中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2009年
3期
209-215
,共7页
婴儿,早产%胃肠外营养%氨基酸类%随机对照试验
嬰兒,早產%胃腸外營養%氨基痠類%隨機對照試驗
영인,조산%위장외영양%안기산류%수궤대조시험
Infant,premature%Parenteral nutrition%Amino acids%Randomized controlled trials
目的 本研究通过早产儿不同方式输注氨基酸,评价早产儿早期输注高剂量氨基酸的有效性和安全性.方法 将2006年1月1日至12月31日出生24 h内体重1000～2000 g进入我院NICU接受静脉营养治疗的早产儿,随机分为3组.高剂最组(HP)生后24 h内给予2.4 g/(kg·d)静脉氨基酸,每天增加1.2 g/kg,预期达到峰值3.6 g/(kg·d).中剂量组(MP)生后24 h内给予1 g/(kg·d)静脉氨基酸,每天增加0.5 g/kg,预期峰值3 g/(kg·d).低剂量组(LP)生后第3天起给予0.5 g/(kg·d)静脉氨基酸,每天增加0.5 g/kg,预期峰值3 g/(kg·d).结果 3组早产儿人口特征及基线资料相似.HP的最大体重下降(-43.4 g,95%CI-74.3,-12.6)、体重下降百分比(-2.84%,95%CI-4.79%,-0.71%),出NICU天数(-5.25 d,95%CI-10.23,-0.28)、体重达2000 g天数(-7.03 d,95%CI-16.01,1.95)、肠内营养达100 kcal/kg(1 kcal=4.184 kJ)天数(-4.52 d,95%CI-7.47,-1.58)均明显少于LP.HP住院费用少于LP(-6275元,95%CI-11 294,-1256)和MP(-5715元,95%CI-10 907,-524).HP(5.85 mg/L,95%CI-1.17,10.52,P=0.015)和MP(5.07 mg/L,95%CI-0.29,9.86,P=0.038)生后第4天的血视黄醇结合蛋白(RBP)浓度明显高于LP.HP尿素第7天较第1天下降程度与LP相比明显减少(-2.28 mmol/L,95%CI-4.46,-0.10),血氨基酸谱中苏氨酸浓度(70.64 mmol/L,95%CI 5.78,135.50)和酪氨酸浓度(63.12 mmol/L,95%CI-0.65,126.90)明显增高.HP血糖平均值低于LP[(5.63±1.89)mg/dl和(6.51±2.28)mg/dl].HP院内感染发生率低于LP(21.9%和40.0%).安全性指标3组没有差异.结论 早产儿生后24 h内即开始输注2.4 g/kg氨基酸有利于改善早产儿住院期间营养状况,增加喂养的耐受性,减少住院费用和院内感染的发生,并且是安全的.
目的 本研究通過早產兒不同方式輸註氨基痠,評價早產兒早期輸註高劑量氨基痠的有效性和安全性.方法 將2006年1月1日至12月31日齣生24 h內體重1000～2000 g進入我院NICU接受靜脈營養治療的早產兒,隨機分為3組.高劑最組(HP)生後24 h內給予2.4 g/(kg·d)靜脈氨基痠,每天增加1.2 g/kg,預期達到峰值3.6 g/(kg·d).中劑量組(MP)生後24 h內給予1 g/(kg·d)靜脈氨基痠,每天增加0.5 g/kg,預期峰值3 g/(kg·d).低劑量組(LP)生後第3天起給予0.5 g/(kg·d)靜脈氨基痠,每天增加0.5 g/kg,預期峰值3 g/(kg·d).結果 3組早產兒人口特徵及基線資料相似.HP的最大體重下降(-43.4 g,95%CI-74.3,-12.6)、體重下降百分比(-2.84%,95%CI-4.79%,-0.71%),齣NICU天數(-5.25 d,95%CI-10.23,-0.28)、體重達2000 g天數(-7.03 d,95%CI-16.01,1.95)、腸內營養達100 kcal/kg(1 kcal=4.184 kJ)天數(-4.52 d,95%CI-7.47,-1.58)均明顯少于LP.HP住院費用少于LP(-6275元,95%CI-11 294,-1256)和MP(-5715元,95%CI-10 907,-524).HP(5.85 mg/L,95%CI-1.17,10.52,P=0.015)和MP(5.07 mg/L,95%CI-0.29,9.86,P=0.038)生後第4天的血視黃醇結閤蛋白(RBP)濃度明顯高于LP.HP尿素第7天較第1天下降程度與LP相比明顯減少(-2.28 mmol/L,95%CI-4.46,-0.10),血氨基痠譜中囌氨痠濃度(70.64 mmol/L,95%CI 5.78,135.50)和酪氨痠濃度(63.12 mmol/L,95%CI-0.65,126.90)明顯增高.HP血糖平均值低于LP[(5.63±1.89)mg/dl和(6.51±2.28)mg/dl].HP院內感染髮生率低于LP(21.9%和40.0%).安全性指標3組沒有差異.結論 早產兒生後24 h內即開始輸註2.4 g/kg氨基痠有利于改善早產兒住院期間營養狀況,增加餵養的耐受性,減少住院費用和院內感染的髮生,併且是安全的.
