早产极低体重儿两种静脉营养方式的对比研究

Comparison of two parenteral nutrition methods in very low birth weight premature infants

目的比较两种静脉营养方法的效果。方法将35例不能耐受全肠道静脉营养的符合条件早产极低出生体重儿随机分为两组,实验组采用早期静脉营养法,对照组采用传统静脉营养法,记录两组患儿生后1周内营养摄入及2周内体重增长情况、过渡到全肠道喂养时间、静脉营养相关并发症,并于生后第1、7天采静脉血测血清前白蛋白。于生后6个月测量身长和体重。结果实验组生后1周内每日摄入的非蛋白热卡量、2周内平均每日增重均高于对照组(P<0.05);相同日龄血清前白蛋白检测结果:第1天实验组与对照组无差异,第7天实验组[(86±10.8)mg/L]高于对照组[(72±10.9)mg/L];实验组与对照组过渡到全肠道喂养时间无差异;两组均无静脉炎、血栓形成、氮质血症、高脂血症及胆汁淤积的发生,两组呼吸暂停、高血糖、高胆红素血症的发生率差异无显著性(P>0.05)。随访生后6个月的体重,实验组高于对照组,但无统计学意义(P>0.05)。结论早产极低出生体重儿采用早期静脉营养比传统静脉营养摄入热卡多,体重增长快;可以避免早产儿早期营养不良的发生;对胃肠功能的恢复无明显作用;不会增加静脉营养相关并发症的发生。

Objective To compare the effects of the two parenteral nutrition （PN）methods on nutrition states and the incidence of complication associated with PN. Methods Thirty-five very low birth weight premature infants who were intolerant to total enteral nutrition, with a gestational age of less than 34 weeks and a birth weight of less than 1500g,were chosen for this study. They were randomly assigned into two groups ：conventitional PN group （n = 15） and early PN group （n=20）. The body weight, the amount of caloric intake, the time taken to attain full enteral nutrition, and the incidence of complication were recorded daily. Serum prealhumin concentration was measured on the 1st and 7th day after birth. Results The caloric intake in the first week and daily weight gain in the first two weeks in the early PN group were much greater than those of the conventional PN group （P〉0. 05）. On the first day, there was no difference in the serum prealbumin concentration between the two groups. However serum prealbumin concentration increased on the 7th day （86±10.8 mg/L）in the early PN group compared with that in the conventional PN group （72±10.9 mg/ L）（P〉0. 05）. The time taken for the two groups to go on full enteral nutrition was similar. No significant difference was observed in the incidence of complication between the two groups. Conclusion Caloric intake and body weight gain are found to be greater in the early PN group than the conventional PN group in very low birth weight premature infants. The incidence of complication associated with PN and the recovery of gastrointestinal function are unrelated to PN administration method.