极低出生体重儿的早期全静脉营养的临床探讨

Early total parenteral nutrition in low-birth-weight infants

目的:观察早期大量快速静脉营养和晚期小量静脉营养对极低出生体重儿(VLBW)能量代谢的影响。方法:将63例VLBW患儿随机分成两组,早期全静脉营养组(ETPN)于生后24h内给予2.0g/(kg·天)的氨基酸和1.5g(kg·天)的20%脂肪乳,之后每天增加1.0g/kg;晚期全静脉营养组(LTPN)于生后24～48h开始给予氨基酸0.5g/(kg·天),48～72h开始给予20%脂肪乳0.5g/(kg·天),按0.5g/(kg·天)递增。两组目标剂量均为氨基酸3.5g/(kg·天),20%脂肪乳3.0g/(kg·天)。观察比较两组患儿氮平衡,能量摄入,同时比较胆固醇、甘油三酯、胆红素、肌酐、血糖等生化指标。结果:ETPN组在氮储存上明显高过LTPN组(P<0.01),生后1～5天的能量摄入亦明显升高(P<0.01)。两组在胆固醇、甘油三酯、胆红素、肌酐上无明显区别。LTPN组的血糖水平较ETPN组明显升高(P>0.05)。结论:早期全静脉营养可以避免负氮平衡,增加热卡供给,且对早期预后没有明显不良反应。

Objective：To observe the effect of early nutrition in very low birth weight infants. Methods：Sixty-three preterm infants with birth weights 〈1 500 g received parenteral nutrition containing both 2.0 g/（kg＇d） amino acids（AA） and 1.5 g/（kg.d） lipid within the first 24 hours with a increase of 1.0 g/（kg＇d） in both of them （ETPN group）, or solely glucose during the first day with 0.5 g/（kg.d） AA in second day and 0.5 g/（kg.d） lipid in the third day with a increase of 0.5 g/（kg.d） in both of them （ETPN group）. The final dose of AA is 3.5 g/（kg.d） and lipid is 3.0 g/（kg.d）. To compare nitrogen balances and caloric intake in the two groups,the plasma concentration of cholesterol, triglyceride, bilirubin, creatinine were determined to evaluate the side effect of ETPN. Results： VLBW infants supplemented with ETPN had no major adverse side effects. They got a positive nitrogen balance at the first day and more calories intake. Conclusion：Early total parenteral nutrition administration to VLBW infants results in a positive nitrogen balance and more calories intake.