목적 본연구통과조산인불동방식수주안기산,평개조산인조기수주고제량안기산적유효성화안전성.방법 장2006년1월1일지12월31일출생24 h내체중1000～2000 g진입아원NICU접수정맥영양치료적조산인,수궤분위3조.고제최조(HP)생후24 h내급여2.4 g/(kg·d)정맥안기산,매천증가1.2 g/kg,예기체도봉치3.6 g/(kg·d).중제량조(MP)생후24 h내급여1 g/(kg·d)정맥안기산,매천증가0.5 g/kg,예기봉치3 g/(kg·d).저제량조(LP)생후제3천기급여0.5 g/(kg·d)정맥안기산,매천증가0.5 g/kg,예기봉치3 g/(kg·d).결과 3조조산인인구특정급기선자료상사.HP적최대체중하강(-43.4 g,95%CI-74.3,-12.6)、체중하강백분비(-2.84%,95%CI-4.79%,-0.71%),출NICU천수(-5.25 d,95%CI-10.23,-0.28)、체중체2000 g천수(-7.03 d,95%CI-16.01,1.95)、장내영양체100 kcal/kg(1 kcal=4.184 kJ)천수(-4.52 d,95%CI-7.47,-1.58)균명현소우LP.HP주원비용소우LP(-6275원,95%CI-11 294,-1256)화MP(-5715원,95%CI-10 907,-524).HP(5.85 mg/L,95%CI-1.17,10.52,P=0.015)화MP(5.07 mg/L,95%CI-0.29,9.86,P=0.038)생후제4천적혈시황순결합단백(RBP)농도명현고우LP.HP뇨소제7천교제1천하강정도여LP상비명현감소(-2.28 mmol/L,95%CI-4.46,-0.10),혈안기산보중소안산농도(70.64 mmol/L,95%CI 5.78,135.50)화락안산농도(63.12 mmol/L,95%CI-0.65,126.90)명현증고.HP혈당평균치저우LP[(5.63±1.89)mg/dl화(6.51±2.28)mg/dl].HP원내감염발생솔저우LP(21.9%화40.0%).안전성지표3조몰유차이.결론 조산인생후24 h내즉개시수주2.4 g/kg안기산유리우개선조산인주원기간영양상황,증가위양적내수성,감소주원비용화원내감염적발생,병차시안전적.
Objective To evaluate the efficacy and safety of the parenteral administration of various quantities of amino acid in preterm infants. Methods Preterm infants (birth weight 1000-2000 g) recruited LP 30. There were no significant differences in demographic or clinical characteristics among the 3 groups. HP group showed lower postnatal weight loss(43.4 g,95% CI 74.3, 12.6)and weight loss% (2.84%, 95% CI 4.79%, 0.71%) than LP group. HP group showed shorter length of stay in NICU(5.25 d), days Cost of hospitalization was significantly lower in HP group than in LP group (- 6275 RMB, 1 US $ = 8 RMB) and MP group (- 5715 RMB). Mean serum RBP (D4), threonine and tyrosine levels were significantly higher in HP group than in LP group. Serum insulin levels were similar; mean serum glucose level was lower in HP group than in LP group. HP infants had lower incidence of sepsis than LP infants (21.9% vs 40.0%). There were no significant differences in the levels of blood ammonia, acid-base balance (as determined by pH and NaHCO<'3->), BUN, Cr, AST, and ALT. Conclusions Intensive and tolerance of enteral feeding. It also reduces the cost of hospitalization, and the incidence of sepsis.
