早期肠内营养治疗对极低出生体重儿近期预后及hGH、IGF-1的影响

Effect of Early Enteral Nutrition Treatment on the Level of hGH,IGF-1 and Short-term Prognosis of Very Low Birth Weight Infants

目的探讨早期肠内营养治疗对极低出生体重儿近期预后的临床影响。方法将136例极低出生体重儿根据肠内营养开始治疗时间分为A组（≤3d,n=73）、B组（4-6d,n=41例）和C组（≥7d,n=22）三组,比较三组极低出生体重儿的生长速度、消化功能改善情况,并比较三组极低出生体重儿治疗前后生长激素（hGH）、胰岛素样生长因子-1（IGF-1）水平变化情况。结果三组低出生体重儿消化道症状发生率及头围增长幅度、体重增长幅度比较差异无统计学意义（P〉0.05）;第1周时A组奶量均高于B组、C组（P〈0.05）,B组奶量高于C组（P〈0.05）;第2、3周时A组、B组奶量均高于C组（P〈0.05）;A组院内感染发生率低于C组（P〈0.05）;第1周时,A组身长增长幅度高于B组和C组（P〈0.05）,B组高于C组（P〈0.05）;A组达全肠内营养时间低于B组和C组（P〈0.05）,B组低于C组（P〈0.05）;A组、B组住院时间均低于C组（P〈0.05）;A组hGH、IGF-1水平均高于B组和C组,B组高于C组,差异有统计学意义（P〈0.05）。结论早期肠内营养治疗增加了极低出生体重儿喂奶量,缩短了达全肠内营养时间、中心静脉置管时间及住院时间,值得临床重视。

Objective To explore the clinical effects of early enteral nutrition treatment on short-term prognosis of very low birth weight infants. Methods 136 cases of very low birth weight infants based on the start time of enteral nutrition therapy were divided into group A（ 3 days,73 cases）,group B（ 4-6 days,41 cases） and group C（ 7 days,22 cases） of three groups. The growth hormone（ hGH） and insulin like growth factor-1（ IGF-1） levels before and after treatment were detected,and the changes growth rate and digestive function improvement were recorded and analyzed. Results The gastrointestinal symptoms,the head circumference and body weight growth rate in three groups of low birth weight infants had no significant difference（P〈0. 05）. The amounts of milk in group A at first week were higher than those in B group and C group（P〈0. 05）,group B yield higher than that of C group（P〈0. 05）. At second and 3rd weeks,the amounts of milk in group A and group B were higher than those in group C（P〈0. 05）; the incidence of nosocomial infection in group A was significantly lower than that in C group（P〈0. 05）. At first week,the height growth rate in Group A was higher than that of group B and group C（P〈0. 05）,and group B higher than that in group C（P〈0. 05）. The time to reach full enteral nutrition in group A was shorter than that of group B and group C（P〈0. 05）,and group B shorter than that in group C（P〈0. 05）. The h GH and IGF-1 levels in group A were higher than those in group B and group C,and group B higher than that in group C（P〈0. 05）. Conclusion The early enteral nutrition treatment could increase the amount of feeding in very low birth weight infants,shorten the time to reach full enteral nutrition,central venous catheter time and hospitalization time.