极低出生体重儿早期静脉营养的临床研究  

Early parenteral nutrition in very-low-birth-weight infants

作　　者：杨丽娟[1] 田兆方[1] 赵赛[1] 孙兴珍[1] 何蓉[1] 程怀平[1] 

机构地区：[1]南京医科大学附属淮安第一医院新生儿科,江苏淮安223300

出　　处：《临床儿科杂志》2009年第9期829-832,共4页Journal of Clinical Pediatrics

摘　　要：目的研究极低出生体重儿对早期静脉营养的耐受情况和疗效。方法32例极低出生体重儿随机分为2组:经典静脉营养组(CPN)和实验静脉营养组(EPN)。CPN组生后24～48h内仅给予5%～10%葡萄糖,之后加6%小儿氨基酸和20%脂肪乳,氨基酸从1.0g/(kg·d)开始每日递增0.5g/(kg·d),直至3.0g/(kg·d);脂肪乳选用含中长链脂肪酸,从0.5g/(kg·d)开始每日递增0.5g/(kg·d),直至3.0g/(kg·d)。EPN组生后24h内起即予6%小儿氨基酸2.4g/(kg·d)和脂肪乳2.4g/(kg·d),72h内均增至3.0g/(kg·d),即达到足量静脉营养。1周内每天计算总热卡包括胃肠内和胃肠外热卡,检测入院72h内和1周后监测血脂、胆红素、肾功能、血碳酸氢盐、血糖等生化指标,并记录体质量最大丢失,计算1周后可以部分胃肠营养的患儿百分比、恢复出生体质量时间和达到完全胃肠营养时间等指标。结果与CPN组相比,EPN组的总能量摄入以及胃肠外提供热卡在生后前5d明显增高,1周内体质量丢失较少,恢复出生体重时间和恢复完全胃肠营养时间缩短,且未增加代谢性酸中毒、脂质代谢紊乱、高胆红素血症以及肾功能损伤等并发症。结论极低出生体重儿早期可以耐受较大剂量的静脉营养,且有一定的临床效应。Objective To study the efficacy of early aggressive parenteral nutrition and biochemi cal tolerance in very-low-birth-weight（VLBW） infants during the first week of life. Methods Thirty-two preterm infants were randomly divided into two groups：experimental parenteral nutrition（ EPN） group and conventional parenteral nutrition group（CPN） . Infants in EPN group received amino acids（AA） 2.4 g /（kg·d） and 20% Intralipid（IL） 2.4 g /（kg·d） within 24 h after birth,and quantities of AA and IL increased into 3.0 g /（kg·d）（complete parenteral nutrition） within 72 h after birth. CPN group started to receive a solution containing glucose and followed by AA 1.0 g /（kg·d） and IL 0.5 g /（kg·d） during the first 48 h of life,AA and IL was each increased by 0.5 g /（kg·d） to a maximum of 3.0 g /（kg·d） . The intravenous nutrition was gradually reduced when the infants could be fed partially and they were supplied with 247.2-370.8 kJ /kg until they could tolerate full feeds. Total enteral and parenteral caloric intake was checked every day within the first week. Plasma cholesterol,triglycerides,bilirubin,urea nitrogen and creatinine,bicarbonate,and glucose were monitored at 72 h after birth and after first week. Maximum weight loss,percentage of infants who were on partial enteral nutrition within one week after birth,time of birth weight recovery and complete enteral nutrition were recorded. Results In comparison with CPN group,infants in EPN group got more calories intake during first 5 days,less weight loss,shorter time of birth weight recovery and complete enteral nutrition. No infants had complications such as metabolic acidosis,disorders of fatty metabolism,hyperbilirubinism,and renal dysfunction. Conclusions This study showed that aggressive intake of AA and IL could be tolerated immediately after birth by VLBW infants. EPN could significantly reduce weight loss,shorten recovery times of birth weight and complete enteral nutrition.

关 键 词：极低出生体重儿 早产儿 静脉营养 

分 类 号：R722[医药卫生—儿科]