早产儿低出生体重儿两种静脉营养方式的对比研究

目的：静脉营养已经成为低出生体重儿现代综合治疗中不可缺少的一环,对于早产儿静脉营养时何时加用氨基酸和脂肪乳,国内外有很大差别,国内传统静脉营养法为生后48h后加用氨基酸,72h后加用脂肪乳,而国外早期静脉营养法为生后第1天即给予氨基酸和脂肪乳。该实验对比研究两种静脉营养方法的效果。方法：将40例不能耐受全肠道营养的符合条件早产儿低出生体重儿随机分为两组,实验组采用早期静脉营养法,对照组采用传统静脉营养法,记录两组患儿生后1周内营养摄入及2周内体重增长情况、过渡到全肠道喂养时间、静脉营养相关并发症,并于生后第1,3,7天采静脉血测血清前白蛋白。对其中21例(实验组11例,对照组10例)于生后6个月测量身长和体重。结果：①实验组生后1周内每日摄入的非蛋白热卡量、2周内平均每日增重均高于对照组(P<0.001);②相同日龄血清前白蛋白检测结果:第1天实验组与对照组无差异;第3日及第7日实验组均高于对照组,分别为(61±11.2mg/Lvs31.5±8.5mg/L;91.5±10.8mg/Lvs78±10.9mg/L,P<0.001);③实验组与对照组过渡到全肠道喂养时间无差异;④两组均无静脉炎、血栓形成、氮质血症、高脂血症及胆汁淤积的发生,两组呼吸暂停、高血糖、高胆红素血症的发生率差异无显著性(P>0.05)。随访生后6个月的体重,实验组高于对照组,但无统计学意义(P>0.05)。结论：早产儿低出生体重儿采用早期静脉营养比传统静脉营养摄入热卡多,体重增长快;可以避免早产儿早期营养不良的发生;对胃肠功能的恢复无明显作用;不会增加静脉营养相关并发症的发生。

Comparison of two parenteral nutrition methods in low birth weight premature infants

OBJECTIVE: Parenteral nutrition (PN) is widely used in the management of low birth weight infants. There are great differences between China and the foreign countries in the PN administration methods. The conventional PN method in China is to administer amino acids 48 hrs after birth, and the fat emulsion, 72 hrs after birth. However, the data from overseas centers have indicated that early PN (started at the first day of life) is safe and more beneficial to the premature infant. This study aimed to compare the effects of the two methods on nutrition states and the incidence of complication associated with PN. METHODS: Forty low birth weight premature infants who were intolerant to total enteral nutrition, with a gestational age of less than 36 weeks and a birth weight of less than 1 600 g, were chosen for this study. They were randomly assigned into two groups: Conventional PN group and Early PN group (n=20 each). The body weight, the amount of caloric intake,the time taken to attain of full enteral nutrition, and the incidence of complication were recorded daily. Serum prealbumin concentrations were measured on the 1st, 3rd and 7th days after birth. RESULTS: The caloric intake in the first week and daily weight gain in the first two weeks in the Early PN group were much greater than those of the Conventional PN group (P<0.001). On the first day, there was no difference in the serum prealbumin concentration between the two groups. However serum prealbumin concentration increased on the 3rd day(61±11.2 mg/L)and on the 7th day (91.5±10.8 mg/L)in the Early PN group compared with those in the Conventional PN group(31.5±8.5 mg/L and 78±10.9 mg/L respectively)(P<0.001).The time taken for the two groups to go on full enteral nutrition was similar. No significant difference was observed in the incidence of complication between the two groups. CONCLUSIONS: Caloric intake and body weight gain were found to be greater in the Early PN group than in the Conventional PN group in low birth weight premature infants. The incidence of complication associated with PN and the initiation of gastro-intestinal function are unrelated to the PN administration method.