高剂量氨基酸和脂肪乳肠外营养在胎龄<34周早产儿中的应用研究

Application of Parenteral Nutrition Base on High Dose Amino Acid and Fat Emulsion in Preterm Infants with Gestational Age<34 Weeks

目的:探讨高剂量氨基酸和脂肪乳肠外营养在胎龄<34周早产儿中的应用效果。方法:选取2019年1月-2021年6月桂林市人民医院收治的100例胎龄<34周早产儿,并按随机数字表法将其分为常规肠外营养组(n=50)和高剂量肠外营养组(n=50)。常规肠外营养组,脂肪乳初始剂量1 g/(kg·d),最大量3 g/(kg·d);氨基酸初始剂量2 g/(kg·d),最大量4 g/(kg·d)。高剂量肠外营养组,脂肪乳初始剂量2 g/(kg·d),最大量3.5 g/(kg·d);氨基酸初始剂量2.5 g/(kg·d),最大量4 g/(kg·d)。比较两组肠外营养时间、停止肠外营养达到全经肠道喂养时日龄、呼吸机支持时间、抗生素使用时间、住院时间、体重、身长、头围、并发症及发育商(DQ)。结果:高剂量肠外营养组肠外营养时间、停止肠外营养达到全经肠道喂养时日龄均短于常规肠外营养组(P<0.05)。两组呼吸机支持时间、抗生素使用时间及住院时间比较,差异均无统计学意义(P>0.05)。出生第2周,高剂量肠外营养组体重增长值高于常规肠外营养组(P<0.05)。出生第2周,两组身长、头围增长值比较,差异均无统计学意义(P>0.05)。出生第4周,两组体重、身长、头围增长值比较,差异均无统计学意义(P>0.05)。高剂量肠外营养组乳糖不耐受发生率低于常规肠外营养组(P<0.05)。两组败血症、支气管肺发育不良、颅内出血、新生儿坏死性小肠结肠炎发生率比较,差异均无统计学意义(P>0.05)。两组适应性行为、语言DQ值比较,差异均无统计学意义(P>0.05)。高剂量肠外营养组大运动、精细运动及个人-社会性行为DQ值均高于常规肠外营养组,差异均有统计学意义(P<0.05)。结论:对胎龄<34周早产儿予以高剂量氨基酸和脂肪乳肠外营养支持,可促进体质量增长和神经系统发育,且安全性较高。

Objective:To explore the effect of parenteral nutrition base on high-dose Amino Acid and Fat Emulsion in preterm infants with gestational age<34 weeks.Method:A total of 100 premature infants with gestational age<34 weeks admitted to Guilin People’s Hospital from January 2019 to June 2021 were selected,they were divided into routine parenteral nutrition group(n=50)and high-dose parenteral nutrition group(n=50)according to random number table method.In routine parenteral nutrition group,the initial dose of Fat Emulsion was 1 g/(kg·d)and the maximum dose was 3 g/(kg·d),the initial dose of Amino Acid was 2 g/(kg·d)and the maximum dose was 4 g/(kg·d).In high-dose parenteral nutrition group,the initial dose of Fat Emulsion was 2 g/(kg·d)and the maximum dose was 3.5 g/(kg·d),the initial dose of Amino Acid was 2.5 g/(kg·d)and the maximum dose was 4 g/(kg·d).The parenteral nutrition time,parenteral nutrition was discontinued until full enteral feeding was achieved time,ventilator support time,antibiotic use time,hospital stay,body weight,body length,head circumference,complications and developmental quotient(DQ)were compared between the two groups.Result:The parenteral nutrition time and parenteral nutrition was discontinued until full enteral feeding was achieved time of high-dose parenteral nutrition group were shorter than those of routine parenteral nutrition group(P<0.05).There were no significant differences in ventilator support time,antibiotic use time and hospital stay between two groups(P>0.05).At the 2 week of birth,the weight gain of high-dose parenteral nutrition group was higher than that of routine parenteral nutrition group(P<0.05).At the 2 week of birth,there were no significant differences in body length gain and head circumference gain between two groups(P>0.05).At the 4 week of birth,there were no significant differences in body weight gain,body length gain and head circumference gain between two groups(P>0.05).The incidence of lactose intolerance of high-dose parenteral nutrition group was less than that of routine parenteral nutrition group(P<0.05).There were no significant differences in the incidences of septicemia,bronchopulmonary dysplasia,intracranial hemorrhage and neonatal necrotizing enterocolitis between the two groups(P>0.05).There were no significant differences in DQ values of adaptive behavior and language between the two groups(P>0.05).The DQ values of gross motor,fine motor and personal-social behavior of high-dose parenteral nutrition group were higher than those of routine parenteral nutrition group(P<0.05).Conclusion:For preterm infants with gestational age<34 weeks,parenteral nutrition base on high-dose Amino Acid and Fat Emulsion can promote body weight growth and nervous system development,and it is safe.