晚期早产儿早期静脉补充氨基酸治疗的临床研究

Study on intravenous amino acid administration to late preterm infants directly after birth

【目的】评价晚期早产儿(34～36+6周)中,在生后2 h内给予静脉补充氨基酸的效果和安全性。【方法】将115例患儿随机分为两组,治疗组在生后2 h内给予静脉输注氨基酸[2.4 g/(kg.d)],对照组则在生后第1天仅给予输注葡萄糖治疗,在第3天逐渐增加到氨基酸2.4 g/(kg.d)。并动态测定患儿的血气、血糖、BUN及氮平衡情况。【结果】治疗组患儿的BE和HCO3-在生后的第2、4天均低于对照组(P<0.05或0.01)。生后第2天血糖监测显示对照组较治疗组偏高(P<0.05)。治疗组生后第2、4天的血尿素氮水平明显高于对照组(P<0.01)。生后第2天,治疗组的氮平衡明显高于对照组(P<0.05),并且对照组呈负氮平衡。【结论】对晚期早产儿早期补充高剂量氨基酸是安全的,使机体处于合成代谢状态,为生长发育所必需。

[Objective] To test the hypothesis that the early administration of amino acids （AA） 2.4 g/（kg · d） to late preterm infants is safe and resultful in a positive nitrogen balance. [Methods] A randomized and clinical trial was conducted. Preterm infants with gestational ages between 34W to 36^＋6W received either glucose and AA 2.4 g/（kg ·d） from birth onward （within 2 hours after birth） （n=56） or solely glucose during the first day with a stepwise increase in AA intake to AA 2.4 g/（kg ·d） on days 3 （n=59）. Blood gas analysis was performed at admission and in the 2^nd , 4^th postnatal days; blood urea nitrogen levels were determined on the 2^nd day and the 4^th day after birth; nitrogen balances were determined on the 2^nd day and the 4^th day after birth. [Results] Modestly altered blood gas values （BE and Bicarbonate） and increased BUN levels with early AA administration in intervention group compared with those in control group （P〈0.05 or 〈0.01 respectively）. The infants in the control group had higher glucose level than those in the intervention group at the second day after birth （P〈0.05）. Nitrogen balance was higher in the intervention group on the 2^nd day after birth as compared with the control group, which had a negative nitrogen balance （P〈0.05）. [Conclusions] High-dose AA administration to late preterm infants can be introduced safely from birth onward and resultful in an anabolic state.