早产儿早期不同剂量氨基酸应用策略的对照研究

Early application of different-doses of amino acids supplementation in preterm infants

目的探讨早产儿早期应用不同剂量氨基酸的近期疗效和耐受情况。方法将2010年1月至2011年6月间出生24h内体质量1000～2000g入住新生儿重症监护室(NICU)接受肠道外营养治疗的早产儿,随机分为2组。大剂量组(HP)于生后24h内输注2.0g/(kg·d)氨基酸起,每天增加0.85g/kg,预期峰值3.7g/(kg·d);低剂量组(LP)于出生24h内输注0.5g/(kg·d)氨基酸起,每天增加0.5g/kg,预期峰值3.7g/(kg·d)。结果两组早产儿一般情况相似。大剂量组第1天RBP和第3天PA高于低剂量组,差异有统计学意义(P均<0.05);大剂量组早产儿体质量下降百分比少于低剂量组,差异有统计学意义(P<0.05);大剂量组头围增长大于低剂量组,差异有统计学意义(P<0.05);大剂量组早产儿肠内营养能量达418.4KJ/(kg·d)天数、恢复出生体质量天数和体质量达到2000g天数均少于低剂量组,差异有统计学意义(P均<0.05)。安全性指标2组没有差异。结论早产儿生后24h内可以耐受输注大剂量2.0g/(kg·d)氨基酸,能改善营养状况,增加喂养的耐受性和促进早产儿生长。

Objective To evaluate the efficacy and safety of parenteral nutrition with different-dose a- mino acid in premature infants. Methods Premature infants （birth weight 1000 -2000 g） recruited into the study were randomized into two groups. High group （HP） ：2. 0 g/（ kg · d） of amino acid IV within 24 hours after birth,increasing by increments of 0. 85 g/（kg · d） to a maximum of 3.7 g/（kg · d）. Low group （LP） ：0. 5 g/（ kg · d） of amino acid IV within 24 hours after birth, increasing by increments of 0. 5 g/（ kg · d） to a maximum of 3.7 g/（ kg · d）. Results Totally 107 premature infants were recruited： HP 56 and LP 51. There were no significant differences in demographic or clinical characteristics among the 2 groups. Mean serum RBP （ D1 ） and PA （ D3 ） levels were significantly higher in HP group than in LP group （P 〈 0. 05 ）. HP group showed lower weight loss% than in LP group, head circumference quickly growth than in LP group （ P 〈 0. 05 ）, shorter length days to tolerate 418.4 KJ/（kg · d） enteral nutrition, days to regain birth weigh and reach 2000 g than in LP group （ P 〈 0. 05 ）. There were no significant differences in the levels of blood ammonia, PH, BUN, Cr, ALT, AST and GLU. Conclusion Early administration of intravenous amino acid [ 2.0 g/（ kg ·d） ] significantly improves in nutrition of premature infants, growth and the tolerance of enteral feeding.