新生儿肠外营养中脂肪乳剂剂量对胆红素代谢影响的研究

Serum bilirubin level and lipid dosage in neonatal parenteral nutrition

目的 观察脂肪乳剂剂量与血清胆红素 (BI)代谢的关系 ,使静脉营养更安全而有效地应用于新生儿。 方法 PN支持≥ 5天的新生儿 39例 ,早产儿 12例 ,足月儿 2 7例 ,持续时间平均10 .5 6d(5～ 31d)。内科NICU中未接受PN支持的高危新生儿 16例作为回顾对照组。静脉营养液中脂肪乳剂 1.0～ 2 .0 g·kg 1·d 117例 ,2 .1～ 3.0 g·kg 1·d 12 2例 ,小儿氨基酸 1.0～ 3 .0 g·kg 1·d 1,葡萄糖 5 .5～ 13 .0 g·kg 1·d 1,热卡 15 5～ 376KJ(37～ 90kcal)·kg 1·d 1,以“全合一”方式经周围静脉缓慢输注。 结果 本组 39例平均血BI值由PN前 91.2± 6 7.8μmol/L降至PN后 46 .5± 42 .2μmol/L(P <0 .0 0 5 )。两组不同剂量的脂肪乳剂应用后的血BI均有明显下降 (P <0 .0 5 ) ,早产儿和足月儿两组应用后的BI值也都有明显下降 (P <0 .0 1)。 39例中 35例治愈出院 ,77% (30 / 39)热卡达2 5 1～ 376KJ(6 0～ 90kcal)·kg 1·d 1,平均体重由PN前的 2 80 8± 6 2 4g增加到 30 2 0± 5 94g ,应用PN的内科治愈出院的 16例患儿与回顾对照组比较 ,平均住院日缩短了 10 .0 8d(P <0 .0 5 )。 结论 新生儿肠外营养时 ,脂肪乳剂应用剂量在 1.0～ 3.0 g·kg 1·d 1是安全的。提示在一般情况下 ,有效剂量范围内不会影响体?

Objective To evaluate the relation of lipids dosage and serum bilirubin level for the safety and effectiveness in neonatal parenteral nutrition(PN). Methods A total of 39 newborns,12 prematures and 27 full term newborns,received PN more than five days.Among them,birth weight was below 2500 grams in 7 of 39 and others was over 2500 grams.Average duration of PN was 10.6 days(range from 5 to 31 days).They were dividede into tow groups based on receiving different lipid dosage,17 infants received 1.0～2.0 g·kg 1 ·d 1 of lipids as a low dosage group and 22 infants received 2.1～3.0 g·kg 1 ·d 1 of lipid as a high dosage group. Results The average serum bilirubin level decreased from 91.2±67.8μmol/L to 46.5±42.2μmol/L after PN in whole population.The serum bilirubin level were decreased in both groups. Conclusions The serum bilirubin level were not influenced by lipids dosage at 1.0～3.0g·kg 1 ·d 1 and it was effective for nutrition support in neonates using this dosage.