极低体质量儿并发晚期代谢性酸中毒86例分析

Analysis of very low birth weight complicated with late metabolic acidosis in 86 infants

目的:探讨极低体质量新生儿(very low birth weight infant,VLBWI)并发晚期代谢性酸中毒的临床特点、治疗方法及预后。方法:选择86例出生时体质量1 000~<1 500 g VLBWI作为研究对象,应用同一样本的对照分析统计法,按照是否出现酸中毒分为酸中毒期和正常期。观察不同时期患儿嗜睡和喂养情况、面色和呼吸改变情况、体质量不增和体温不升情况、血糖升高情况、静脉营养状况、治疗效果和预后。结果:86例患儿主要为发生在出生9~20 d的晚期酸中毒,酸中毒期患儿嗜睡和吃奶量减少,面色灰暗、口周发绀、呼吸不规则,血糖升高,体质量不增和体温不升的发生比例均明显高于正常期(P<0.01)。完全/部分胃肠外营养均对发生酸中毒有一定影响,所有酸中毒患儿经1.4%碳酸氢钠治疗后大多缓解。结论:VLBWI易并发晚期代谢性酸中毒,需密切监测其各项体征,部分和全母乳喂养可减低酸中毒的发生,可应用碳酸氢钠早期预防和治疗。

Objective： To investigate the clinical characteristics,treatment and prognosis of very low birth weight infants（ VLBWI）complicated with late metabolic acidosis. Methods： Eighty-six infants with birth weight less than 1 500 g and more than 1 000 g were divided into the acidosis period and normal period according to the acid poisoning using the self-control analysis method. The drowsiness and feeding,facial and respiratory changes,body weight,heat,blood glucose,venous nutrition,treatment outcome and prognosis in different period infants were observed. Results： Among 86 VLBWI,it was mainly late metabolic acidosis occurred within 9-20 days old. The incidence rates of the lethargy,intaking milk decreasing,dark complexion,perioral cyanosis,irregular breathing,blood glucose increasing,weight unincreasing and heat ungain in acidosis period group were significantly higher than those in normal period group（ P 0. 01）. The complete/partial parenteral nutrition affected on the occurrence of acidosis. The acidosis relieved in all cases after treatment with 1. 4% of sodium bicarbonate. Conclusions： The late metabolic acidosis often occurs in VLBWI,the signs should be closely observed. The complete/partial breastfeeding can reduce the occurrence of acidosis. Sodium bicarbonate can be used in early prevention and symptomatic treatment.