CAJ | 학술논문

目的了解快速增加氨基酸剂量对早产儿的影响,评价其有效性及安全性,探讨合理的早产儿氨基酸应用方案.方法 2011年11月至2013年1月出生体重1 000～1 800g、出生24 h内入住本院的早产儿,根据随机数字表法分为研究组和对照组.两组患儿均在出生后24 h内开始静脉营养,氨基酸起始剂量均为1.5g/(kg·d),研究组每天增加1g/kg,对照组每天增加0.5g/kg,终点目标达到3.5g/(kg·d).脂肪乳、葡萄糖及电解质的应用均按本院静脉营养方案执行.研究遵循双盲原则.结果共纳入早产儿37例,研究组18例,对照组19例.两组早产儿的胎龄、出生体重、头围等人口学特征相似,宫内感染、窒息、新生儿呼吸窘迫综合征等合并症差异无统计学意义(P＞0.05).接受静脉营养5d内两组早产儿氮平衡状态差异无统计学意义(F =0.025,P=0.652),但研究组恢复出生体重的时间(7.23 ±2.48)d显著早于对照组(9.42 ±2.03)d(t=-2.090、P=0.044).其他指标包括完全喂养的时间、体重增长速度、头围增长速度、平均住院日、住院费用两组比较差异无统计学意义(P＞0.05),常见并发症包括新生儿坏死性小肠结肠炎、败血症、机械通气、肝肾功能异常发生率两组比较差异无统计学意义(P＞0.05).接受不同剂量氨基酸对研究组和对照组早产儿每天的热量摄入无影响(F=1.893,P=0.218).结论早产儿需尽早供给氨基酸,起始剂量宜高于1.5g/(kg·d),快速增加氨基酸剂量未影响早产儿早期的氮平衡状态,但有助于早产儿体重增长,且不增加并发症和住院负担.
목적 료해쾌속증가안기산제량대조산인적영향,평개기유효성급안전성,탐토합리적조산인안기산응용방안.방법 2011년11월지2013년1월출생체중1 000～1 800g、출생24 h내입주본원적조산인,근거수궤수자표법분위연구조화대조조.량조환인균재출생후24 h내개시정맥영양,안기산기시제량균위1.5g/(kg·d),연구조매천증가1g/kg,대조조매천증가0.5g/kg,종점목표체도3.5g/(kg·d).지방유、포도당급전해질적응용균안본원정맥영양방안집행.연구준순쌍맹원칙.결과 공납입조산인37례,연구조18례,대조조19례.량조조산인적태령、출생체중、두위등인구학특정상사,궁내감염、질식、신생인호흡군박종합정등합병증차이무통계학의의(P＞0.05).접수정맥영양5d내량조조산인담평형상태차이무통계학의의(F =0.025,P=0.652),단연구조회복출생체중적시간(7.23 ±2.48)d현저조우대조조(9.42 ±2.03)d(t=-2.090、P=0.044).기타지표포괄완전위양적시간、체중증장속도、두위증장속도、평균주원일、주원비용량조비교차이무통계학의의(P＞0.05),상견병발증포괄신생인배사성소장결장염、패혈증、궤계통기、간신공능이상발생솔량조비교차이무통계학의의(P＞0.05).접수불동제량안기산대연구조화대조조조산인매천적열량섭입무영향(F=1.893,P=0.218).결론 조산인수진조공급안기산,기시제량의고우1.5g/(kg·d),쾌속증가안기산제량미영향조산인조기적담평형상태,단유조우조산인체중증장,차불증가병발증화주원부담.
Objective To explore the influence of early rapidly increased amino acid dosaging on the nitrogen balance and growth in preterm infants.Methods A total of 37 prematures admitted to our NICU within 24 hours after birth and with birth weight of 1 000 g to 1 800 g from November 2011 to January 2013 were randomly divided into study group (n =18) and control group (n =19).Parenteral nutrition (PE) was provided in both groups within 24 hours after birth.The starting amino acid dose was 1.5g/kg per day,then rose by 1 g/kg per day in study group and by 0.5 g/kg per day in control group,until to maximum of 3.5 g/kg per day.The dosage of lipids,glucose,and electrolytes in parenteral nutrition was provided routinely.The trial was double-blinded.Results In the first 5 days of PE,the nitrogen balance had no significant difference between these two groups (F =0.025,P =0.652) ; however,the time of regaining birth weight was significantly shorter in study group [(7.23±2.48) d] than in control group [(9.42±2.03) d] (t=-2.090,P=0.044).There were no differences between these two groups in trems of completely feeding time,weight gain rate,head circumference growth rate,length of hospital stay,and hospital costs (all P ＞ 0.05).Meanwhile,the rates of neonatal necrotizing enterocolitis,sepsis,mechanical ventilation administration,and damage of hepatic and renal function were also not significantly different.The administration of different dosages of amino acids did not affect the energy intake in both groups (F =1.893,P =0.218).Conclusions Prematures need early amino acid administration,with a starting dosage of more than 1.5 g/(kg · d).Rapid increase of amino acid dosing will not affect early nitrogen balance in premature infants; meanwhile,it contributes to weight gain without increasing the complications and hospitalization costs.