项崇悟++高丽娟++王传光++王赏莉++何晓红++兰菊红

[摘要] 目的 通過早产儿标准化微量喂养支持护理的临床应用，探讨该护理方式对早产儿生长发育的影响。 方法 选择2014年5月～2016年5月在NICU治疗的早产儿80例，在出生第1天即经鼻胃管输注母乳0.5～1.0 mL/（kg·次），每3小时1次，奶量总控制在6～12 mL/（kg·d），不足部分辅助肠外营养护理的设为观察组；将采用肠外营养（PN）支持护理的设为对照组（n=40）。记录两组早产儿在出生后第1天（T1）、出院时（T2）的血清前蛋白、肾功能、血糖；测量体重、身长、上臂围、头围；记录过度到全肠道营养、生理体重下降恢复、开始全量胃肠内喂养的时间，住院总时间，喂养耐受等。 结果 观察组早产儿在出生日龄、出生后5 min Apgar评分方面与对照组比较，差异无统计学意义（P>0.05）。观察组在生理体重下降的恢复时间、住院总时间、开始全量胃肠营养时间方面与对照组相比较，差异有统计学意义（P<0.05）。观察组喂养耐受率（72.50%）与对照组（30.00%）比较，差异有统计学意义（P<0.05）。T2时点观察组在平均体重、身长、头围、上臂围以及血清前白蛋白与对照组比较，差异有统计学意义（P<0.05）。 结论 采用早期标准化微量胃肠道营养支持护理的方式能满足新生儿对能量和营养的需求，促进早产儿的生长发育。

[关键词] 标准化；早产儿；微量；护理；生长发育

[中图分类号] R473.72；R722.1 [文献标识码] B [文章编号] 1673-9701（2016）35-0146-04

Effect of early standardized micro-feeding support nursing on growth and development of premature infants

XIANG Chongwu1 GAO Lijuan1 WANG Chuanguang2 WANG Shangli2 HE Xiaohong1 LAN Juhong1

1.NICU， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China； 2.Department of Anesthesiology， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To study the clinical application of standardized micro-feeding support nursing in preterm infants and to explore the effect of the nursing method on the growth and development of premature infants. Methods Eighty premature infants who were treated in NICU from May 2014 to May 2016 were selected. On the first day of birth， the breast milk was infused through the nasogastric tube at 0.5 to 1.0 mL/kg once for every 3 hours. The total amount of milk was controlled at（6-12） mL/kg per day. For the insufficient part， the patients who were given auxiliary parenteral nutrition care were selected as the observation group； the patients who were given parenteral nutrition （PN） support care was selected as the control group（n=40）. The serum pre-protein， renal function and blood glucose were recorded on the first day after birth（T1） and at the time of discharge（T2） in the two groups of premature infants. Body weight， body length， upper arm circumference and head circumference were measured； the time transiting to the whole intestine nutrition， recovery of physiological weight decrease， the beginning time of the total amount of gastrointestinal feeding， the total length of hospitalization， and feeding tolerance were recorded. Results There were no significant differences in the birth age in days and 5-min Apgar score in premature infants between the observation group and the control group（P>0.05）. There were significant differences between the observation group and the control group in the recovery time of physiological weight decrease， total length of stay， and the beginning time of total gastrointestinal nutrition（P<0.05）. There was significant difference in the feeding tolerance rate between the observation group（72.50%） and the control group（30.00%） （P<0.05）. There were significant differences between the observation group and the control group in the average body weight， body length， head circumference， upper arm circumference and serum prealbumin at T2（P<0.05）. Conclusion Early standardized micro-gastrointestinal nutrition support nursing can meet the newborn's energy and nutrition needs， and promote the growth and development of premature infants.

[Key words] Standardization； Premature infants； Trace amount； Nursing care； Growth and development

早产儿出生后发育不完善或多器官系统功能不全，是影响出生后生存质量的主要的因素，出生后治疗、护理及营养支持显得优为重要[1]。研究认为早产儿出生后喂养不当可导致患儿营养不良[2]，影响中枢神经系统的发育[3]，导致这类早产儿出生后认知、应答、运动、生活、行为能力等方面等的不可逆转变[4-6]，这也是临床中早产儿护理中的首要问题[7]。为减少上述问题的发生，2014年起丽水市中心医院根据早产儿生长发育的特点与喂养需求，开展了早产儿早期的标准化微量喂养支持护理，现报道如下。