of VLBWIs have good nutrition tolerance, fast weight gain, shortened total gastrointestinal feeding time and no increase of parenteral nutrition related complications. Growth and development