肠内营养开始时间对极低出生体重儿消化功能及生长速度的影响

Effects of enteral nutrition starting time on digestive function and growth rate in very low birth weight infants

摘要:

目的 探讨极低出生体重儿（VLBWI）适宜的肠内营养开始时间，观察不同肠内营养开始时间对VLBWI 消化功能、生长速度及院内感染率的影响。方法 选择NICU 病区2012 年2~12 月入院的全部VLBWI，根据肠内营养开始时间，将其分为3 组，即≤ 3 d 组（116 例）、4~6 d 组（36 例）、≥ 7 d 组（26 例）。分析不同肠内营养开始时间对消化功能、生长速度及院内感染率等的影响。结果 ≤ 3 d 组生后1 周奶量明显高于另2 组，≤ 3 d 组及4~6 d 组生后2 周、3 周奶量明显高于≥ 7 d 组。3 组生长速度指标比较差异无统计学意义。≤ 3 d 组中心静脉置管时间明显短于另外2 组，≥ 7 d 组达全肠内营养的时间明显长于另外2 组。≤ 3 d组院内感染率（13.8%）明显低于≥ 7 d 组（46.2%）。结论 肠内营养开始时间对VLBWI 生长速度无影响，但早期开始肠内营养能促进其胃肠功能成熟，利于奶量增长，能更快达到全肠内营养，缩短中心静脉置管时间，降低院内感染率。

Abstract:

Objective To study the appropriate time of starting enteral nutrition and observe the effects of different enteral nutrition starting times on the digestive function, growth rate, and nosocomial infection rate in very low birth weight infants (VLBWI). Methods All the VLBWI admitted to the neonatal intensive care unit between February and December, 2012 were selected. Depending on different times of starting enteral nutrition, these infants were divided into three groups: ≤3 days (n=116), 4-6 days (n=36), and ≥7 days (n=26). The effects of different enteral nutrition starting times on digestive function, growth rate and nosocomial infection rate were analyzed. Results The ≤3 days group had significantly higher milk intake than the other two groups at one week after birth; the ≤3 days and 4-6 days group had significantly higher milk intake than the ≥7 days group at two and three weeks after birth. The growth rate showed no significant differences between the three groups. The ≤3 days group had a significantly shorter time of central venous catheterization than the other two groups, and the ≥7 days group had a significantly longer time to full enteral feeding than the other two groups. The nosocomial infection rate of the ≤3 days group (13.8%) was significantly lower than that of the ≥7 days group (46.2%). Conclusions For VLBWI, the time of starting enteral nutrition has no impact on growth rate, but starting enteral nutrition early can promote the development of gastrointestinal function, increase milk intake, shorten the time to full enteral feeding, reduce the time of central venous catheterization, and significantly reduce nosocomial infection rate.