极低出生体质量儿早期经外周中心静脉置管下肠外营养临床研究

Clinical Study of Early Parenteral Nutrition Through Peripheral Central Venous Catheter in Very Low Birth Weight Infants

【目的】探讨极低出生体质量儿（VLBWIs）对早期经外周中心静脉置管下肠外营养的耐受性及其临床效果。【方法】将本院新生儿科住院的不能耐受全胃肠道营养的早产 VLBWIs患儿98例随机分为两组，观察组49例于出生2 h内经外周中心静脉置管应用肠外营养；常规治疗组49例于生后48 h开始应用传统的静脉营养方案。住院期间计算出两组患儿热卡、蛋白质，监测血糖、头围、身长，住院期间定期抽血测定各项生化指标，并进行统计学分析。【结果】出生3d观察组所摄入热卡、蛋白质分别达早产儿摄入标准，与常规治疗组比较，差异有统计学意义（P＜0．01）；出生9 d观察组所摄入热卡、蛋白质与常规治疗组比较，差异无统计学意义（P＞0．05）；出生3 d、9 d、21 d观察组热卡和蛋白质累积丢失，明显低于常规治疗组，差异有统计学意义（P＜0．01）。观察组恢复正常出生体质量时间明显短于常规治疗组，差异有统计学意义（P ＜0．01）；观察组头围、身长增长较常规治疗组快，差异有统计学意义（P＜0．05）；两组间比较均未增加相应的并发症。【结论】VLBWIs早期经外周中心静脉置管下足量肠外营养耐受性好，体质量增长快，达全胃肠喂养时间缩短，没有增加肠外营养相关并发症。

[Obj ective]To explore the tolerance and clinical efficacy of early parenteral nutrition through pe-ripheral central venous catheter in very low birth weight infants（VLBWIs）.[Methods]Totally 98 VLBWIs who were not tolerant to full enteral nutrition in neonatology department of our hospital were randomly divided into two groups.The observation group（n=49）received parenteral nutrition through peripheral central venous catheter within 2h after birth,while the routine treatment group（n=49）received traditional venous nutrition scheme at 48h after birth.Calories and protein in two groups during hospitalization were calculated.Blood glucose,head circumference and body weight were monitored.Blood samples were collected to determine biochemical indexes. All the results were statistically analyzed.[Results]Calories and protein intake in observation group at 3 days after birth reached the intake standard of premature infant,and there was significant difference between observation group and routine treatment group（P〈0.01）.There was no significant difference in calories and protein intake at 9 days after birth between observation group and control group（P〉0.05）.The accumulation lose of calories and protein in observation group at 3,9 and 21 days after birth were obviously lower than those in routine treatment group,and there was significant difference（P〈0.01）.The time to regain birth weight in observation group was obviously shorter than that in routine treatment group,and there was significant difference（P 〈0.01）.The growth of head circumference and body height in observation group were faster than those in routine treatment group,and there was significant difference（P 〈0.05）.There was no significant difference in the incidence of complications between two groups.[Conclusion]VLBWIs have good tolerance to early parenteral nutrition.The weight gain is fast,and the time to reach full enteral feeding is shortened,and parenteral nutrition-related compli-cations are not increased.