中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2010年
2期
100-103
,共4页
微量喂养%肠内喂养%静脉营养%早产儿%极低出生体重儿%半随机对照试验
微量餵養%腸內餵養%靜脈營養%早產兒%極低齣生體重兒%半隨機對照試驗
미량위양%장내위양%정맥영양%조산인%겁저출생체중인%반수궤대조시험
Trophic feeding%Enteral feeding%Parenteral nutrition%Preterm infants%Very low birth weight infants%Quasi-randomized controlled trial
目的 观察早期微量喂养对极低出生体重儿(VLBWI)生后6周宫外生长与预后的影响.方法 选择2007年1月至2009年1月无锡市儿童医院与南京医科大学附属南京儿童医院NICU收治的出生体重﹤1 500 g且需要辅助通气和静脉营养的VLBWI为研究对象,根据单双病床号分为早期微量喂养组和对照组.早期微量喂养组:在静脉营养的同时从生后第3天开始经鼻饲管给予早产儿配方乳0.5～1 mL·h~(-1),直至辅助通气结束;对照组:仅予静脉营养直至辅助通气结束.监测生后6周内的能量摄入、生长状况、脓毒症(血培养阳性)发生率、肝功能、喂养耐受情况、辅助通气时间、住院时间和喂养相关并发症的发生率.结果 早期微量喂养组18例,对照组22例进入分析.早期微量喂养组入组时胎龄、出生体重和新生儿临床危险指数评分与对照组差异均无统计学意义.①早期微量喂养组生后6周内总能量摄入显著高于对照组,平均差异为261.1 kJ·kg~(-1),P＝0.03.②早期微量喂养组生后6周时点体重增长值显著高于对照组,两组差异为120 g,P＝0.02;头围增长值显著高于对照组,平均差异为0.6 cm,P＝0.04;中臂围两组差异为0.30 cm,P＝0.48;三头肌皮肤皱褶厚度两组差异为0.22 mm,P＝0.51.③两组生后6周内肝功能指标与黄疸持续时间差异无统计学意义;早期微量喂养组生后6周内脓毒症发生率显著低于对照组,P＝0.03.④早期微量喂养组需要静脉营养的时间显著少于对照组,P＝0.03;过渡到完全肠内营养的时间显著少于对照组,P＝0.03.⑤早期微量喂养组需氧时间显著少于对照组,P＝0.02;平均住院时间显著少于对照组,P＝0.03.⑥两组生后6周内各种喂养相关并发症(腹胀、呕吐、坏死性小肠结肠炎和吸入性肺炎)的发生率差异无统计学意义.结论 早期微量喂养可改善VLBWI生后6周宫外生长状况.
目的 觀察早期微量餵養對極低齣生體重兒(VLBWI)生後6週宮外生長與預後的影響.方法 選擇2007年1月至2009年1月無錫市兒童醫院與南京醫科大學附屬南京兒童醫院NICU收治的齣生體重﹤1 500 g且需要輔助通氣和靜脈營養的VLBWI為研究對象,根據單雙病床號分為早期微量餵養組和對照組.早期微量餵養組:在靜脈營養的同時從生後第3天開始經鼻飼管給予早產兒配方乳0.5～1 mL·h~(-1),直至輔助通氣結束;對照組:僅予靜脈營養直至輔助通氣結束.鑑測生後6週內的能量攝入、生長狀況、膿毒癥(血培養暘性)髮生率、肝功能、餵養耐受情況、輔助通氣時間、住院時間和餵養相關併髮癥的髮生率.結果 早期微量餵養組18例,對照組22例進入分析.早期微量餵養組入組時胎齡、齣生體重和新生兒臨床危險指數評分與對照組差異均無統計學意義.①早期微量餵養組生後6週內總能量攝入顯著高于對照組,平均差異為261.1 kJ·kg~(-1),P＝0.03.②早期微量餵養組生後6週時點體重增長值顯著高于對照組,兩組差異為120 g,P＝0.02;頭圍增長值顯著高于對照組,平均差異為0.6 cm,P＝0.04;中臂圍兩組差異為0.30 cm,P＝0.48;三頭肌皮膚皺褶厚度兩組差異為0.22 mm,P＝0.51.③兩組生後6週內肝功能指標與黃疸持續時間差異無統計學意義;早期微量餵養組生後6週內膿毒癥髮生率顯著低于對照組,P＝0.03.④早期微量餵養組需要靜脈營養的時間顯著少于對照組,P＝0.03;過渡到完全腸內營養的時間顯著少于對照組,P＝0.03.⑤早期微量餵養組需氧時間顯著少于對照組,P＝0.02;平均住院時間顯著少于對照組,P＝0.03.⑥兩組生後6週內各種餵養相關併髮癥(腹脹、嘔吐、壞死性小腸結腸炎和吸入性肺炎)的髮生率差異無統計學意義.結論 早期微量餵養可改善VLBWI生後6週宮外生長狀況.
