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目的探讨早产极低出生体重儿(very low birth weight infant,VLBWI)早期生长与肠外肠内营养的关系,为早产VLBWI肠外营养(parenteral nutrition,PN)和肠内营养(enteral nutrition,EN)实践管理提供科学依据。方法根据早产VLBWI出院校正胎龄与出生胎龄的体重Z-评分(Z-score)改变(ΔWt SDS)分为两组:非生长减速(non-catch-down,NCD)组,ΔWt SDS≥-0.67;生长减速(catch-down,CD)组,ΔWt SDS<-0.67。两组临床资料行回顾性分析。结果NCD组92例、CD组85例早产VIBWI。两组母亲孕期主要并发症发生率、出生胎龄、出生体格指标(体重、身长、头围)及相应Z-score差异无统计学意义(P>0.05)。NCD组出院体格指标及相应Z-score显著高于CD组(P<0.05或<0.01)。NCD组支气管肺发育不良和静脉营养相关性胆汁淤积症发生率显著低于CD组(P<0.05)。NCD组PN时间显著低于CD组(P<0.01)。出生5~7dNCD组PN脂肪乳摄入量和PN能量摄入量均显著高于CD组(P均<0.05),而出生2~6周NCD组PN能量摄入量显著低于CD组(P<0.05);出生5d~6周NCD组EN摄入奶量则显著高于CD组(P<0.05或<0.01);出生5d~5周NCD组PN和EN总蛋白质摄入量显著高于CD组(P<0.05)。结论早产VLBWI出生1周内充足PN脂肪乳和能量摄入,EN喂养量增加,可降低PN时间,获早期生长改善。
Objective To investigate the relationship between early growth and parenteral enteral nutrition of very low birth weight infant (VLBWI) preterm premature VLBWI (PN) and enteral nutrition (EN) Practice management to provide a scientific basis. Methods According to the change of Z-score (ΔWt SDS) between pre-delivery VLBWI discharge corrected gestational age and gestational age at birth, the patients were divided into two groups: non-catch-down (NCD) group, ΔWt SDS≥- 0.67; Catch-down (CD) group, ΔWt SDS <-0.67. Two sets of clinical data retrospective analysis. Results NCD group 92 cases, CD group 85 cases of preterm delivery VIBWI. There were no significant differences in the incidence of major complications during pregnancy, gestational age at birth, birth and birth weight (body weight, length, head circumference) and corresponding Z-score between the two groups (P> 0.05). Physical status and corresponding Z-scores of discharged patients in NCD group were significantly higher than those in CD group (P <0.05 or <0.01). The incidence of bronchopulmonary dysplasia and parenteral nutrition-related cholestasis in the NCD group was significantly lower than that in the CD group (P <0.05). PN time in NCD group was significantly lower than that in CD group (P <0.01). The intake of PN fat emulsion and the PN energy intake of the NCD group were significantly higher than those of the CD group at 5-7 d after birth (all P <0.05), while those of the NCD group at 2-6 weeks after birth were significantly lower than those of the CD group (P <0.05 or <0.01). The intake of PN and EN total protein in NCD group was significantly higher than that of CD group Group (P <0.05). CONCLUSIONS: Adequate PN fat emulsion and energy intake within one week after birth of preterm VLBWI were observed. Increased EN feeding could reduce PN duration and improve early growth.