早期不同剂量氨基酸在早产儿静脉营养中的应用价值研究

Value of early application of different doses of amino acids in parenteral nutrition among preterm infants

目的：探讨应用不同剂量氨基酸在早产儿静脉营养中的近期疗效及耐受情况。方法根据早期应用氨基酸剂量的不同，将2013年3月至2014年6月收治的生后24 h内入院，出生体重1000-2000 g的86例早产儿随机分成低剂量组（n=29，每日1.0 g/kg，每天增加1.0 g/kg，最大达每日3.5 g/kg），中剂量组（n=28，每日2.0 g/kg，每天增加1.0 g/kg，最大达每日3.7 g/kg），高剂量组（n=29，每日3.0 g/kg，每天增加0.5-1.0 g/kg，最大达每日4.0 g/kg），同时进行常规的其他静脉营养及肠内营养支持。结果早产儿最大体重下降程度随氨基酸输注量增加而降低，恢复出生体重天数、肠道营养达100 kcal/（kg ＆#183; d）天数、住院时间及住院费用均随氨基酸输注量增加而减少，头围增长则随氨基酸输注量增加而增加（均P〈0.05）。高剂量组早产儿血尿素氮（BUN）水平在生后7 d时高于中剂量组和低剂量组（均P〈0.05）；肌酐、pH值、碳酸氢盐、胆红素及转氨酶水平在生后7 d，以及并发症发生率在各组间差异均无统计学意义（均P〉0.05）。结论早产儿在生后24 h内静脉应用高剂量氨基酸可以改善早产儿生后近期营养状况，但有一过性BUN升高。

Objective To study the short-term response and tolerance of different doses of amino acids in parenteral nutrition among preterm infants. Methods This study included 86 preterm infants who had a birth weight between 1 000 to 2 000 g and were admitted to the hospital within 24 hours of birth between March 2013 and June 2014. According to the early application of different doses of amino acids, they were randomized into low-dose group （n=29, 1.0 g/kg per day with an increase of 1.0 g/kg daily and a maximum of 3.5 g/kg per day）, medium-dose group （n=28, 2.0 g/kg per day with an increase of 1.0 g/kg daily and a maximum of 3.7 g/kg per day）, and high-dose group （n=29, 3.0 g/kg per day with an increase of 0.5-1.0 g/kg daily and a maximum of 4.0 g/kg per day）. Other routine parenteral nutrition and enteral nutrition support were also applied. Results The maximum weight loss was lower and the growth rate of head circumference was greater in the high-dose group than in the low-dose group （P〈0.05）. The infants in the medium-and high-dose groups had faster recovery of birth weight, earlier attainment of 100 kcal/（kg.d） of enteral nutrition, shorter duration of hospital stay, and less hospital cost than those in the low-dose group （P〈0.05）. Blood urea nitrogen （BUN） levels in the high-dose group increased compared with the other two groups 7 days after birth （P〈0.05）. The levels of creatinine, pH, bicarbonate, bilirubin, and transaminase and the incidence of complications showed no signiifcant differences between groups （P〉0.05）. Conclusions Parenteral administration of high-dose amino acids in preterm infants within 24 hours after birth can improve the short-term nutritional status of preterm infants, but there is a transient increase in BUN level.