脐静脉置管对早产儿生后早期营养状况的影响

Effect of umbilical vein catheterization on early postnatal nutrition of preterm infants

目的探讨脐静脉置管(UVC)对早产儿生后早期营养状况的影响。方法将2017年1月至2019年2月我科所有实施中心静脉置管的早产儿,根据置管种类,分为UVC组、经外周静脉穿刺中心静脉置管(PICC)组及UVC+PICC组,同时选取符合要求的未实施中心静脉置管的早产儿纳入对照组,分别将UVC组与对照组,UVC+PICC组与PICC组的营养相关指标及并发症情况进行对比,了解UVC对早产儿生后早期营养状况的影响。结果 UVC组与对照组在性别、生产方式、胎龄、出生体质量及有无窒息、新生儿呼吸窘迫综合征(NRDS)等生后严重并发症等方面比较,差异无统计学意义(P> 0.05),而在恢复出生体质量时日龄、达足量喂养时日龄、住院期间日均体质量增长等营养指标上优于对照组,差异有统计学意义(P <0.05),在出院时与出生时白蛋白差值、好转出院率、住院时长、出院时足量喂养率、直接胆红素(DBil)异常率、丙氨酸氨基转移酶(ALT)异常率、喂养不耐受发生率、败血症发生率、坏死性小肠结肠炎(NEC)发生率上比较,差异无统计学意义(P>0.05);UVC组与UVC+PICC组在性别、生产方式上比较,差异无统计学意义(P>0.05),而UVC+PICC组的胎龄、出生体质量较PICC组更小,差异有统计学意义(P <0.05),窒息及NRDS等生后严重并发症的发生率较PICC组更高,差异有统计学意义(P <0.05),在出院时与出生时白蛋白差值、DBil异常率、喂养不耐受发生率上优于PICC组,差异有统计学意义(P <0.05),在恢复出生体质量日龄、达足量喂养日龄、住院期间日均体质量增长、好转出院率、住院时长、出院时足量喂养率、ALT异常率、败血症发生率、NEC发生率上与PICC组比较,差异无统计学意义(P>0.05)。结论 UVC无论是单独应用,还是联合PICC,均能改善早产儿生后早期的营养状况,而在导管相关并发症的发生率上并不高于未行中心静脉置管组。

Objective To investigate the effect of umbilical vein catheterization(UVC) on early postnatal nutritional state of preterm infants. Methods All preterm babies who received central vena catheterization at our department from January 2017 to February 2019 were divided into UVC group, UVC + peripherally inserted central catheterization(PICC) group, and PICC group according to the type of catheterization. And the control group cases were chosen from those who did not receive central vena catheterization. Nutrition state and nutritional/catheter-related complications were compared among different groups to investigate the effect of UVC on early postnatal nutrition of preterm infants. Results Gestational age, sex, mode of delivery, birth weight, and severe postnatal complications such as asphyxia and neonatal respiratory distress syndrome did not differ significantly between the UVC group and control group(P>0.05), while age at which birth weight was restored, age at which adequate feeding was achieved, and average daily weight gain during hospitalization were significantly better in the UVC group than in the control group(P < 0.05). Other indexes including adequate feeding rate till discharge, cure and discharge rates, hospitalization time, albumin increase, abnormal direct bilirubin(DBil) and alanine transaminase(ALT) rates, feeding intolerance rate, and the incidence of sepsis and necrotizing enterocolitis(NEC) had no statistical differences(P > 0.05). Sex composition and mode of delivery were comparable between the UVC + PICC and PICC group, while gestational age, birth weight, and rate of perinatal complications were significantly worse in the UVC + PICC group than in the PICC group(P < 0.05). In terms of nutritional index, the UVC + PICC group had significantly better albumin increase, the abnormal DBil rate and feeding intolerance rate(P < 0.05), although there were no statistical difference in age at which birth weight was restored, age at which adequate feeding was achieved, average daily weight gain during hospitalization, cure and discharge rates, hospitalization time, adequate feeding rate till discharge, abnormal ALT rate, or incidence of sepsis and NEC(P > 0.05). Conclusion UVC, either used individually or in combination with PICC, can improve early postnatal nutritional state of preterm infants, without increasing the incidence of nutritional/catheterrelated complications.