不同肠外营养方法对早产低出生体质量儿的临床效果

Clinical efficacy of two different parenteral nutrition （PN）method for premature and low birth weight infants

目的探讨对早产低出生体质量儿出生24h内行早期肠外营养（parenteral nutrition，PN）与出生72h后行晚期肠外营养的临床效果。方法选取68例早产低出生体质量儿，随机分治疗组35例和对照组33例，治疗组出生24h内输注氨基酸（初始量1g·kg-1·d-1）与脂肪乳（初始量0．5—1．0g·kg-1·d-1），对照组出生72h后予氨基酸（初始量0．5g·kg-1·d-1）和脂肪乳（初始量0．5～1．0g·kg-1·d-1），PN期间适情给予肠内喂养，记录并对比两组患儿出生7d后体质量、肝肾功能、血脂、血糖指标及并发症发生情况。结果（1）理化指标变化：两组早产儿出生7d后理化指标均较之出生后明显提高（治疗组t=2．169、5．963、11．773、5．920、5．870、8．998、2．076，对照组t=1．755、2．610、9．255、4．697、4．062、7．489、2．042，均P〈0．05）。（2）并发症比较：患儿高胆红素血症血症、胆汁淤积、继发感染等并发症发生率比较，差异均无统计学意义（X2=0．215、0．235、0．173、0．190，均P〉0．05）。结论在氨基酸、脂肪乳初始量分别为1g·kg-1·d-1、0．5—1．0g·kg-1·d-1前提下，早期PN较之晚期PN更能改善早产低体质量儿的营养状况，两者临床安全性相近；对早产低出生体质量儿可考虑在出生24h内给予氨基酸、脂肪乳的摄入。

Objective To observe and discuss clinical effect of early parenteral nutrition（PN） born within 24h and late PN within 72h on premature and low birth weight irffants. Methods 68 admitted cases were divided into treatment group（ n = 35 ） and control group（ n = 33 ） with random number table. Treatment group was infused of amino acids（ initial value lg/kg · d） and fat emulsion（ initial value 0. 5-1. 0g/kg · d） born within 24h ,control group was infused of amino acids （ initial value 0.5 g/kg · d） and fat emulsion（ initial value 0. 5-1. 0g/kg · d） born after 72h, during which breast feeding was arranged in terms of suitable situation, and body weight, liver and kidney function, blood lipid, blood glucose, complications were noted and compared between two groups born after 7d. Results （ 1 ） The preterm children born after 7d of physicochemical parameters were significantly improved after birth（ the treatment group t = 2. 169,5. 963,11. 773,5. 920,5. 870,8. 998,2. 076, the control group t = 1. 755,2. 610,9. 255,4. 697,4. 062, 7. 489,2. 042 ,all P 〈 0.05 ）. （2）PN time of treatment group was 8-17d,9-20d in the control group,there was signifi- cant difference between the two groups（ t = 1. 458 ,P 〉 0.05 ）. Two groups of children in hyperlipidemia hyperbilirubinemia,cholestasis,secondary infection, the incidence of complications was no significant difference （x^2 = 0. 215, 0. 235,0. 173,0. 190, all P 〉 0.05 ）. Conclusion Under the premise of initial value of amino acid,fat emulsion were 1 g/kg · d,0.5-1.0g/kg · d, early PN born within 24h compared with latePN born after 72h can better improve nutritional status of premature and low birth weight infants, and clinical safety of two methods are much similar; for premature and low birth weight infants, amino acid and fat emulsion may be considered to intake born within 24h.