新生儿科全肠外营养液的应用分析

Application Analysis of Total Parenteral Nutrition Use in Neonatal Units

目的初步了解暨南大学附属第一医院新生儿科全肠外营养液(TPN)的应用情况,为进一步规范TPN使用、制定合适的指南提供参考依据,保证合理安全用药。方法从2012年1月—2013年6月暨南大学附属第一医院新生儿科TPN的处方中,选取胎龄<37周,出生体质量<2 500 g、使用TPN≥3 d的早产儿,按出生后≤3 d(n=27)和出生后>3 d(n=28)开始使用TPN进行分组,记录出院时的体质量、恢复出生体质量的天数及TPN使用前、后的各生化指标,并对比分析,以评价两组的疗效和并发症。结果早期组和较晚组对比,使用后的住院时间、使用TPN时间、体质量增长速率、血糖、K+、Ca2+、Cl-、BUN、肌酐和血清胆红素均差异无统计学意义(P>0.05),但早期组恢复出生体质量时间(8.9±5.5)d短于较晚组[(12.5±7.2)d,t=2.29,P<0.05],对血糖影响也差异有统计学意义(P<0.05),两组使用TPN均能较好预防和纠正低血糖、低血钙,而BUN、肌酐、血清胆红素水平无较大异常。结论早期使用TPN可使早产儿获得更好的生长,使用TPN可预防和纠正低血糖和电解质紊乱,但不影响肝肾功能。两组的营养支持均未达到理想状况,需进一步改善。

Objective To investigate how total parenteral nutrition （TPN） is applied in the neonatal units of the first affiliated hospital of Jinan university, provide reference for the standardized use of TPN, formulate appropriate guidelines, and ensure that clinical nutrition is properly and safely used in prenatal patients. Methods Preterm infants with gestational age〈37 weeks and birth weights 〈2 500 g who used TPN in the neonatal units from January 2012 to June 2013 were assigned into two groups, Patients in Group 1 （ n = 27 ） began TPN within 3 d after birth, and patients in Group 2 （ n = 28 ） began TPN 3 d after birth. Body weight and the time to regain birth weight were obtained at discharge,, and biochemical indexes before and ＂after TPN were also evaluated. Results ＇ Compared with late TPN, early TPN significantly reduce the time to regain birth weight[ （ 12.5±7.2） d vs （8.9±5.5） d, P〈0.05 ], and maintained normal blood glucose level （P〈0.05）. There were no differences with regards to length of hospitalization, duration of TPN use, growth rate, blood glucose, K＋, Ca2＋, C1 , BUN, serum creatinine, BUN and serum bilirubin （ all P〉0.05 ）. Both groups can effectively prevent and correct hypoglycemia and hypocalcemia. Conclusion Early TPN can promote growth of preterm infant. The use of TPN can improve hypoglycemia and hypocalcemia without effect on liver and kidney function. Neither group achieved ideal nutritional support outcome and therefore requires further improvement.