肠外营养中氨基酸用量对早产儿电解质的影响  

The effects of amino acid contents in parenteral nutrition on serum electrolytes in preterm infants

作　　者：茹喜芳[1] 冯琪[1] 王颖[1] 张欣[1] 李星[1] Ru Xifang;Feng Qi;Wang Ying;Zhang Xin;Li Xing(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中华新生儿科杂志（中英文）》2021年第3期1-7,共7页Chinese Journal of Neonatology

摘　　要：目的探讨肠外营养中氨基酸用量对极/超低出生体重儿(very/extremely low birth weight infant,VLBWI/ELBWI)电解质的影响。方法前瞻性队列研究。选择2016年1~12月北京大学第一医院新生儿重症监护病房生后12 h内入院的VLBWI/ELBWI,参照指南进行早期肠内外营养支持。收集患儿基本情况,记录生后7 d内每日体重、肠内肠外营养、血钾和血钙情况,生后第2、4、7天检测血磷。按生后第1周平均氨基酸用量[g/(kg·d)]将早产儿分为<2.0、2.0~2.49、2.5~2.99和≥3.0组,分析氨基酸用量与早产儿早期电解质水平的关系。结果共纳入符合标准的早产儿71例,其中男40例,女31例,胎龄(29.5±2.0)周,出生体重(1194±176)g,小于胎龄儿15例(21.1%)。生后3 d内和7 d内低钾血症发生率分别为54.9%(39/71)和64.8%(46/71);生后7 d内低磷血症、严重低磷血症和高钙血症发生率分别为67.6%(48/71)、26.8%(19/71)和1.4%(1/71)。<2.0、2.0~2.49、2.5~2.99、≥3.0组生后第3天血钾分别为(4.4±0.9)、(3.4±0.7)、(3.6±0.8)、(3.5±0.5)mmol/L,<2.0组高于其余3组,差异有统计学意义(P<0.05);7 d内低钾血症发生率分别为37.5%、63.6%、70.0%、68.2%,组间比较差异无统计学意义(P>0.05);氨基酸用量越多,生后7 d内低磷血症发生率越高,分别为37.5%、54.5%、66.7%、86.4%(P<0.05);血钙水平组间比较差异无统计学意义(P>0.05)。生后第1周钾补充量与氨基酸用量成正相关(r=0.491,P<0.001)。生后3 d内氨基酸用量为生后第3天血钾的影响因素,生后第1周体重增长百分数和氨基酸用量为生后第7天血钾的影响因素。以生后第1周平均氨基酸用量预测7 d内低钾/低磷血症,受试者工作特征曲线下面积为0.689(P=0.040),界值为2.25 g/(kg·d)时灵敏度88.1%,特异度50.0%。结论早期氨基酸用量对VLBWI/ELBWI至关重要,但可能引起电解质紊乱,尤其应关注低钾血症和低磷血症。Objective To study the effects of amino acid intake in parenteral nutrition on electrolytes in very low birth weight(VLBW)/extremely low birth weight(ELBW)infants.Method This was a prospective study.From January 2016 to December 2016,VLBW/ELBW infants admitted to our neonatal intensive care unit(NICU)within 12 hours after birth received nutritional support in accordance with guidelines.The actual nutrient supply and body weight were recorded every day for 7 days.Serum potassium and calcium levels were examined every day for 7 days after birth and phosphorus was monitored on d2,d4 and d7.The relationship between amino acid intake and serum electrolyte levels in premature infants were analyzed.Result A total of 71 preterm infants were included,including 40 male infants and 31 female infants with a gestational age of(29.5±2.0)weeks and a birth weight of(1194±176)g.15(21.1%)cases were small for gestational age(SGA)infants.The incidences of hypokalemia within 3 and 7 days were 54.9%(39/71)and 64.8%(46/71),respectively;the incidences of hypophosphatemia,severe hypophosphatemia and hypercalcemia within 7 days were 67.6%(48/71),26.8%(19/71)and 1.4%(1/71).According to the mean level of amino acid intake[g/(kg.d)]during the first week,the infants were assigned into four groups(<2.0,2.0~2.49,2.5~2.99 and≥3.0).Among the 4 groups,the mean potassium level on d3 after birth were(4.4±0.9),(3.4±0.7),(3.6±0.8)and(3.5±0.5)mmol/L(P<0.05).The incidences of hypokalemia within 7 days were 37.5%,63.6%,70.0%and 68.2%(P>0.05).The more amino acid intake,the incidences of hypophosphatemia increased(37.5%,54.5%,66.7%,and 86.4%,P<0.05).No statistically significant differences existed among the groups in calcium levels(P>0.05).In the first week after birth,potassium supplementation was positively correlated with amino acid intake(r=0.491,P<0.001).The amino acid intake within 3 days after birth was the influencing factor of serum potassium on d3,the percentage of weight gain and amino acid intake during the first week after birth were i

关 键 词：婴儿 早产 肠外营养 低钾血症 低磷血症 再喂养综合征 

分 类 号：R722.6[医药卫生—儿科]