肠外营养联合肠内喂养对早产儿体格发育的影响

论文编号:HL221 论文字数:10378,页数:28

论文题目：肠外营养联合肠内喂养对早产儿体格发育的影响

摘　要
 目的：探讨肠外营养联合肠内喂养对早产儿体格发育的影响。
 方法：选取我院新生重症监护病房收治的早产儿90例，随机分为对照组(A组)、观察组（B组），每组45例，A组在肠外营养的基础上，按照20mL /(kg·d) 的递增奶量进行肠内营养，B组在肠外营养的基础上，按照30mL /(kg·d) 的递增奶量进行肠内营养。测量两组早产儿出生时的体重、身长、头围、1分钟Apgar评分、5分钟Apgar评分；测量两组早产儿出生后10天和1月时的体重、身长、头围；对两组早产儿在矫正胎龄40周时进行NBNA评分；记录两组早产儿相关并发症发生例数及相关临床指标。
 结果：两组早产儿性别、胎龄、出生时体重、身长、头围、1分钟Apgar评分、5分钟Apgar评分相比较，差异均无统计学意义(P＞0.05)，具有可比性。两组出生后10天内体重的变化趋势是相似的，但观察组在4天后的上升幅度大于对照组，较快恢复到出生时的水平；观察组第10天体重高于对照组，但差异无显著性(P＞0.05)；观察组1月时的体重明显高于对照组，差异有统计学意义（P＜0.05）；观察组第10天、1月的身长均高于对照组，但差异均无统计学意义(P＞0.05)；观察组第10天、1月的头围均高于对照组，差异均亦无统计学意义(P＞0.05)。观察组在矫正胎龄40周时行为能力、被动肌张力、主动肌张力、原始反射的评分均高于对照组，差异均有统计学意义（P＜0.05）；观察组在矫正胎龄40周时一般评估的评分与对照组相比，差异无统计学意义(P＞0.05)；观察组矫正胎龄40周时NBNA评分高于对照组，两组相比差异有统计学意义(P＜0.05)。观察组与对照组在住院期间的喂养不耐受、高胆红素血症、呼吸暂停及NEC发生率相比，差异均无统计学意义(P＞0.05)。观察组达到完全肠内喂养的时间、恢复出生体重的时间、肠外营养的时间、住院时间及住院费用均低于对照组，差异有统计学意义（P＜0.05）。
 结论：1 肠外营养加30mL/(kg·d)的喂养添加量可以促进早产儿体重的增长。
 2 肠外营养加30mL/(kg·d)的喂养添加量不增加早产儿喂养的相关并发症，
 尤其是不会增加NEC的发生率。
 3肠外营养加30mL/(kg·d)的喂养添加量可以促进早产儿尽快达到完全肠内喂养，缩短早产儿恢复出生体重和肠外营养的时间。
 
 关 键 词：早产儿；肠外营养；肠内营养
 论文类型：应用研究
 
  
 
 Title: Effects of parenteral nutrition combined with enteral feeding on premature infants' physical development.

Abstract
 Objectives: To explore the effects of parenteral nutrition combined with enteral feeding on premature infants' physical development.
 Methods: 90 cases of premature infants in the neonatal intensive care unit of our hospital were randomly assigned into control group(group A),the observation group(group B).There are 45 cases in each group. All infants in the two groups received parenteral nutrition .At the same time ,the infants in group A received enteral nutrition according to  20mL / ( kg·d ) increasing milk quantity .While the infants in group B received enteral nutrition according  to 30mL / ( kg·d ) increasing milk quantity. The birth weight, length, head circumference, Apgar score at 1 min,Apgar score at 5 min of all preterm infants were measured when they were born. The birth weight, length, head circumference of preterm infants in two groups were measured when they were 10 days old and one month old respectively.NBNA score of  premature infants in two groups were measured when the corrected gestational age was 40 weeks.Record the cases of related complications in two groups and their relevant clinical indexes.
 Results：There were no ssignificant differences between the two groups in the gender, gestational age, birth weight, length,head circumferenc, 1 minute Apgar score, Apgar score at 5 min. The weight change tendency of two groups in 10 days are similar, but after 4 days the rising amplitude in the observation group was greater than that of the control group, more rapid recovery to levels at birth;The body weight of the observation group was higher than that of the control group in the tenth day, but the difference was not significant ( P > 0.05 ). The body weight in the observation group was significantly higher than that in the control group when they were one month old, the difference was statistically significant ( P < 0.05 ).When they were 10 days old,one month old,the length in the observation group was higher than that of the control group, but the differences were not statistically significant ( P
> 0.05 ). When they were 10 days old,one month old, the head circumference in the observation group was higher than that of the control group,there was also no  significant difference.When the corrected gestational age was 40 weeks , passive muscle tension, capacity of active muscle tone, primitive reflexes score of premature infants in the observation group were higher than those in the control group, the difference was statistically significant ( P < 0.05 ). When the corrected gestational age was 40 weeks, the general assessment score of the observation group was not statistically significant compared with the control group( P >0.05 ). When the corrected gestational age was 40 weeks, the NBNA score in the observation group was higher than the control group, there were significant differences between the two groups ( P < 0.05 ). There were no significant differences between the two groups in feeding intolerance , hyperbilirubinemia, apnea and the incidence of NEC during the hospitalization period( P >0.05 ). The time of reaching full enteral feeding , the time of reaching the birth weight, the duration of parenteral nutrition, duration of hospital stay and hospital costs of the observation group were lower than the control group, the differences were statistically significant( P < 0.05 ).
 Conclusion:1 Parenteral nutrition plus 30mL / ( kg·d ) feeding amount can promote the growth of body weight of premature infants.
 2 Parenteral nutrition plus 30mL / ( kg·d ) feeding amount dose not increase the feeding associated complications of premature infants, especially does not increase the incidence of NEC.
 3 Parenteral nutrition plus 30mL / ( kg·d ) feeding amount can promote the premature infants to achieve full enteral feeding as soon as possible and shorten the recovery of birth weight and the duration of parenteral nutrition.
 Key Words：premature infants；parenteralnutrition；enteral nutrition
 Type Of Thesis: Applied  Research
 
目  录
1 绪论 1
1.1背景及意义 1
1.2目的及目标 2
1.3关键词及定义 2
1.4文献回顾 2
2 研究方法 5
2.1 研究设计 5
2.2 研究对象 5
2.3研究工具/方法 5
2.3.1  测量并记录两组研究对象的基础资料 5
2.3.2  测量两组研究对象在矫正胎龄40周时NBNA的评分 5
2.3.3  记录两组早产儿的喂养相关并发症 6
2.3.4  记录两组早产儿的相关临床指标 6
2.4 研究步骤 6
2.5 统计学分析方法 6
3 研究结果 7
3.1  两组研究对象基础资料的比较 7
3.2  观察组与对照组出生后体重、身长、头围的比较 8
3.3  观察组与对照组矫正胎龄40周时NBNA评分的比较。 9
3.4  观察组与对照组早产儿相关并发症的比较。 10
3.5  观察组与对照组早产儿相关临床指标的比较。 10
4 讨论 13
4.1基础资料分析 13
4.2  两种喂养添加量对早产儿生长发育的影响 14
4.3  两种喂养添加量下早产儿相关并发症的比较 15
4.4  两种喂养添加量下早产儿相关临床指标的比较 16
5 推论及建议 17
5.1推论 17
5.2建议 17
致    谢 19
参考文献 21
附    录 23