早期肠胃营养对于小于胎龄儿宫外生长发育的影响

目的：探讨早期肠内营养联合肠外营养支持对小于胎龄儿（ SGA）宫外生长发育的影响。方法选取2011至2014年温州市中心医院出生的SGA患儿90例，按照胎龄及出生体重分组：①胎龄分组：≥37周组12例及＜37周组78例；②出生体重分组：≥2．5 kg组36例及＜2．5 kg组54例，均接受早期肠内营养联合肠外营养支持治疗，监测生化指标、体重、头围及恢复出生体重时间；统计宫外发育迟缓（ EUGR）的发生率；评价患儿喂养的耐受情况。结果①不同出生体重组：总胆红素（ TBIL）、胆固醇（CH）、甘油三酯（TG）及尿素氮（BUN）、头围及体重增长情况的差异无统计学意义（t值分别为9．009、9．435、9．221、9．758、10．297、9．502，均P＞0．05）；出生体重≥2．5kg组的恢复出生体重时间（t＝6．663，P＜0．05）及EUGR发生率均显著下降，两组比较差异有统计学意义（χ2＝5．632，P＜0．05）；②不同胎龄组：生化指标（TBIL、CH、TG、BUN）及EUGR的发生率比较，差异无统计学意义（t值分别为11．039、11．445、10．280、10．775，（χ2＝11．457，均P＞0．05）；与胎龄＜37周组相比较，胎龄≥37周组头围及体重增长速度增加，恢复至出生体重的时间显著缩短，两组比较差异有统计学意义（ t值分别为5．647、4．090、3．677，均P＜0．05）；③所有病例无喂养不耐受情况发生。结论早期肠内营养联合肠外营养支持有助于改善SGA的宫外生长发育情况。

Effect of early gastrointestinal nutrition on extrauterine growth of small-for-gestational-age infants

Objective To evaluate the effect of early gastrointestinal nutrition combined with parenteral nutrition on extrauterine growth of small-for-gestational-age （SGA） infants.Methods From 2011 to 2014, totally 90 cases of SGA infants born in Wenzhou Central Hospital were selected, and they were divided into four groups according to gestational age and birth weight： ≥37 weeks group （ n=12 ） , 〈37 weeks group （n=78）,≥2.5 kg group （n=36） and 〈2.5 kg group （n=54）, respectively.All of them received early enteral nutrition combined with parenteral nutrition support.Biochemical indicators, body weight, head circumference and the time return to birth weight were determined.The incidence of extrauterine growth retardation （ EUGR） was recorded and the feeding tolerance of infants was assessed. Results There were no significant differences in TBIL, CH, TG, BUN, head circumference and weight gain between two groups with different birth weight （t value was 9.009, 9.435, 9.221, 9.758, 10.297 and 9.502, respectively, all P〉0.05）.The time return to birth weight reduced （ t=6.663,P〈0.05） and the incidence of URGR decreased in≥2.5kg group, and the differences were significant （χ2 =5.632,P〈0.05）.The differences in biochemical indicators （TBIL,CH,TG,BUN） and the incidence of EUGR were not significant between groups with different gestational age （t value was 11.039, 11.445, 10.280 and 10.775, respectively, χ2 =11.457,all P〉0.05）.Compared with 〈37 weeks group, the increasing of head circumference and body weight was faster and the time return to birth weight reduced in≥37 weeks group.The differences were significant （t value was 5.647, 4.090 and 3.677, respectively, all P〈0.05）. No feeding intolerance was found in any cases.Conclusion Early enteral nutrition combined with parenteral nutrition support is helpful to improve the growth and development of SGA.