CAJ | 학술논문

目的：为改善早产儿宫外生长速度，尽快完成追赶性生长，予以早期输注高剂量氨基酸和脂肪乳，观察其有效性和安全性。方法经患儿父母知情同意，并签署知情同意书后，将83例不能耐受全肠道营养的符合条件早产儿低出生体质量儿按数字表法随机分为2组，实验组采用早期高静脉营养法，对照组采用传统静脉营养法，记录2组患儿生后2周内体质量增长速度，恢复出生体质量时间，达到全肠道喂养时间，并于生后第1、7、14天采静脉血测血清前白蛋白，静脉营养第1、7天采血检测白细胞、血红蛋白、血小板、转氨酶、胆红素、肌酐、尿素氮、血脂、血气碱剩余（base excess，BE）值。结果（1）实验组生后2周内体质量增长速度显著高于对照组（P ＜0．01），恢复出生体质量时间、达到全胃肠道喂养时间及住院时间、住院费用均低于对照组（P ＜0．05）；（2）相同日龄血清前白蛋白检测结果：第1天实验组和对照组无明显差异（P ＞0．05），但第7天明显高于对照组（P ＜0．05），第14天血清白蛋白含量仍高于对照组，但差异无统计学意义（P ＞0．05）；（3）2组均无血栓形成、氮质血症、高脂血症、胆汁淤积及脓毒症的发生。结论早产儿低出生体质量儿采用早期高剂量氨基酸和脂肪乳比传统静脉营养摄入体格增长快；达到全胃肠道喂养时间短，住院时间、住院费用降低；目前静脉营养水平尚未发现不良并发症的发生。
목적：위개선조산인궁외생장속도，진쾌완성추간성생장，여이조기수주고제량안기산화지방유，관찰기유효성화안전성。방법경환인부모지정동의，병첨서지정동의서후，장83례불능내수전장도영양적부합조건조산인저출생체질량인안수자표법수궤분위2조，실험조채용조기고정맥영양법，대조조채용전통정맥영양법，기록2조환인생후2주내체질량증장속도，회복출생체질량시간，체도전장도위양시간，병우생후제1、7、14천채정맥혈측혈청전백단백，정맥영양제1、7천채혈검측백세포、혈홍단백、혈소판、전안매、담홍소、기항、뇨소담、혈지、혈기감잉여（base excess，BE）치。결과（1）실험조생후2주내체질량증장속도현저고우대조조（P ＜0．01），회복출생체질량시간、체도전위장도위양시간급주원시간、주원비용균저우대조조（P ＜0．05）；（2）상동일령혈청전백단백검측결과：제1천실험조화대조조무명현차이（P ＞0．05），단제7천명현고우대조조（P ＜0．05），제14천혈청백단백함량잉고우대조조，단차이무통계학의의（P ＞0．05）；（3）2조균무혈전형성、담질혈증、고지혈증、담즙어적급농독증적발생。결론조산인저출생체질량인채용조기고제량안기산화지방유비전통정맥영양섭입체격증장쾌；체도전위장도위양시간단，주원시간、주원비용강저；목전정맥영양수평상미발현불량병발증적발생。
Objective To improve the growth rate of premature infants outside the womb,to complete the catch-up growth of premature infants as soon as possible by early infusion of high-dose amino acids and fat emulsion,and to observe the efficacy and safety of the treatment.Methods Eighty-three low birth-weight premature infants intolerate to total enteric nutrition were randomly divided into 2 groups:the experimental group and the control group.The experimental group was treated with parenteral nutrition (PN),while the control group was treated with conventional intravenous nutrition supply.The rate of weight gain,the time to regain birth weight and the time to attain full enteral nutrition were recorded daily in the first two weeks after birth for the premature infants of the two groups.Serum prealbumin concentration was measured on the 1 st ,3 rd ,and 7 th days after birth.White blood cell,hemoglo-bin,platelet,transaminase,bilirubin,creatinine,urea nitrogen,blood lipid,blood BE value were detected on the 1 st and 7 th days. Results (1)Two weeks after birth,the rate of weight gain for the infants in the experimental group was significantly higher than that of the control group (P <0.01).The time to regain birth weight,the time to reach full enteral nutrition,the duration of stay at hospi-tal and medical cost for the infants in the experimental group were all lower than those of the control group (P <0.05).(2)The fol-lowing were the detection results of serum prealbumin concentration on the same days after birth:There was no significant difference between the experimental group and the control group in serum prealbumin concentration on the 1 st day (P <0.05 ),however,the concentration of serum prealbumin on the 7 th day for the experimental group was significantly higher than that of the control group (P <0.05).Serum prealbumin on the 14 th day for the experimental group was still higher than that of the control group (P <0.05),but without statistical significance (P <0.05).(3)There was no occurrence of hrombosis,azotemia,hyperlipidemia,cholestasis, and sepsis in the two groups.Conclusion By taking high doses of amino acids and fat emulsion,the rate of weight gain in the pre-mature infants with low birth weight was much higher,as compared with that of the control group.Furthermore,the time to attain full enteral nutrition,the duration of stay at hospital and medical costs were also lower,and most importantly,complication associated with parenteral nutrition was not found.