早期营养支持策略对早产儿生长和代谢的影响

目的 探讨早期营养支持策略对早产儿生长和代谢的影响.方法 回顾性分析我院2005-2007年(A组82例)和2008-2010年(B组82例)出生体重≤1800 g、无先天畸形、住院2周以上、存活出院早产儿的临床资料,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组相比,B组早产儿应用氨基酸、脂肪乳剂更早[氨基酸:(1.8±0.4)天比(2.1±0.9)天,脂肪乳:(2.2±0.6)天比(2.6±1.6)天],起始剂量更高[氨基酸:(1.4±0.5)g/(kg·d)比(0.8±0.3)g/(kg·d),脂肪乳:(0.9±0.2)g/(kg·d)比(0.6±0.3)g/(kg·d)],且开奶时间早(1天比2天),肠内热卡达到100 kcal/(kg·d)的日龄更早(20天比25天),第7天摄入奶量明显增多(45 ml/天比22 ml/天),母乳喂养及混合喂养率明显增加(56.1%比40.0%),肠外营养时间缩短(24天比27天),体重和身长增长速度更快[体重:(22.6±3.3)g/(kg·d)比(18.6±4.4)g/(kg·d),身长:(1.1±0.6)cm/周比(0.8±0.4)cm/周],出院时宫外生长迟缓发生率降低(58.5%比72.0%),住院时间缩短(30天比35天),血白蛋白、前白蛋白、尿素氮、血磷水平明显增高[白蛋白:(34.2±2.8) g/L比(31.8±2.9)g/L,前白蛋白:(112.0±25.0)mg/L比(89.0±19.0)mg/L,尿素氮:(4.1±2.1)mmol/L比(3.3±1.8)mmol/L,血磷:(2.0±0.5) mmol/L比(1.8±0.5)mmol/L],总胆汁酸和碱性磷酸酶明显降低[总胆汁酸:(25.1±19.7)μmol/L比(38.6±25.2)μmol/L,碱性磷酸酶:(315.4±120.0)U/L比(471.1±202.3)U/L],差异均有统计学意义(P<0.05).结论 早期更积极的营养支持策略能促进早产儿的生长,减少宫外生长迟缓的发生,缩短住院时间,改善营养状况.

The effect of early nutritional support strategy on the growth and metabolism of preterm infants

Objective To study the effect of early nutritional support strategy on growth and metabolism of preterm infants. Methods Total 82 preterm infants, born between 2005 and 2007 (group A), and 82 patients, born between 2008 and 2010 (group B) were recruited. The inclusion criteria were as follows:birth weight less 1800grams, without major congenital malformation,hospital stay duration for more than 2 weeks and the patients survived until discharged. The general condition at birth, enteral and parenteral nutrition intake, growth parameters and blood biochemical parameters between two groups were retrospectively compared. Results Comparing with group A, patients in group B started amino acid and fat emulsion therapy earlier [(1.8±0.4)d vs. ( 2.1±0.9)d, (2.2±0.6)d vs. (2.6±1.6)d], with a higher initial dose[(1.4±0.5)g/(kg·d) vs. (0.8±0.3)g/(kg·d),(0.9±0.2)g/(kg·d) vs. (0.6±0.3)g/(kg·d)], and an earlier enteral feeding time (1 d vs. 2 d). Group B reached oral energy intake of 100 kcal/kg.d earlier (20 d vs. 25 d), and a higher volume of feeding milk on the 7th day of life (45 ml /d vs. 22 ml/d). The rate of breast milk feeding was higher in group B (56.1% vs. 40.0%), and the duration of parenteral nutrition was shorter (24 d vs. 27 d) in group B. Group B had faster average weight and length growth rate [(22.6±3.3) g/(kg·d) vs. (18.6±4.4)g/(kg·d),(1.1±0.6) cm/w vs. (0.8±0.4)cm/w], lower incidence of EUGR (48% vs. 59%), and shorter hospital stay (30 d vs. 35 d). The blood biochemical parameters including ALB, PA, BUN and phosphate levels in group B were significantly higher than group A [(34.2±2.8) g/L vs. (31.8±2.9) g/L, (112.0±25.0) mg/L vs. (89.0±19.0) mg/L, (4.1±2.1) mmol/L vs. (3.3±1.8) mmol/L, (2.0±0.5) mmol/L vs. (1.8±0.5) mmol/L], TBA, ALP were lower[ (25.1±19.7) μmol/L vs. (38.6±25.2) μmol/L, (315.4±120.0) U/L vs. ( 471.1±202.3) U/L]. Conclusions Early proactive nutritional support strategy can promote the growth velocity of premature infants, reduce the incidence of EUGR, shorten hospital stays, and improve nutritional status of premature infants.