목적 관찰조기미량위양대겁저출생체중인(VLBWI)생후6주궁외생장여예후적영향.방법 선택2007년1월지2009년1월무석시인동의원여남경의과대학부속남경인동의원NICU수치적출생체중﹤1 500 g차수요보조통기화정맥영양적VLBWI위연구대상,근거단쌍병상호분위조기미량위양조화대조조.조기미량위양조:재정맥영양적동시종생후제3천개시경비사관급여조산인배방유0.5～1 mL·h~(-1),직지보조통기결속;대조조:부여정맥영양직지보조통기결속.감측생후6주내적능량섭입、생장상황、농독증(혈배양양성)발생솔、간공능、위양내수정황、보조통기시간、주원시간화위양상관병발증적발생솔.결과 조기미량위양조18례,대조조22례진입분석.조기미량위양조입조시태령、출생체중화신생인림상위험지수평분여대조조차이균무통계학의의.①조기미량위양조생후6주내총능량섭입현저고우대조조,평균차이위261.1 kJ·kg~(-1),P＝0.03.②조기미량위양조생후6주시점체중증장치현저고우대조조,량조차이위120 g,P＝0.02;두위증장치현저고우대조조,평균차이위0.6 cm,P＝0.04;중비위량조차이위0.30 cm,P＝0.48;삼두기피부추습후도량조차이위0.22 mm,P＝0.51.③량조생후6주내간공능지표여황달지속시간차이무통계학의의;조기미량위양조생후6주내농독증발생솔현저저우대조조,P＝0.03.④조기미량위양조수요정맥영양적시간현저소우대조조,P＝0.03;과도도완전장내영양적시간현저소우대조조,P＝0.03.⑤조기미량위양조수양시간현저소우대조조,P＝0.02;평균주원시간현저소우대조조,P＝0.03.⑥량조생후6주내각충위양상관병발증(복창、구토、배사성소장결장염화흡입성폐염)적발생솔차이무통계학의의.결론 조기미량위양가개선VLBWI생후6주궁외생장상황.
Objective To investigate the effect of early trophic feeding on clinical outcomes in very low birth weight infants(VLBWI).Methods A controlled, prospective study on preterm infants, weighting less than 1 500 g at birth and requiring ventilatory support and parenteral nutrition, was performed in the NICU of Nanjing Children′s Hospital Affiliated to Nanjing Medical School from January 2007 to January 2009. Preterm infants enrolled into the study were divided into trophic feeding group and control group according to odd and even numbers. Trophic feeding group received trophic feeding from day 3 (0.5-1 mL·h~(-1)) along with parenteral nutrition until ventilatory support was finished. Control group received parenteral nutrition alone. "Nutritive" milk feeding was then introduced to both groups. Clinical outcomes were measured including total energy intake and growth over the first six postnatal weeks, sepsis incidence, liver function, milk tolerance, duration of respiratory support, duration of hospital stay and feeding related complications incidence. Results According to the inclusion and exclusion criteria, 40 VLBWI hospitalized in the NICU were enrolled into the study, 18 in trophic feeding group and 22 in control group. There were no significant differences in birth weight, gestational age and neonatal clinical risk index scores(CRIB) between the two groups. There were significant differences in energy intake (mean difference=261.1 kJ·kg~(-1), P=0.03),weight gain (mean difference=120 g, P=0.02), head circumference gain (mean difference=0.6 cm, P=0.04), fewer episodes of culture confirmed sepsis (mean difference=35%, P=0.02), less parenteral nutrition (mean difference=9.5 days, P=0.03), tolerated full milk feeding (150 mL·kg~(-1)·d~(-1)) earlier (mean difference=12 days, P=0.03), reduced requirement for supplemental oxygen (mean difference=21.5 days, P=0.02) and being discharged from hospital earlier (mean difference=20.5 days, P=0.03) between trophic feeding group and control group. There was no significant difference in the feeding related complications such as bloating, vomiting, necrotizing enterocolitis and aspiration pneumonia. Conclusions Trophic feeding could improve clinical outcomes in very low birth weight preterm infants requiring parenteral nutrition.
