早产儿静脉营养中不同剂量氨基酸的应用研究  

Strategies of parenteral nutrition for premature infants

作　　者：章晔[1] 任义梅[1] 罗妍妍[1] 李悦[1] 丁蓉[1] 卜欣欣[1] 崔曙东[1] 胡毓华[1] 陈筱青[1] 

机构地区：[1]南京医科大学第一附属医院儿科,南京210029

出　　处：《中华全科医师杂志》2017年第2期122-127,共6页Chinese Journal of General Practitioners

基　　金：江苏省妇幼保健重点学科资助项目（FXK201212）;国家自然科学基金资助（81300521）

摘　　要：目的 评价适宜氨基酸营养对早产儿的生长发育和代谢的影响及其安全性及有效性,探讨合理的早产儿氨基酸应用策略.方法 纳入2015年6月至2016年1月出生体质量为1 000～2 500 g的早产儿107例,对照组81例,研究组26例.患儿均在出生后2h内开始静脉营养,对照组氨基酸起始剂量为1.0～1.5 g·kg^-1·d^-1,研究组起始剂量为2.0～2.5 g·kg^-1·d^-1.脂肪乳、葡萄糖及电解质的应用均按统一静脉营养方案执行.记录患儿出生基本情况、生长发育、生化指标、并发症等资料.结果 两组早产儿的胎龄、出生体质量、新生儿窒息发生率等差异无统计学意义（均P＞0.05）.研究组生后1周内总蛋白、非蛋白热卡摄入高于对照组,生后2周内的总热卡摄入高于对照组,但差异无统计学意义（均P＞0.05）.与对照组相比,研究组较早开奶[（3.54±3.18）d比（5.64±5.81）d,P =0.02],较快达完全肠内营养[（16.50 ±9.54）d比（21.21±15.63）d,P=0.07],较早恢复出生体质量时间[（7.35 ±4.55）d比（9.19±9.50）d,P=0.19],静脉营养时间缩短[（16.88±8.99）d比（22.33±18.10）d,P=0.04],住院时间缩短[（20.62±10.41）d比（24.22±15.62）d,P=0.18],住院费用减少[（21 929.00±11 945.42）元比（37 499.58±71 146.80）元,P=0.14].研究组代谢性酸中毒发生率下降[5（19.23％）比37 （45.68％）,P=0.02],坏死性小肠结肠炎、败血症、宫外发育迟缓、胆汁淤积、动脉导管未闭、新生儿呼吸窘迫综合征、院内感染等并发症发生率以及人工通气时间、氧疗时间不增加,代谢紊乱（高血糖、低血糖、低钙血症、低钠血症、低钾血症、低镁血症）等并发症与对照组相当,均P＞0.05.结论 早产儿需尽早于生后2h内供给氨基酸,起始剂量高于2g· kg^-1·d^-1有助于早产儿提早开奶、缩短静脉营养,有利于代谢的稳定,减少并发症,缩短住院时间,降低住院费用.Objective To evaluate the appropriate strategies of parenteral nutrition for premature infants.Methods One hundred and seven preterm babies with birth weights ranging from 1 000-2 500 g received parenteral nutrition within 2 h after birth during June 2015 to January 2016.Lipids,glucose and electrolytes were applied with standard protocol of parenteral nutrition;while the amino acids contents were1.0-1.5 g · kg^-1 · d^-1 in 81 cases （control group） and 2-2.5 g · kg^-1 · d^-1 in 26 cases （study group）.The data of demographics,development,laboratory findings and complications were documented.Results There were no significant differences in the baseline data of gestational age,birth weight between two groups （P 〉 0.05）.There were also no significant differences in total protein intake and target non-protein calorie intake within the first week after birth and the total calorie intake during the first two weeks between study group and control group （P 〉 0.05）.The start of enteral feeding [（3.54 ± 3.18） d vs.（5.64±5.81） d,P=0.02）],the start of total enteral nutrition [（16.50±9.54） d vs.（21.21 ±15.63） d,P=0.07）],the recovery of birth weight [（7.35±4.55） vs.（9.19±9.50） d,P=0.19）] in study group were earlier than those in control group.The duration of parenteral nutrition [（16.88 ± 8.99） d vs.（22.33 ± 18.10） d,P =0.04],the duration of hospital stay [（20.62 ± 10.41] d vs.（24.22 ± 15.62） d,P =0.18] were shorter and the hospitalization expenses [（21 929.00 ± 11 945.42] Yuan vs.（37 499.58 ±71 146.80） Yuan,P =0.14] were lower in study group than those in control group.The incidence of metabolic acidosis was significantly lower in study group than that in control group （19.23% vs.45.68%,P =0.02）.There were no significant differences in complications of necrotizing enterocolitis,sepsis,extrauterine growth retardation,parenteral nutrition-associated cholestasis,patent ductus arteriosus,respiratory distress syndrome,nosocomial and the duratio

关 键 词：胃肠外营养 婴儿 早产 氨基酸类 

分 类 号：R722.6[医药卫生—儿科]