小儿氨基酸(19AA-1)用于新生儿严重消化道畸形术后全静脉营养支持的安全性及有效性

Security and Effectiveness of Pediatric Amino Acid( 19AA-1) as Nutrition Support for Newborns Applied in Total Parenteral Nutrition for Children with Severe Digestive Tract Malformation after Operation

目的:观察19AA-1氨基酸作为全静脉营养的氮源对严重消化道畸形患儿术后营养支持的疗效及安全性,为临床新生儿外科严重消化道畸形手术后完全静脉营养实施配方提供实验依据。方法:选取我院2011年10月至2014年4月新生儿外科重症监护病房收治的严重消化道畸形需手术治疗的患儿,随机分为观察组和对照组各50例,观察组为使用小儿氨基酸(19AA-1)为氮源的全肠外营养(TPN),对照组使用其他氨基酸为氮源的TPN,比较两组患儿术前、术后7 d的营养状况指标、肝肾功能指标以及患儿术后出现的并发症及总住院时间等。结果:两组患儿性别、胎龄、体质量、分娩方式、身长、头围等比较差异均无统计学意义(P>0.05);术前两组患儿的营养指标包括体质量、白蛋白(Alb)、总蛋白(TP)、前白蛋白(PA)比较差异均无统计学意义(P>0.05),而在术后7 d时,观察组患儿的体质量、Alb、TP、PA水平均显著高于对照组患儿(P<0.01);两组患儿术前、术后7 d的肝肾功能指标(ALT、AST、TBIL、BUN、CREA等)比较差异均无统计学意义(P>0.05);两组患儿的术后并发症发生率比较差异无统计学意义,观察组患儿的平均住院时间短于对照组(P<0.01)。结论:严重消化道畸形术后采用19AA-1为氮源的TPN比使用其他氨基酸为氮源的TPN改善患儿营养状况更佳,住院时间更短,对患儿的肝肾功能影响较小,术后并发症较少,安全性高。

Objective： To observe the security and effectiveness of 19AA-l as nitrogen source of total paranteral nutrition（ TPN） for children with severe digestive tract malformation after operation,and offer experimental basis to formula of TPN for the clinical newborns with severe digestive tract malformation after operation. Methods： Clinical data of children with severe digestive tract malformation after operation received treatment at neonatal surgical intensive care unit in our hospital from October 2011 to April 2014 were retrospectively analyzed. Children included were divided into two groups（ 50 children in each group） according to the treatment,observe group（ TPN of 19AA-l as nitrogen source） and control group（ TPN of other amino acids as nitrogen source）. The nutritional status indicators,liver and kidney function index,complications appeared after operation in children,the total duration of hospitalization and other indexes of the 7th day before and after operation in two groups were compared. Results： There were no significant statistical differences in the general information including gender,gestational age,body weight,body length,head circumference and so on in two groups. There were no statistical differences in nutrition indexes including body weight,Alb,TP,PA before operation in two groups. But at the 7th day after operation,body weight,the levels of Alb,TP,PA in observe group were obviously higher than those in control group. There were no statistical differences in liver and kidney function indexes including ALT,AST,TBIL,BUN,CREA at the 7th day before and after operation in two groups. There was no significant difference in the incidence of complications in two groups. The time of stay in hospital of children in observe group was obviously shorter than that in control group. Conclusion： The children with severe digestive tract malformation after operation accepted TPN of 19AA-1 as nitrogen source are better than accepted TPN of other amino acids in improving the nutritional status of children,length of stay in hospital,liver and kidney function,the incidence of complications and security.