不同剂量氨基酸营养策略在极低出生体质量儿早期的应用

Early Application of Different Doses of Amino Acid Supplementation in Very Low Birth Weight Infants

目的探讨极低出生体质量儿(VLBWI)早期应用不同剂量氨基酸营养策略的有效性和安全性。方法 VLBWI 30例随机分为3组,每组各10例。高剂量氨基酸组:出生24 h内予2.0 g.kg-1.d-1氨基酸静脉输入,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。低剂量氨基酸组:出生24 h内予1.0 g.kg-1.d-1氨基酸,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。对照组:出生24 h不予氨基酸,出生第2天予1.0 g.kg-1.d-1氨基酸,后增加1.0 g.kg-1.d-1,目标剂量为氨基酸3.5 g.kg-1.d-1。比较3组VLBWI氮平衡、能量摄入、血氨基酸、血胆红素、尿素氮、肌酐、血糖等生化指标。结果高剂量组VLBWI体质量下降百分比、体质量回升天数均低于对照组(Pa<0.05),低剂量组体质量下降百分比、体质量回升天数与对照组比较差异均无统计学意义(Pa>0.05)。3组VLBWI第1、7天血糖、血清尿素氮、肌酐、总胆红素、结合胆红素、AST、ALT比较差异均无统计学意义(Pa>0.05),高剂量组和低剂量组患儿第1、7天氮平衡均高于对照组(Pa<0.05)。3组VLBWI第1天血17种氨基酸比较差异均无统计学意义(Pa>0.05),高剂量组患儿第7天血天冬氨酸、亮氨酸、异亮氨酸、缬氨酸均高于对照组(Pa<0.05),其余氨基酸比较差异均无统计学意义(Pa>0.05)。3组患儿病死率比较差异无统计学意义。结论 VLBWI出生24 h内即开始静脉输注2.0 g.kg-1.d-1氨基酸可避免负氮平衡,减少体质量下降百分比,缩短体质量回升天数,无明显不良反应。

Objective To explore the efficacy and safety of different doses of amino acid supplementation early application in very low birth weight infants （VLBWI）. Methods Thirty VLBWI were randomly divided into 3 groups. High amino acid group：2.0g·kg^-·d^-1of amino acid intravenous（iv） within 24 hours after birth,increased by increments of 1.0 g·kg^-·d^-1 to a maximum of 3.5g·kg^-·d^-1 low amino acid group：1. 0g·kg^-·d^-1 of amino acid（iv） within 24 hours after birth,increased by increments of 1.0g·kg^-·d^-1 until a maximum of 3.5g·kg^-·d^-1 ; and control group ： 1.0g·kg^-·d^-1 of amino acid （iv） after 24 hours of birth,increased by increments of 1.0 g·kg^-·d^-1 until a maximum of 3.5g·kg^-·d^-1. The nitrogen balances, caloric intake, the levels of blood amino acid were compared in the 3 groups, and the plasma concentration of bilirubin, blood urea nitrogen （BUN）, Creatinine, Glucose were determined to evaluate the side effects. Results The percentage of weight loss and days for reaching birth weight were lower in high amino acid group than those in control group （Pa 〈 0.05 ）. There was no significant difference in the percentage of weight loss and days for reaching birth weight between the low amino acid group and control group （P 〉 0.05 ）. There was no significant difference in the plasma concentration of total bilirubin, direct bilirubin, aspartate aminotransferase （AST） , alanine transaminase （ALT） , BUN, Creatinine, Glucose among the 3 groups （ P 〉 O. 05）. The ni- trogen balances were higher in high amino acid group or low amino acid group than that in control group on the 5^th and 7^5th day after birth （P 〈0. 05）, There was no significant difference in the plasma levels of amino acid among the 3 groups on the first day after birth （P 〉 0.05 ）. The plasma levels of amino acid Met, lie, Leu, Val were higher in high amino acid group than those in control group on the 7^th day after birth （ Pa 〈 0.05 ）. There was no significant difference in the plasma levels of other amino acids between the high amino acid group and control group on the 7th day after birth （P 〉 0.05 ）. There was no significant difference in the mortality among the 3 groups. Conclusions VLBWI supplemented with 2.0 g·kg^-·d^-1 of amino acid （iv） within 24 hours after birth have no major adverse side effects. They get a positive ni- trogen balance ,reduce the percentage of weight loss and days to reach birth weight.