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

Short-term Efficacy and Tolerability of Different Doses of Amino Acids in Premature Infants with Parenteral Nutrition

目的探讨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。方法选择2013年4月至2015年5月出生后24 h内在成都玛丽亚妇产儿童医院进行治疗的120例早产儿为研究对象,按照随机数字表法分为高、中、低剂量组,每组40例。高剂量组静脉注射氨基酸3.0 g/kg,中剂量组静脉注射氨基酸2.0 g/kg,低剂量组静脉注射氨基酸1.0 g/kg。观察三组早产儿出生后1周时静脉氨基酸及肠内营养摄入量的情况、临床有效性、出生后7 d内体质量变化情况、7 d后实验室指标以及对耐受性。结果高剂量组早产儿总蛋白摄入量为(3.58±0.08)g/(kg·d),高于中剂量组[(2.52±0.10)g/(kg·d)]和低剂量组[(1.57±0.14)g/(kg·d)],差异有统计学意义(P<0.05)。高剂量组恢复出生质量时间、肠外营养时间、住院时间分别为(8±2)d、(11±3)d、(20±6)d,均低于中剂量组[(11±3)d、(14±4)d、(24±7)d]和低剂量组[(14±3)d、(19±5)d,(29±8)d],头围增长高于中剂量组和低剂量组[(0.99±0.23)cm/周比(0.90±0.11)cm/周、(0.79±0.15)cm/周],差异有统计学意义(P<0.05)。高剂量组耐受率为90.0%(36/40),高于中剂量组和低剂量组[65.0%(26/40)、57.5%(23/40)],差异有统计学意义(P<0.05)。结论使用高剂量的氨基酸在早产儿静脉营养中有显著的效果,有效地促进了胎儿的生存发育情况,利于胎儿的远期成长,值得在临床上应用推广。

Objective To investigate the efficacy and tolerability of different doses of amino acids in premature infants with parenteral nutrition. Methods Total of 120 cases of preterm infants treated in Chengdu Maria Women and Children＇s Hospital within 24 h of birth from April 2013 to May 2015 were included in the study,and divided into high,medium,low dose groups according to the random number table method,40 cases each group. The dosage of intravenous amino acids of the high dose group was 3 g / kg,of the middle dose group was 2. 0 g / kg,of the low dose group was 1. 0 g / kg. The intravenous amino acids and enteral nutrition,clinical efficacy,body mass change,lab indexes and tolerability 7 d after birth of the three groups were observed. Results The total protein intake[（ 3. 58 ± 0. 08） g /（ kg·d） ]of the high dose group were significantly higher than those in the medium dose group [（ 2. 52 ± 0. 10） g /（ kg · d） ] and low dose group[（ 1. 57 ± 0. 14） g/（ kg·d） ],the differences were statistically significant（ P〈0. 05）. of the maximum body mass loss,time of recovery to birth body mass,parenteral nutrition time,and hospitalization time of the high dose group[（ 8 ± 2） d,（ 11 ± 3） d,（ 20 ± 6） d]were lower than the middle dose group[（ 11 ± 3） d,（ 14 ± 4） d,（ 24 ± 7） d]and low dose group[（ 14 ± 3） d,（ 19 ± 5） d,（ 29 ± 8） d],head circumference growth was higher than the other two groups [（ 0. 99 ＋ 0. 23） cm / week vs（ 0. 90 ± 0. 11） cm / week vs（ 0. 79 ± 0. 15） cm/week],the differences were statistically significant（ P〈0. 05）; The tolerance rate of the high dose group was higher than that the middle dose group and low dose group[90. 0%（ 36 /40） vs 65. 0%（ 26 /40） vs 57. 5%（ 23 /40） ],the differences were statistically significant（ P〈0. 05）. Conclusion The use of high dose of amino acids in premature infants with intravenous nutrition has a significant effect,which effectively promotes the survival and development of the fetus,and is good for the long-term growth of the fetus,thus is worthy of promotion in clinical practice.