低出生体重儿脂肪乳临床应用的安全性分析

Safety Analysis of Fat Emulsion Infusion in Low Birth Weight Infants

目的:探讨低出生体重儿早期应用不同剂量脂肪乳营养支持的临床安全性。方法:选取2010年6月至2012年6月鄂州市中心医院收治的低出生体重儿52例,采用随机数表法分为治疗组28例和对照组24例。治疗组于生后24h内静脉给予脂肪乳,脂肪乳用量从1.0g/(kg.d)开始,以后每天增加1.0g/kg,最大剂量为3.0g/kg;对照组于第4天开始静脉给予脂肪乳,脂肪乳用量从1.0g/(kg.d)开始,以后每天增加0.5g/kg,最大剂量为3.0g/kg,至肠内营养热卡达100kcal/(kg.d)时停用胃肠外营养。比较两组患儿营养支持7d后体重、恢复出生体重时间、胆固醇、甘油三酯、胆红素、转氨酶、尿素氮等血生化指标和相关并发症。结果:治疗7d后治疗组患儿体重增加明显,恢复至出生体重时间缩短,与对照组比较差异有统计学意义(P<0.05);两组患儿血清胆固醇、甘油三酯、胆红素、转氨酶、尿素氮等血生化指标比较差异无统计学意义(P>0.05);治疗组患儿发生败血症2例(7.1%)、呼吸暂停9例(32.1%)、高血糖4例(14.2%)、胆汁淤积症2例(7.1%),与对照组比较差异无统计学意义(χ2分别为0.027、0.527、0.055、0.019,P均>0.05)。结论:早期大剂量外周静脉应用脂肪乳营养支持可增加低出生体重儿热卡摄入,促进低出生体重儿生长发育,与对照组比较未增加不良反应发生率,临床应用安全有效。

Objective： To evaluate the safety of different applications of fat emulsion in early parenteral nutrition in low birth weight infants. Methods： Fifty-two low birth weight infants in E＇zhou central hospital from June 2010 to June 2012 were randomly assigned into two groups, 28 cases in the treatment group, 24 cases in the observation. The observation group received fat emulsion 24 hours after birth. The initial dose was 1.0 g/kg every day with an increment of 1.0 g/kg daily; the maximum dose was 3.0 g/kg every day. The control group received fat emulsion four days after birth; the initial dose were 1.0 g/kg every day with an increment of 0.5 g/kg daily; the maximum dose was 3.0 g/kg every day. After treatment for seven days, the weight, the time to return to birth weight, blood cholesterol, trig｜yceride level, bilirubin, transaminase, urea nitrogen and correlate complications of the two groups were observed and analyzed. Results： The time to return to birth weight in the observation group were shorter than that in the control group; and the weight of the observation were increased remarkably （P〈0.05）. There were no significant differences in biochemical indicators between the two groups. The fat emulsion correlated complications in the observation group such as septicaemia （7. 1% ）, apnea （32. 1% ）, hyperglycosemia （14. 2% ）, and cholestasis （7. 1% ） did not change remarkably compared with the control group （P〉0. 05 ）. Conclusions ： Administration of a larger dose of fat emulsion in early premature infants can increase calorie intake and promote growth. The fat emulsion infusion is safe for clinical application.