极低出生体重儿早期输注不同剂量氨基酸的临床探讨

The clinical comparison of early parenteral supply with different dosage amino acids for very low birth weight infants

目的通过对极低出生体重儿(VLBWI)早期不同方式输注氨基酸的观察,评价VLBWI早期大剂量输注氨基酸的有效性和安全性。方法选择我院新生儿科于2007年1月至2009年1月收治的VLBWI,随机分成两组,观察组于生后24 h内给予氨基酸2.0 g.kg-1.d-1,第2天增加1.0 g/kg,第3天增加0.5 g/kg;对照组于生后24 h内给予氨基酸0.5 g.kg-1.d-1,每天按0.5 g/kg递增。两组其他治疗措施比较,差异无统计学意义。观察氮储存、总的蛋白质摄入、恢复出生体质量时间、平均静脉营养时间、住院时间、住院费用、总胆红素、谷丙转氨酶、血尿素、血肌酐、血气pH及碳酸氢盐。结果共入选43例,观察组23例,对照组20例。观察组生后一周内氮储存、总的蛋白质摄入明显高于对照组(P<0.01);在恢复出生体质量时间(d)、平均静脉营养时间(d)、住院时间(d)、住院费用(万元)上(观察组分别为9.7±1.8、13.6±4.1、30.1±4.2、1.035±0.344;对照组分别为14.9±2.7、18.5±5.9、45.4±5.8、1.687±0.955),观察组均明显少于对照组(P<0.05);两组在总胆红素、谷丙转氨酶、血尿素、血肌酐、血气pH及碳酸氢盐上差异无统计学意义。结论早期大剂量输注氨基酸可以避免负氮平衡、增加蛋白质摄入、缩短恢复出生体质量时间和平均静脉营养时间、减少住院时间和住院费用,并且是安全的。

Objective To compare the therapeutic efficacy and safety of early parenteral supply of high dosage amino acids （AA） for very low-birth-weight infants （VLBWI） with low dosage AA. Methods The VLBWIs who were admitted to our department from January 2007 to January 2009 were randomly divided into two groups. The infants in study group were treated with 2. 0 g·kg^-1·d^-1 AA within the first 24 hours then increased 1.0 g/kg at the second day and 0. 5 g/kg at the third day. The infants in control group were treated with 0. 5 g·kg^-1·d^-1 AA within the first 24 hours then increased 0. 5 g/kg daily. There is no significant difference between two groups for other clinical management. The indices to evaluate two groups are nitrogen storage, total protein intake, the length of recovery to birth weight, the length of parenteral nutrition supply, the length of hospitalization and total expense in hospital. The safety indices are monitored parallel with two groups of infants. Results Total of 43 VLBWIs were enrolled, 23 of them in study group and 20 of them in control group. The results of nitrogen storage and total protein intake in study group were significantly higher than that in control group （ both P 〈 0. 01 ）. The length of recovery to birth weight （ 9.7 ± 1.8 d ）, The length of parenteral nutrition supply （ 13.6 ± 4. 1 d）, the length of hospitalization （ 30. 1 ± 4.2 d） and total expense in hospital （10 350 ±3440 Yuan） in study group were significantly less than that in control group （14. 9 ± 2. 7 d, 18.5 ±5.9 d, 45.4 ±5.8 d, 16 870 ±9550 Yuan, respectively） all P 〈0.05. There were no statistic significant differences in the safety indices of total bilirubin, glutamate-pyruvate transaminase, blood urea nitrogen, ereatinine or pH and HCO3 of blood-gas between two groups. Conclusion The early parenteral supply of high dosage AA may avoid negative nitrogen balance and increase protein intake in VLBWIs. It can be more effective and safe to treat VLBWIs.