早产儿早期静脉营养中氨基酸起始剂量的临床研究

Amino acid's initial dose in early parenteral nutrition for preterm infants

目的评价静脉营养中不同起始剂量氨基酸对早产儿住院期间生长发育的影响。方法 2013年4月1日至2014年4月1日西安交通大学医学院第一附属医院新生儿重症监护病房(NICU)中收治的81例早产儿据氨基酸不同起始剂量随机分为A、B、C组,分别于生后24小时内静脉给予氨基酸1.0、1.5、2.0g·kg^(-1)·d^(1-),3组均按0.5~1.0g·kg^(-1)·d^(-1)递增,1周内达到目标剂量3.5g·kg^(-1)·d~^(-1)。收集早产儿生后第1、7、14、21、28天的临床资料和实验室数据。比较各组的最大体重下降、恢复出生体重时间、稳定生长期体重增长率、出院时宫外发育迟缓发生率等临床有效性指标、临床治疗和早产儿并发症。结果最大体重下降C组小于B、A组(F=0.590,P>0.05),恢复出生体重时间C组短于B、A组(F=2.115,P>0.05),稳定生长期体重增长率C组大于B、A组,但差异无统计学意义(F值分别为0.590、2.115、1.064,均P>0.05);宫外迟缓发生率C组低于B、A组,差异亦无统计学意义(X^2=4.485,P>0.05);A与B组合并为AB组后,恢复出生体重时间C组短于AB组,差异有统计学意义(F=3.988,P<0.05);出院时宫外发育迟缓发生率C组低于AB组,差异有统计学意义(X^2=4.254,P<0.05);临床治疗及早产儿并发症比较,组间差异无统计学意义(均P>0.05)。结论生后24小时内输注1.0~2.0g·kg~^(-1)·d^(-1)的静脉营养氨基酸并不能完全满足早产儿生理需要和促进生长发育,在液体量允许的情况下,应增加氨基酸起始剂量及速度,当外周静脉液体量及浓度限制氨基酸起始剂量时,可考虑至少从2.0g·kg~^(-1)·d^(-1)开始。

Objective To assess the effects of different initial amino acid （ AA） doses in parenteral nutrition on the development of preterm infants during hospitalization .Methods Eighty-one preterm infants were randomly divided into group A , B and C according to initial dose of AA, and they were given 1.0g/kg per day, 1.5g/kg per day and 2.0g/kg per day, respectively within 24 hours of life.For each group 0.5-1.0g/kg per day AA increased and reached the planned dose of 3.5g/kg per day within one week .The laboratory and clinical data were collected on day 1, 7, 14, 21 and 28.The maximum weight loss, time to regain birth weight （BW）, weight growth in stable growing stage, extrauterine growth retardation （ EUGR） incidence when discharged , clinical treatments and complications were compared among groups.Results Compared with group A and group B , maximum weight loss in group C was lower , time to regain BW was shorter, and weight growth rate in stable growing stage was faster in group C , but the differences were not significant （F value was 0.590, 2.115 and 1.064, respectively, all P〉0.05）.The incidence of EUGR when discharged in group C was lower than in group A and group B , and the difference was not statistically significant （χ2 =4.485, P〉0.05）.When merging group A with group B into group AB , the time to regain BW in group C was still shorter than in group AB with statistical significance （F=3.988,P〈0.05）.The incidence of EUGR when discharged in group C was significantly lower than in group AB （χ2 =4.254, P〈0.05）.The differences in complications and clinical treatments among three groups were not statistically significant （both P〉0.05）.Conclusion An initial dose of 1.0-2.0g/kg per day in parenteral nutrition within 24 hours after birth can not entirely meet the needs of physiological need and growth for preterm infants , so the initial dose and rate of increasing AA should be increased when fruid volume is permitted .But if the initial dose of AA is limited by peripheral venous fluid and concentration , at least 2.0g/kg per day should be considered to start .