早期大剂量氨基酸对小早产儿生长发育和代谢的影响  

Effect of Early Large Dose of Amino Acids on Growth and Metabolism of Small Preterm Infants

作　　者：刘颖[1] 张珍[1] 樊娟[1] 周于新[1] 

机构地区：[1]北京大学深圳医院儿科,广东省深圳市518036

出　　处：《中国全科医学》2013年第35期4163-4166,共4页Chinese General Practice

摘　　要：背景早期使用大剂量氨基酸进行肠外营养有利于小早产儿的生长发育,国外报道多从>2.0 g·kg-1·d-1开始,但国内相关文献报道较少,现行常用方案多从1.0 g·kg-1·d-1开始。目的探讨早期大剂量氨基酸对小早产儿生长发育和代谢的影响。方法选择2010年1月—2013年3月在我院分娩的小早产儿62例,采用随机数字表法分为观察组32例和对照组30例。观察组小早产儿在出生后2 h内补充小儿氨基酸,剂量从2.5 g·kg-1·d-1开始,第2天增加到3.5 g·kg-1·d-1,体质量<1 000 g的小早产儿第3天增加到4.0 g·kg-1·d-1;对照组小早产儿出生后2 h内补充小儿氨基酸,剂量从1.0 g·kg-1·d-1开始,第2天起按1.0 g·kg-1·d-1递增,直至3.5 g·kg-1·d-1(最高剂量)。观察两组小早产儿生长发育指标、代谢指标及并发症情况。结果 (1)观察组小早产儿体质量下降幅度、宫外发育迟缓发生率低于对照组,体质量增加速度、身长增加速度大于对照组,恢复出生体质量时间、达足量经口喂养时间短于对照组(P<0.05);两组小早产儿头围增加速度比较,差异无统计学意义(P>0.05)。(2)两组小早产儿出生时血清前清蛋白(Pre-ALB)水平比较,差异无统计学意义(P>0.05);观察组小早产儿出生第7、14天血清Pre-ALB水平均高于对照组(P<0.05);两组小早产儿出生第14天血清肌酐、尿素氮、直接胆红素、总胆汁酸、钙、磷、钾水平及剩余碱、二氧化碳结合力比较,差异均无统计学意义(P>0.05)。(3)两组小早产儿肠外营养相关性胆汁淤积症发生率比较,差异无统计学意义(P>0.05),而观察组高钾血症、败血症发生率均低于对照组(P<0.05)。结论早期使用大剂量氨基酸进行胃肠外营养可改善小早产儿营养状况,促进其生长发育且耐受性良好,对机体代谢影响小。Backgrounds Early large dose of amino acids （AA）, benefiting the growth of small preterm infants, of- ten starts, by abroad reports, from 〉 2. 0 g · kg- 1 · d - 1. But it is less reported in domestic literatures. The common - used program started from 1.0 g· kg-1· d - 1. Objective To evaluate the effect of early large dose of AA on the growth and metabo- lism of small preterm infants. Methods Total 62 small preterm infants （ gestational age≤ 32 weeks, birth weight ≤ 1 800g） were divided randomly into groups study （n = 32 ）, control （n = 30 ）. The study group were supplemented with paediatric AA 2 h after birth, the initial dose started from 2. 5 g · kg-1 · d-1 , then increased to 3.5 g · kg-l · d -1 on days 2, and for those whose body masses were 〈 1 000 g, increased to 4. 0 g · kg -1· d -1 on days 3. The control group were supplemented with paedi- atric AA 2 h after birth, the initial dose was 1.0 g ~ kg-J · d- 1, then increased progressively by 1.0 g · kg- 1· d -1 from days 2, till 3.5 g · kg- l · d - 1. The indexes of growth and metabolism and complications were observed. Results The descend range of body mass and EUGR incidence lower, increase of body mass, body length were larger, time for returning to birth body mass and reaching adequate oral feeding shorter in study group than those in control group （ P 〈 0. 05 ）. There was no significant difference in increase of head circumference between 2 groups （P 〉 0. 05 ）. No significant difference was noted in level of preal- bumin （ Pre - ALB） between 2 groups （ P 〉 0. 05 ） on birthday; Level of Pre - ALB was higher in study group than those in control group on days 7, 14 after birth （P 〈 0. 05 ）. There was no significant difference in levels of serum creatinine, urea nitro- gen, bilirubin direct, total bile acid, calcium, phosphorus, potassium or base excess, carbon dioxide combining power be- tween 2 groups on days 14 after birth （ P 〉 0. 05 ）. There was no difference in incidence of paren

关 键 词：婴儿 早产 婴儿 出生时低体重 胃肠外营养 氨基酸类 生长和发育 代谢 

分 类 号：R153.2[医药卫生—营养与食品卫生学] R722.6[医药卫生—公共卫生与预防医学]