早期强化氨基酸营养策略在早产儿静脉营养中的临床观察

Clinical observation on early intensive amino acid nutritional strategy in parenteral nutrition of premature infants

目的：探讨早期强化氨基酸营养治疗在早产儿临床治疗中的安全性和有效性。方法：将我院2010年7月至2010年12月收治的体重在1-2.5 kg的早产儿104例按随机数字表法分为高剂量组和低剂量组。高剂量组：出生12 h开始使用氨基酸3.0 g/（kg·d）;低剂量组：出生24 h后使用氨基酸,剂量从1.0 g/（kg·d）开始,每日增加0.5 g/（kg·d）,直至总量达3.0 g/（kg·d）。两组均及早开始胃肠内微量喂养,同时按常规治疗并发症。结果：高剂量组体质量下降,体质量回升天数均低于低剂量组;两组总胆红素尿素氮比较差异有统计学意义;AST、ALT比较差异无统计学意义;颅内出血、高胆红素血症、NEC等并发症差异无统计学意义。高、低剂量组中出生体重为1-1.5 kg的低体重组最大体重下降值、恢复出生体重天数、开始持续肠道营养天数、住院天数、住院费用等一般资料有效性指标均与同组体重〉1.5 kg的对照组对比无统计学意义（P〉0.05）,且颅内出血、高胆红素血症、NEC等并发症发生率对比也无统计学意义（P〉0.05）。结论：体重大于1 kg小于2.5 kg的早产儿在出生12 h开始静脉微量泵匀速输注小儿复方氨基酸3.0 g/（kg·d）,可明显减少体质量下降,缩短体质量回升天数,缩短住院时间,从而降低住院费用。但高剂量组总胆红素尿素氮与低剂量组比较差异有统计学意义。该样本量较少,仍需大样本随机对照实验进一步证实。

Objective： To explore the safety and efficacy of early intensive amino acid nutritional therapy in the clinical treatment of premature infants. Methods： A total of 104 cases of premature infants whose weight was 1-2.5 kg treated in our hospital between July and December 2010 were divided into high dose group and low dose group according to the random number table method. The high dose group was treated with amino acid 3.0 g/（kg·d） at 12 h after birth. The low dose group was also treated with amino acid at 12 h after birth, and the initial dose was 1.0 g/（kg·d） and then increased by 0.5 g/（kg·d） every day till the total amount reached 3.0 g/（kg·d）. Both two groups started early minimal enteral feeding. Meanwhile, complications were treated by routine therapies. Results： The body mass of the high dose group decreased, and the number of days of body mass recovery was shorter than that of the low dose group. The differences in total bilirubin and urea nitrogen between the two groups were significant; there was no significant difference in AST and ALT, intracranial hemorrhage, hyperbilirubinemia, NEC and other complications. In the high and low dose groups, there were no significant differences in maximum decreased weight, days of recovering to birth weight, days of beginning continuous enteral nutrition, days of hospitalization, hospitalization expenses and other general data and effective indexes between low-weight group whose weight was 1-1.5 kg and patients whose weight 1.5 kg in the same group（P〉0.05）. Besides, there were no differences in the incidence rates of intracranial hemorrhage, hyperbilirubinemia and NEC（P〉0.05）. Conclusion： To intravenously inject premature infants whose weight was higher than 1 kg and lower than 2.5 kg with paediatric compound amino acid 3.0 g/（kg·d） with micropump at constant speed at 12 h after birth can significantly reduce body weight loss, shorten the days of body mass recovery, shorten the hospitalization time, thereby reduce hospitalization expenses. However, there was significant difference in total bilirubin and urea nitrogen between the high dose group and low dose group. The sample size is small, so large sample randomized controlled experiment is necessary for further confirmation.