极低出生体重儿早期积极营养支持临床观察

Hospital Actively Strategies of Nutritional Support for very low Birth Weight Infants in the early Clinical Observation

目的:探讨积极的营养支持策略对极低出生体重儿(VLBW)早期生存质量的影响.方法:选择2012年3月至2018年3月入住我院新生儿重症监护病房的VLBW 174例,根据生后营养支持程度分为2组,观察组采用积极的营养支持策略,对照组应用传统的肠道内外营养支持治疗,比较两组出生情况、喂养情况、体格增长、血生化指标及并发症的发生情况.结果:观察组患儿肠内喂养开始时间、达完全肠内营养时间、恢复出生体重时间、最大体重丢失值和住院时间均少于对照组(P<0.05),观察组生长速率要快于对照组(P<0.05).两组间白蛋白、前白蛋白、尿素氮、碱性磷酸酶、磷水平在入院时差异无统计学意义(P>0.05),而在生后2周和出院前差异明显增高(P<0.05),出院前观察组25-OH-D3水平高于对照组,差异有统计学意义(P<0.05).两组住院期间坏死性小肠结肠炎、喂养不耐受、代谢性骨病、宫外生长发育迟缓的发病率差异有统计学意义(P<0.05),呼吸窘迫、湿肺、胆汁淤积、支气管肺发育不良、颅内出血、早产儿视网膜病变、败血症、贫血、肾功能损害、高脂血症、黄疸发病率差异无统计学意义(P>0.05).结论:早期积极的营养支持策略有利于VLBW生长发育,缩短住院时间,降低宫外发育迟缓、代谢性骨病、喂养不耐受、坏死性小肠结肠炎的发生率,且并未增加并发症的发生率.

Objective:To study the effect of aggressive nutrition support strategy on the early quality of life of very low birth weight infant(VLBW).Methods:A total of 174 very low birth weight infants admitted to the neonatal intensive care unit of our hospital from March 2012 to March 2018 were selected and they were divided into two groups according to the degree of postnatal nutrition support.The observation group adopted a early aggressive nutrition support strategy,The control group used the traditional nutrition support treatment,The general condition at birth,feeding,physical growth,blood biochemical parameters and complications were compared between the two groups.Results:The starting of enteral feeding,the time before total enteral nutrition,the recovery of birth weight,the maximum weight loss value and the duration of hospitalization stay in the observation group were earlier than those in the control group(P<0.05).The growth rate of the observation group was faster than that of the control group(P<0.05).There was no statistically significant difference in albumin,prealbumin,urea nitrogen,alkaline phosphatase,and phosphorus levels between the two groups at admission(P﹥0.05),but the difference was significantly increased 2 weeks after birth and before discharge(P<0.05).The 25-OH-D3 level of the observation group before discharge was higher than that of the control group,and the difference was statistically significant(P<0.05).There were statistically significant differences in the incidence of necrotizing enterocolitis,feeding intolerance,metabolic bone disease and extrauterine growth retardation between the two groups during hospitalization(P<0.05),respiratory distress,transient tachypnoea of the newborn,cholestasis,bronchopulmonary dysplasia,intracranial hemorrhage,retinopathy of prematurity,sepsis,anemia,renal impairment,hyperlipidemia,jaundice incidence differences have no statistical significance(P﹥0.05).Conclusions:Early aggressive nutritional support strategies can promote the growth of VLBW,shorten hospital stays,reduce the incidence of extrauterine growth retardation、metabolic bone disease、feeding intolerance and necrotizing enterocolitis,and without increasing incidence of complications.