静脉补充谷氨酰胺对极低出生体重儿肠道功能的影响

Effect of parenteral glutamine supplementation on gut function in very low birth weight infants

目的评价含丙氨酰谷氨酰胺（Ala—Gln）肠外营养（parenteral-nutrmon，PN）对极低出生体重儿肠道功能的影响。方法对两家儿童医疗中心2006年4月至2007年2月收治的30例极低出生体重儿进行研究，采用平行、随机、双盲、对照试验，随机分为常规PN组（对照组）和常规PN＋Ala—Gln组（研究组），两组各15例，对照组按照常规给予肠外营养支持，氨基酸的剂量按照中国新生儿营养支持临床应用指南给予[从1．0～2．0g／（kg·d）开始，增至3．5g／（kg·d）]；研究组添加0．3g／（kg·d）Ala—Gln双肽，其中Ala—Gln双肽取代了处方中相应氨基酸的量，谷氨酰胺应用的时间和肠外营养应用的时间一致。本项研究的首要终点指标为达到全肠内喂养H龄（标准配方摄人量≥120ml／（kg·d））、胃潴留次数、完全脱离肠外营养时间和病死率。结果两组患儿比较，达到全肠内喂养H龄[研究组（20±6）d，对照组（21±9）d]、胃潴留次数[研究组（3±4）次，对照组（1±2）次]、以及脱离肠外营养时间[研究组（17±7）d，对照组（17±8）d）]差异均无统计学意义。对照组无患儿死亡，4例自动出院，研究组2例放弃治疗（未完成此项研究），2例自动出院，病死率通过意向性分析，RR值为1．182，95％CI为0．937～1．490，病死率比较差异无统计学意义。结论静脉补充谷氨酰胺未能缩短达到全肠内喂养天数、减少胃潴留次数、缩短全肠外营养应用时间及降低病死率。

Objective To assess the effect of parenteral （PN） glutamine supplementation on gut function in the very low birth weight infants（VLBWIs）. Methods A multieentered, randomized, double-blinded, clinical trial was conducted. Thirty VLBWIs （〈1500 g at birth） at two children＇s medical centers were randomly and equally assigned to either control group [sPN; amino acid was given at the dosage recommended by Chinese guidelines for the use of nutritional support in critically ill neonates（Jun. 2006） ] or glutamine-supplemented group [GlnPN; glutamine intake, 0.3 g/（kg · d） ]. The primary endpoints were the time to achieve full enteral nutrition, the incidence of gastric residuals, duration of parenteral nutrition and mortality. Results There were no significant differences between GlnPN and sPN group in the time to achieve full enteral nutrition F（20 ± 6）d vs （21±9） d], the number of gastric residuals [-（3 ± 4） vs （1 ± 2）] and duration of parenteral nutrition [（17±7）d vs （17±8）d]. Of the 15 infants in the GlnPN group, 2 dropped out and 4 suspended treatment, and 4 in the control group suspended treatment （intention-to-treat analysis showed RR= 1. 182; 95%CI：0. 937-1. 490）. Conclusions Parenteral glutamine supplementation can not shorten the time to achieve full enteral nutrition and duration of parenteral nutrition, or reduce the incidence of gastric residuals and mortality in VLBWIs.