多种油脂肪乳在超低出生体重儿中应用的疗效分析

Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants

目的分析多种油脂肪乳(SMOF)在超低出生体重(ELBW)儿中应用的疗效。方法回顾性选取2018年1月1日至2020年7月30日收治的ELBW儿49例为研究对象,入院时日龄≤14 d,接受胃肠外营养时间>14 d。根据应用的脂肪乳剂种类,分为SMOF组(n=26)和中长链脂肪乳(MCT/LCT)组(n=23),比较两组患儿间临床特征、并发症发生情况、营养支持治疗及相关结局。结果49例患儿平均出生体重为(892±83)g,平均出生胎龄为(28.2±2.3)周。两组间血流动力学意义的动脉导管未闭、脑室内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良(BPD)、BPDⅢ度、败血症、肺炎等并发症发生率比较差异均无统计学意义(P>0.05)。两组间胃肠外营养应用时间、达全肠内营养日龄及出院时头围、身长、体重等比较差异均无统计学意义(P>0.05)。共有22例(45%)患儿发生胃肠外营养相关性胆汁淤积症(PNAC),其中SMOF组13例(50%),MCT/LCT组9例(39%),两组间比较差异无统计学意义(P>0.05);但SMOF组PNAC患儿的直接胆红素及谷氨酸氨基转移酶峰值均低于MCT/LCT组(P<0.05)。结论ELBW儿应用SMOF没有降低相关并发症的发生率;但和应用MCT/LCT比较,SMOF能减轻ELBW儿发生PNAC的严重程度。

Objective To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight(ELBW)infants.Methods A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1,2018 to July 30,2020,with an age of≤14 days on admission and a duration of parenteral nutrition of>14 days.According to the type of lipid emulsion received,the ELBW infants were divided into two groups:soybean oil,medium-chain triglycerides,olive oil,and fish oil(SMOF)(n=26)and medium-chain triglycerides/long-chain triglycerides(MCT/LCT)(n=23).The two groups were compared in terms of clinical features,complications,nutrition support therapy,and outcome.Results The 49 ELBW infants had a mean birth weight of(892±83)g and a mean gestational age of(28.2±2.3)weeks.There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus,intraventricular hemorrhage,neonatal necrotizing enterocolitis,retinopathy of prematurity,bronchopulmonary dysplasia(BPD),gradeⅢBPD,sepsis,and pneumonia(P>0.05).There was also no significant difference in the duration of parenteral nutrition,the age of total enteral nutrition,and head circumference/body length/body weight at discharge between the two groups(P>0.05).Of all the infants,22(45%)had parenteral nutrition-associated cholestasis(PNAC),with 13(50%)in the SMOF group and 9(39%)in the MCT/LCT group but there was no significant difference in the incidence of PNAC between the two groups(P>0.05);however,the infants with PNAC in the SMOF group had significantly lower peak values of direct bilirubin and alanine aminotransferase than those in the MCT/LCT group(P<0.05).Conclusions The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications,but compared with MCT/LCT emulsion,SMOF can reduce the severity of PNAC in ELBW infants.