积极肠外营养支持方案在胎龄小于34周早产儿中的远期效果研究

目的 探讨应用积极肠外营养支持方案在胎龄小于34周早产儿肠外营养中的远期疗效。 方法 根据早期应用脂肪乳和氨基酸剂量的不同,将2019年5~12月收治的生后24 h内入院、胎龄小于34周的早产儿分为积极肠外营养组和常规肠外营养组,每组各50例,分别收集两组早产儿在随访6个月和13个月时的体格指标及Gesell发育量表测定值。 结果 6月龄时,积极肠外营养组早产儿（n=46）在大运动、精细运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=34）（P<0.05）;13月龄时,积极肠外营养组早产儿（n=25）在适应性行为、大运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=19）（P<0.05）。两组患儿在整个随访过程中的体重、身长、头围等体格发育指标差异均无统计学意义（P>0.05）。 结论 在生后24 h内给予胎龄小于34周早产儿含高剂量脂肪乳和氨基酸的积极肠外营养支持策略可显著改善其远期神经系统发育。     

谷氨酰胺在早产儿肠外营养中的应用研究

目的研究谷氨酰胺(Gln)对早产儿的生长发育、胃肠功能成熟及感染发生率的影响。方法将35例早产儿分为两组,Gln组给予经静脉添加Gln的肠外营养(PN),对照组常规 PN,PN时间均大于2周。监测两组生长发育、喂养耐受情况、胃肠功能及感染发生率。结果 Gln 组生后4周时尿素氮(BUN)水平较对照组高(P=0．044),但仍在正常范围内。平均PN及平均住院时间Gln组均明显短于对照组(P=0．031;P=0．020)。血清胃动素水平Gln组生后2周较生后 3天明显升高(P=0．037);Gln组生后2周较生后3 d胃电节律中节律过快的百分数明显增加 (P=0．017)。Gln组发生感染的次数较对照组明显减少(P=0．001)。结论初步观察提示Gln 有助于早产儿胃肠功能的成熟,减少院内感染的发生。     

谷氨酰胺在早产儿肠外营养中的应用研究

目的研究谷氨酰胺（Gln）对早产儿的生长发育、胃肠功能成熟及感染发生率的影响。方法将35例早产儿分为两组，Gln组给予经静脉添加Gln的肠外营养（PN），对照组常规PN，PN时间均大于2周。监测两组生长发育、喂养耐受情况、胃肠功能及感染发生率。结果Gln组生后4周时尿素氮（BUN）水平较对照组高（P=0．044），但仍在正常范围内。平均PN及平均住院时间Gln组均明显短于对照组（P=0．031；P=0．020）。血清胃动素水平Gln组生后2周较生后3天明显升高（P=0．037）；Gln组生后2周较生后3d胃电节律中节律过快的百分数明显增加（P=0．017）。Gln组发生感染的次数较对照组明显减少（P=0．001）。结论初步观察提示Gln有助于早产儿胃肠功能的成熟，减少院内感染的发生。     

早产儿肠外营养方法的对比研究

目的 探讨早产儿应用早期及传统两种肠外营养方法的疗效.方法 不能耐受全胃肠道喂养的早产儿60例(胎龄28～36周,体质量l 200～2 500 g),随机分为两组,早期组于生后24 h以后添加氨基酸及脂肪乳;晚期组采用传统的肠外营养方法,即72 h以后应用氨基酸及脂肪乳,同时均根据病情尽早经口微量喂养.两组患儿均于生后第1天与第7天检测血肝功能、总胆红素、三酰甘油、总胆固醇、尿素氮,每天监测体质量、微量血糖.比较两组患儿恢复至出生体质量时间、体质量下降幅度、第3天热量、第7天热量、肠外营养时间、住院天数、过渡到全肠道营养的时间、并发症发生例数及血清胆固醇、三酰甘油、胆红素、尿素氮的变化.结果 早期组患儿恢复至出生体质量时间较晚期组短(P<0.01),第3天热量、第7天热量较晚期组高(P<0.01),体质量下降幅度、并发症发生例数两组差异无统计学意义(P>0.05);两组患儿生后相同日龄测得的总胆红素、直接胆红素、总胆固醇、三酰甘油及尿素氮差异均无统计学意义(P均>0.05).结论 早期积极规范的肠外营养支持对早产儿是有益且安全的.     

早产儿肠外营养相关性胆汁淤积防治进展

肠外营养相关性胆汁淤积(PNAC)是早产儿肠外营养(PN)治疗过程中最常见的并发症,其病因及发病机制尚不明确.该文总结了近年来国内外有关早产儿PNAC的研究报道,提出了避免早产、合理喂养、优化PN方案等多种预防措施.熊去氧胆酸是目前治疗PNAC的一线药物.     

