腸外營養聯合腸內喂養對早產兒體格發育的影響

論文編號:HL221 論文字數:10378,頁數:28

論文題目：腸外營養聯合腸內喂養對早產兒體格發育的影響

摘　要
 目的：探討腸外營養聯合腸內喂養對早產兒體格發育的影響。
 方法：選取我院新生重癥監護病房收治的早產兒90例，隨機分為對照組(A組)、觀察組（B組），每組45例，A組在腸外營養的基礎上，按照20mL /(kg·d) 的遞增奶量進行腸內營養，B組在腸外營養的基礎上，按照30mL /(kg·d) 的遞增奶量進行腸內營養。測量兩組早產兒出生時的體重、身長、頭圍、1分鐘Apgar評分、5分鐘Apgar評分；測量兩組早產兒出生后10天和1月時的體重、身長、頭圍；對兩組早產兒在矯正胎齡40周時進行NBNA評分；記錄兩組早產兒相關并發癥發生例數及相關臨床指標。
 結果：兩組早產兒性別、胎齡、出生時體重、身長、頭圍、1分鐘Apgar評分、5分鐘Apgar評分相比較，差異均無統計學意義(P＞0.05)，具有可比性。兩組出生后10天內體重的變化趨勢是相似的，但觀察組在4天后的上升幅度大于對照組，較快恢復到出生時的水平；觀察組第10天體重高于對照組，但差異無顯著性(P＞0.05)；觀察組1月時的體重明顯高于對照組，差異有統計學意義（P＜0.05）；觀察組第10天、1月的身長均高于對照組，但差異均無統計學意義(P＞0.05)；觀察組第10天、1月的頭圍均高于對照組，差異均亦無統計學意義(P＞0.05)。觀察組在矯正胎齡40周時行為能力、被動肌張力、主動肌張力、原始反射的評分均高于對照組，差異均有統計學意義（P＜0.05）；觀察組在矯正胎齡40周時一般評估的評分與對照組相比，差異無統計學意義(P＞0.05)；觀察組矯正胎齡40周時NBNA評分高于對照組，兩組相比差異有統計學意義(P＜0.05)。觀察組與對照組在住院期間的喂養不耐受、高膽紅素血癥、呼吸暫停及NEC發生率相比，差異均無統計學意義(P＞0.05)。觀察組達到完全腸內喂養的時間、恢復出生體重的時間、腸外營養的時間、住院時間及住院費用均低于對照組，差異有統計學意義（P＜0.05）。
 結論：1 腸外營養加30mL/(kg·d)的喂養添加量可以促進早產兒體重的增長。
 2 腸外營養加30mL/(kg·d)的喂養添加量不增加早產兒喂養的相關并發癥，
 尤其是不會增加NEC的發生率。
 3腸外營養加30mL/(kg·d)的喂養添加量可以促進早產兒盡快達到完全腸內喂養，縮短早產兒恢復出生體重和腸外營養的時間。
 
 關 鍵 詞：早產兒；腸外營養；腸內營養
 論文類型：應用研究
 
  
 
 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  錄
1 緒論 1
1.1背景及意義 1
1.2目的及目標 2
1.3關鍵詞及定義 2
1.4文獻回顧 2
2 研究方法 5
2.1 研究設計 5
2.2 研究對象 5
2.3研究工具/方法 5
2.3.1  測量并記錄兩組研究對象的基礎資料 5
2.3.2  測量兩組研究對象在矯正胎齡40周時NBNA的評分 5
2.3.3  記錄兩組早產兒的喂養相關并發癥 6
2.3.4  記錄兩組早產兒的相關臨床指標 6
2.4 研究步驟 6
2.5 統計學分析方法 6
3 研究結果 7
3.1  兩組研究對象基礎資料的比較 7
3.2  觀察組與對照組出生后體重、身長、頭圍的比較 8
3.3  觀察組與對照組矯正胎齡40周時NBNA評分的比較。 9
3.4  觀察組與對照組早產兒相關并發癥的比較。 10
3.5  觀察組與對照組早產兒相關臨床指標的比較。 10
4 討論 13
4.1基礎資料分析 13
4.2  兩種喂養添加量對早產兒生長發育的影響 14
4.3  兩種喂養添加量下早產兒相關并發癥的比較 15
4.4  兩種喂養添加量下早產兒相關臨床指標的比較 16
5 推論及建議 17
5.1推論 17
5.2建議 17
致    謝 19
參考文獻 21
附    錄 23