早期充分氨基酸营养在低出生体质量早产儿中的应用

Application of early administration of high-dose amino acids in parenteral nutrition for low body weight infants of prematurity

目的探讨早期充分氨基酸营养对低出生体质量早产儿生长代谢及预后的影响。方法选取2015年6月至2016年12月南京医科大学第一附属医院收治的早产儿191例，按照氨基酸首剂量用法不同分为2组：研究组（110例）氨基酸起始剂量为1.8～2.5 g/（kg·d），逐日增加1.0 g/（kg·d），直至达到最大剂量4.0 g/（kg·d）；对照组（81例）氨基酸起始剂量为1.0～1.5 g/（kg·d），逐日增加0.5 g/（kg·d），直至达到最大剂量3.5 g/（kg·d）。脂肪乳、葡萄糖及电解质等应用按标准静脉营养方案执行。比较2组患儿住院期间的开奶时间、达完全肠内营养时间、静脉营养时间、恢复出生体质量时间、住院时间、呼吸窘迫综合征的发生率、人工通气时间、低钾血症的发生率等临床指标。结果研究组早产儿住院期间的开奶时间、达完全肠内营养时间、静脉营养时间、恢复出生体质量时间均较对照组显著缩短[（3.83±3.15） d比（5.53±5.63） d，（15.47±10.54） d比（19.47±14.57） d，（16.46±10.33） d比（21.41±18.00） d，（6.36±4.88） d比（8.48±9.27） d]，差异均有统计学意义（t＝2.455、2.097、2.217、2.041，P＝0.016、0.038、0.029、0.043）。研究组住院时间较对照组缩短，住院费用也相应减少，但差异均无统计学意义（均P〉0.05）。研究组呼吸窘迫综合征的发生率明显低于对照组[20.91%（23/110例）比35.80%（29/81例）]，且人工通气时间较对照组缩短[（1.12±2.62） d比（3.31±8.13） d]，差异均有统计学意义（χ^2＝5.223，P＝0.022；t＝2.231，P＝0.028）。研究组低钾血症的发生率高于对照组[30.91%（34/110例）比17.28%（14/81例）]，差异有统计学意义（χ^2＝4.603，P＝0.032）；研究组脓毒症、胆汁淤积、宫外生长发育迟缓、坏死性小肠结肠炎、院内感染、动脉导管未闭、其他代谢紊乱等并发症发生率与对照组比较，差异均无统计学意义（均P〉0.05）。结论早期积极充分的氨基酸营养策略有利于患儿提早恢复出生体质量，缩短静脉营养时间，且不增加并发症发生率及住院经济负担。

ObjectiveTo explore the effect of early administration of high-dose amino acids in parenteral nutrition for low birth weight infants of prematurity.MethodsA total of 191 prematures admitted to the First Affiliated Hospital of Nanjing Medical University from June 2015 to December 2016 were selected, and they were randomly divided into the study group（n=110） and the control group（n=81）. The starting amino acid dose was 1.8-2.5 g/（kg·d） and 1.0-1.5 g/（kg·d） in the study group and the control group, respectively.Lipids, glucose, and electrolytes in parenteral nutrition were applied according to standard protocol of the guideline.And the start of enteral feeding, the recovery of birth weight, the duration of parenteral nutrition, the time before total enteral nutrition, duration of hospital stay, incidence of respiratory distress syndrome, duration of mechanical ventilation and incidence of kaliopenia were compared between the 2 groups.ResultsThe start of enteral feeding, the recovery of birth weight, the duration of parenteral nutrition, the time before total enteral nutrition in the study group were earlier than those in the control group[（3.83±3.15） d vs.（5.53±5.63） d, （15.47±10.54） d vs.（19.47±14.57） d, （16.46±10.33） d vs.（21.41±18.00） d, （6.36±4.88） d vs.（8.48±9.27） d], and the differences were all statistically significant（t=2.455, 2.097, 2.217, 2.041, P=0.016, 0.038, 0.029, 0.043）. The duration of hospital stay was shorter and the hospitalization expenses were lower in the study group than those in the control group, but the differences were not significant （all P〉0.05）. The incidence of respiratory distress syndrome in the study group was significantly lower than that in the control group[20.91%（23/110 cases）vs.35.80%（29/81 cases）], and the difference was statistically significant（χ^2=5.223, P=0.022）. The duration of mechanical ventilation in study group was shorter than that in control[（1.12±2.62） d vs.（3.31±8.13） d], and the difference was statistically significant（t=2.231, P=0.028）. The incidence of kaliopenia in the study group was higher than that in the control group[30.91%（34/110 cases）vs.17.28%（14/81 cases）], and the difference was statistically significant（χ^2=4.603, P=0.032）. There were not significant differences in terms of complications of necrotizing enterocolitis, sepsis, extrauterine growth retardation, hospital infection, metabolic acidosis, hyperglycemia, glucopenia, patent ductus arteriosus and respiratory distress syndrome between 2 groups （all P〉0.05）.ConclusionsEarly administration of high-dose amino acids in parenteral nutrition for preterm infants can result in earlier enteral nutrition, shorter parenteral nutrition duration without increasing incidence of complications and hospitalization expenses.