中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2013年
3期
268-272
,共5页
李月凤%张敏%刘方%周平%卢光进
李月鳳%張敏%劉方%週平%盧光進
리월봉%장민%류방%주평%로광진
近期临床结局%围生期%危险因素%肠道喂养延迟%极低出生体重儿
近期臨床結跼%圍生期%危險因素%腸道餵養延遲%極低齣生體重兒
근기림상결국%위생기%위험인소%장도위양연지%겁저출생체중인
Short-term clinical outcome%Perinatal period%Risk factor%Delayed enteral feeding%Very low birth weight infants
目的 探讨极低出生体重儿(very low birth weight infants,vLBwI)肠道喂养延迟的近期临床结局和围生期因素与VLBWI肠道喂养延迟的关系.方法 选取2007年1月至2011年10月入住我科的355例VLBWI为研究对象,根据生后肠道喂养开始时间分为两组:延迟喂养组57例(开奶时间≥5 d)和早期喂养组298例(开奶时间≤4d),并比较住院天数＞14d、治愈或好转出院的299例VLBWI近期临床结局(包括延迟喂养组44例和早期喂养组255例).采用单因素和多因素Logistic回归对VLBWI的围生期高危因素进行分析.结果 355例VLBWI喂养延迟发生率为16.05％ (57/355).延迟喂养组患儿恢复到出生体重的时间明显长于早期喂养组[(11.86±3.86) dvs (9.76±3.83)d,P＜0.01].延迟喂养组患儿合并静脉营养相关性胆汁淤积症和出院时宫外发育迟缓的比例为27.27％(12/44)和79.55％ (35/44),亦明显高于早期喂养组[分别为11.76％(30/255)和61.57％(157/255),P＜0.05)].多因素Logistic回归分析显示,胎盘早剥和机械通气增加了VLBWI生后肠道喂养延迟的风险(OR =2.74,95％ CI 1.06 ～7.05；OR =3.51,95％ CI 1.92～ 6.42,P＜0.05).结论 胎盘早剥和机械通气是VLBWI生后肠道喂养延迟的独立危险因素.加强产前保健及产儿合作是改善早产儿结局、减少肠道喂养延迟的关键.
目的 探討極低齣生體重兒(very low birth weight infants,vLBwI)腸道餵養延遲的近期臨床結跼和圍生期因素與VLBWI腸道餵養延遲的關繫.方法 選取2007年1月至2011年10月入住我科的355例VLBWI為研究對象,根據生後腸道餵養開始時間分為兩組:延遲餵養組57例(開奶時間≥5 d)和早期餵養組298例(開奶時間≤4d),併比較住院天數＞14d、治愈或好轉齣院的299例VLBWI近期臨床結跼(包括延遲餵養組44例和早期餵養組255例).採用單因素和多因素Logistic迴歸對VLBWI的圍生期高危因素進行分析.結果 355例VLBWI餵養延遲髮生率為16.05％ (57/355).延遲餵養組患兒恢複到齣生體重的時間明顯長于早期餵養組[(11.86±3.86) dvs (9.76±3.83)d,P＜0.01].延遲餵養組患兒閤併靜脈營養相關性膽汁淤積癥和齣院時宮外髮育遲緩的比例為27.27％(12/44)和79.55％ (35/44),亦明顯高于早期餵養組[分彆為11.76％(30/255)和61.57％(157/255),P＜0.05)].多因素Logistic迴歸分析顯示,胎盤早剝和機械通氣增加瞭VLBWI生後腸道餵養延遲的風險(OR =2.74,95％ CI 1.06 ～7.05；OR =3.51,95％ CI 1.92～ 6.42,P＜0.05).結論 胎盤早剝和機械通氣是VLBWI生後腸道餵養延遲的獨立危險因素.加彊產前保健及產兒閤作是改善早產兒結跼、減少腸道餵養延遲的關鍵.
목적 탐토겁저출생체중인(very low birth weight infants,vLBwI)장도위양연지적근기림상결국화위생기인소여VLBWI장도위양연지적관계.방법 선취2007년1월지2011년10월입주아과적355례VLBWI위연구대상,근거생후장도위양개시시간분위량조:연지위양조57례(개내시간≥5 d)화조기위양조298례(개내시간≤4d),병비교주원천수＞14d、치유혹호전출원적299례VLBWI근기림상결국(포괄연지위양조44례화조기위양조255례).채용단인소화다인소Logistic회귀대VLBWI적위생기고위인소진행분석.결과 355례VLBWI위양연지발생솔위16.05％ (57/355).연지위양조환인회복도출생체중적시간명현장우조기위양조[(11.86±3.86) dvs (9.76±3.83)d,P＜0.01].연지위양조환인합병정맥영양상관성담즙어적증화출원시궁외발육지완적비례위27.27％(12/44)화79.55％ (35/44),역명현고우조기위양조[분별위11.76％(30/255)화61.57％(157/255),P＜0.05)].다인소Logistic회귀분석현시,태반조박화궤계통기증가료VLBWI생후장도위양연지적풍험(OR =2.74,95％ CI 1.06 ～7.05；OR =3.51,95％ CI 1.92～ 6.42,P＜0.05).결론 태반조박화궤계통기시VLBWI생후장도위양연지적독립위험인소.가강산전보건급산인합작시개선조산인결국、감소장도위양연지적관건.
Objective To investigate the short-term clinical outcomes and perinatal risk factors in very low birth weight infants (VLBWI) with delayed enteral feeding (DEF).Methods Three hundred and fifty-five cases of VLBWI admitted to neonatal intensive care unit from Jan 2007 to Oct 2011 served as study objects,and the clinical data of which were analysed retrospectively.According to days to initiate enteral feeding after birth,355 VLBWI were divided into two groups:DEF group (initiate enteral feeds ≥5 days,n =55)and early feeding group (initiate enteral feeds ≤4 days,n =298).The short-term clinical outcomes were compared in 299 cases,including DEF group 44 cases and early feeding group 255 cases,in which cure or improvement were achieved and hospital stay ＞ 14 d.The perinatal risk factors were subjected to univariate and multivariate logistic regression analysis.Results The incidence of DEF was 16.05％ (57/355) in VLBWI.The time to regain birth weight in DEF group was significantly longer than early feeding group [(11.86 ± 3.86) d vs (9.76 ± 3.83) d,P ＜ 0.01],and the incidences of parenteral nutrition associated cholestasis [27.27％ (12/44)] and extrauterine growth retardation at discharge [79.55 ％ (35/44)] in DEF group were also significantly higher than early feeding group respectively [11.76％ (30/255) and 61.57％ (157/255),P ＜ 0.05].Multivariable logistic regression analysis showed that infants born to mother with placental abruption had higher risk of exposure for DEF than those without placental abruption (OR =2.74,95％ CI 1.06 ～7.05,P ＜ 0.05).Similarly,infants with mechanical ventilation had also higher odds of DEF than those with-out mechanical ventilation (OR =3.51,95 ％ CI 1.92 ～ 6.42,P ＜ 0.01).Conclusion Placental abruption and mechanical ventilation are independent risk factors for DEF in VLBWI.Improving neonatal outcome through enhancing obstetric quality and strengthening cooperation between obstetric and neonatology department is still the key to reduce DEF in VLBWI.
