早期营养支持策略对极低出生体重儿生长代谢及并发症的影响

目的探讨早期营养支持策略对极低出生体重儿生长代谢及并发症的影响。方法回顾性分析我院2009-2012年出生体重〈1500g、无先天消化道畸形、住院2周以上、存活出院的极低出生体重儿临床资料，2009-2010年为A组，2011-2012年为B组。比较两组出生时一般情况、肠内外营养摄入、体格增长及血生化指标。结果与A组（118例）相比，B组（130例）早产儿应用氨基酸、脂肪乳剂更早氨基酸：21．0（17．0，31．5）h比28．0（22．5，41．8）h，脂肪乳：40．0（28．0，46．0）h比45．0（30．0，75．8）h]，起始剂量更高氨基酸：（1．21±0．40）g／（kg·d）比（1．07±0．33）g/（kg·d），脂肪乳：（0．86±0．35）g／（kg·d）比（0．66±0．24）g／（kg·d）]，热卡达到120kcal／（kg·d）时间更短（24．9±9．2）天比（28．4±9．9）天]，开奶时间更早48．0（36．0，71．5）h比56．5（37．0，88．0）h]，禁食时间缩短4．5（2．5，7．5）天比5．0（2．9，8．0）天]，体重增长速度更快（17．04-3．7）g／（kg·d）比（14．54-4．6）g／（kg·d）]，出院时宫外生长迟缓发生率降低（59．2％比82．2％），体重最大下降值减少70．0（40．0，110．0）g比80．0（50．0，117．5）g]，差异均有统计学意义（P〈0．05）。两组坏死性小肠结肠炎、胆汁淤积症、医院感染、早产儿视网膜病变、支气管肺发育不良、呼吸窘迫综合征发生率、氧疗及机械通气时间差异无统计学意义（P〉0．05）。结论早期更积极的营养支持策略能促进早产儿生长，减少宫外生长迟缓的发生，缩短住院时间．不会增加坏死性小肠结肠炎、胆汁淤积症、支气管肺发育不良、早产儿视网膜病变、呼吸窘迫综合征的发生率以及氧疗、机械通气的时间。

The effect of early nutritional support strategy on the growth and complication of very low birth weight infants

Objective To study the effect of an early nutritional support strategy on the growth and complications of very low birth weight infants. Methods A retrospective study of 248 very low birth weight infants admitted to our hospital, who were born between 2009 and 2012 with birth weight lower than 1500 g, without congenital gastrointestinal tract malformation, being hospitalised for at least 2 weeks and safely discharged. They were divided into 2 groups according to their time of hospitalisation ： group A were hospitalised between 2009 and 2010; and group B were hospitalised between 2011 and 2012. General conditions at birth, enteral and parenteral nutrition intake, growth parameters and blood biochemical parameters between the two groups were retrospectively compared. Results Compared with group A,patients in group B started amino acid and fat emulsion therapy earlier 21.0（17.0,31.5） ]h vs. 28.0 （22. 5,41.8） ] h, 40. 0 （28.0,46. 0） ] h vs. 45.0 （30. 0,75. 8 ） h respectively, with a higher initial dose （1.21 ±0. 40）g/（kg.d）vs. （1.07 ±0. 33）g/（kg·d）, （0. 86±0. 35）g/（kg.d） vs. （0. 66 ±0. 24） g /（ kg·d） ] respectively, and earlier enteral feeding time 48.0 （ 36.0,71.5 ） h vs. 56.5 （37.0,88.0）h]. Group B compared to Group A, reached oral energy intake of 120 kcal/kg, d earlier （24. 86 ± 9.20） d vs. （ 28.44 ± 9. 92） d ], had less fasting time 4. 5 （2.5,7. 5 ） d vs. 5.0 （ 2.9,8.0 ） d ], had faster average weight growth rate （ 17. 0 ± 3.7 ） g / （ kg·d）比（ 14. 5±4. 6 ） g / （ kg· d） ], had a lower incidence of extrauterine growth retardation （EUGR） （ 59.2% vs. 82. 2% ）, and less weight decrease 70. 0 （ 40. 0,110.0 ） g vs. 80. 0 （ 50. 0,117.5 ） g ]. These comparisons were all statistically significant （ P 〈 0. 05 ）. The two groups had no statistical significance in the rates of complications - necrotizing enterocolitis （ NEC ）, cholestatic syndrome, infection, retinopathy of prematurity （ ROP）, bronchopulmonary dysplasia （BPD）, respiratory distress syndrome （RDS）, and the duration of oxygen therapy and mechanical ventilation. Conclusions Early nutritional support strategy can promote the growth velocity of very low birth weight infants, reduce the incidence of EUGR, shorten hospital stays, and had no influence on the rates of complications.