早产儿静脉营养的临床观察

Clinical observation on parenteral nutrition regimen in preterm infants

目的：探讨静脉营养早产儿的应用价值及安全性。方法：将64例早产儿随机分为观察组（32例）和对照组（32例），观察组生后第3d开始应用氨基酸，开始剂量0．5g／（kg·d），每日增加0．5～3．0g／kg；生后第4d开始应用脂肪乳，开始剂量每日0．5g／kg，每日增加0．5～3.0g／kg；生后第3d开始补充维生素及微量元素适量。静脉营养液采用“全合一”方式，包括葡萄糖、氨基酸、脂肪乳、维生素、微量元素，经外周静脉用微量输液泵在24h内均匀输入，对照组给予一般综合治疗。结果：①两组间胆固醇、甘油三脂、胆红素、尿素氮、碱剩余均无统计学差异。治疗组未发生高胆红素血症及肝肾功能损害。②体重增长比较：观察组生后5～7d开始增长，住院期间体重平均每日增加（15．24±6．32）g。对照组存活32例，生后7～10d体重开始增长，住院期间体重平均每日增加（9．87±3．03）g，两组比较有差异（P〈0．05）。③治愈率比较：观察组32例治愈31例，自动出院1例，治愈率96．87％；对照组32例患儿，治愈24例，好转4例，死亡2例，自动出院2例，治愈率75％。两组比较差异有显著性（P〈0．05）。④并发症比较：观察组32例中发生并发症6例，发生率18．75％，对照组32例中发生并发症14例，发生率43．75％，两组比较差异有显著性（P〈0．05）。结论：周围静脉营养能使早产儿更快更早地增加体重，减少并发症，降低病死率，提高早产儿的存活率和生存质量。

Objective ：To evaluate the application value and safety of peripheral intravenous alimentation in premature infants under medical treatment. Methods ： 64 premature infants were randomly assigned into observation group（32） or control group（32 ）. Amino acid solution was given on the third day of life beginning with a dosage of 0.5 g/kg per day followed by an increase of it in a dose of 0.5 g/kg. a day up to a maximum of daily 3.0 g/kg. Lipids were started on the forth day of the new life with a dosage of 0.5 g/kg per day followed by a daily increase of 0.5 g/kg up to a maximum of 3.0 g/kg a day. Nutritional solution was given with all-in-one, which included glucose, amino acids, lipids, vitannins and trace elements. Parenteral nutrition was administrated through peripheral vein with micro-computer infusion pump in 24 hours a day. The control group received general treatment. Results ： （1）There was no difference in concentration of cholesterol, triglyceride, bilirubin, blood urea nitrogen and base excess between the two groups, and no hyperbilirubinemia, liver or kidney damages occurred in observation group. （2）The weight gain of the infants in the observation group began after birth of from the 5th to 7th day with a daily average of （ 15.24 ± 6.32） g. As far as the control group was concemed,body weight of the infants tended to increase after 7 - 10 days of their birth with daily average of （19.87 ± 3.03 ） g, which suggested significant difference （ P 〈 0.05 ）. The percentage of complication was 18.75 % compared with 43.75% in the control group and that was significantly different （P 〈 0.05 ）. Conclusion： Preterm infants can receive parenteral nutrition regimen with little side effects. As compared with control group, parenteral nutrition may improve the weight gain,shorten hospital stay and cut down complications of preterm infants.