34 周以下适于胎龄及小于胎龄早产儿出生 2 周内 蛋白质、能量摄入及体质量变化

目的了解34周以下早产适于胎龄儿(AGA)和小于胎龄儿(SGA)生后蛋白质、能量摄入量以及体质量z评分的变化情况。方法回顾收集2012年1月至2014年12月入院的314例早产儿,比较268例AGA和46例SGA早产儿生后2周内蛋白质、能量摄入情况和体质量变化。结果 SGA组住院时间、肠外联合肠内营养时间、全肠内营养时间、达足量喂养时间均较AGA早产儿长,差异有统计学意义(P??0.05);SGA组生后第4、8、12天能量摄入量明显低于AGA组,SGA组生后第6、8天总蛋白质摄入量明显低于AGA组,差异均有统计学意义(P??0.05);SGA组日平均体质量增长量大于AGA组,差异有统计学意义(P??0.05);AGA组与SGA组生后2周内体质量z评分均逐渐远离中位水平,且SGA组2周时体质量z评分低于AGA组(P??0.05)。结论胎龄??34周的SGA早产儿恢复出生体质量后的生长速率快于AGA早产儿,存在一定的追赶生长;但SGA、AGA早产儿的生长均有待提高。     

早产儿营养支持难点与对策

宫外生长发育迟缓（EUGR）在我国还相当普遍,如何对早产儿进行合理营养支持是新生儿科医生需关注的问题之一。该文介绍了早产儿肠外营养支持的途径选择和脂肪乳剂的选择、肠外营养应用时间及肠外营养相关的肝损害等并发症等问题。肠外营养相关的肝损害其机制仍不清,目前主要预防措施是尽早口服喂养、总热卡控制、积极抗感染等。     

两种肠道外营养方法在早产儿中的应用研究

目的 探讨早产儿应用两种肠道外营养(parenteral nutrition,PN)方法的疗效.方法 选择不能耐受完全胃肠道喂养的早产儿42例,随机分为观察组(22例)和对照组(20例).观察组患儿生后24 h内应用氨基酸,自1.0/g(kg·d)开始,每日递增1.0g/(kg·d),直至3.0/g(kg·d);48 h内应用脂肪乳,剂量及添加方法同氨基酸,生后第5天达全静脉营养.对照组患儿生后48 h应用氨基酸,自0.5g/(kg·d)开始,每日递增0.5g/(kg·d),直至3.0g/(kg·d);72 h后应用脂肪乳,剂量及添加方法同氨基酸,生后8～9 d达全静脉营养.两组患儿均监测营养效果,出生72 h内和第10天分别监测血生化指标,观察并发症发生情况.结果 观察组恢复至出生体质量时间、体质量下降幅度、PN时间、过渡到全胃肠道营养时间均较对照组短,差异有统计学意义(P＜0.01).并发症发生情况比较两组差异无统计学意义(x2=0.191,P＞0.05).两组患儿在血糖、总胆红素、尿素氮、二氧化碳结合力、总胆固醇等方面比较差异均无统计学意义(P＞0.05).结论 早产儿可以耐受生后24 h内早期足量的PN.     

谷草转氨酶与血小板比值指数联合总胆汁酸对胎龄<34周早产儿肠外营养相关性胆汁淤积症的预测价值北大核心CSCD

目的探讨谷草转氨酶与血小板比值指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合总胆汁酸(total bile acid,TBA)对胎龄<34周早产儿肠外营养相关性胆汁淤积症(parenteral nutritionassociated cholestasis,PNAC)的预测价值。方法回顾性分析2019年1月—2022年9月在皖南医学院第一附属医院住院期间接受肠外营养(parenteral nutrition,PN)的270例胎龄<34周早产儿的临床资料,包括PNAC 128例和非PNAC 142例。比较两组的临床资料,通过多因素logistic回归分析探讨PNAC发生的预测因素,并采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评价APRI、TBA单独及二者联合预测PNAC的价值。结果PNAC组在PN 1、2及3周后的TBA水平均高于非PNAC组(P<0.05);PN 2、3周后PNAC组APRI均高于非PNAC组(P<0.05)。多因素logistic回归分析显示,PN 2周后APRI和TBA升高是早产儿发生PNAC的预测因素(P<0.05)。ROC曲线分析显示,PN 2周后APRI联合TBA预测PNAC发生的灵敏度、特异度及曲线下面积(area under the curve,AUC)分别为0.703、0.803、0.806;APRI联合TBA预测PNAC发生的AUC高于APRI、TBA单独预测的AUC(P<0.05)。结论在PN 2周后,APRI联合TBA对胎龄<34周早产儿PNAC的预测价值较高。     

Carnitine deficiency in premature infants receiving total parenteral nutrition

Carnitine plays a significant role in fatty acid utilization and ketone body production. Its availability is especially important during the immediate postnatal period. To determine whether low birth weight infants who cannot be orally fed are at risk of developing carnitine deficiency, we compared the carnitine blood levels and urinary excretion of 12 premature infants (Group A) receiving total parenteral nutrition (TPN) with those of 8 infants of similar gestational age and birth weight (Group B) who received carnitinecontaining milk formulas.In Group A, serum levels of total and free carnitine fell after 5 days of carnitine-deficient parenteral nutrition, and urinary excretion was significantly reduced. Serum levels and urinary excretion increased after the onset of oral feedings. The control Group B exhibited no significant changes in carnitine blood levels between the first and fifth days of life, but did show a later increase. Children in Group A had lower carnitine blood levels compared to those in Group B on the fifth day of life.These findings suggest that premature infants are not able to synthesize enough carnitine to maintain blood levels, and that carnitine deficiency can occur following TPN. Further investigation of metabolic consequences secondary to deficient carnitine intake in premature infants is necessary before carnitine supplementation should be considered.     

早产儿肠道外营养相关性胆汁淤积的临床研究

目的 探讨早产儿肠外营养相关性胆汁淤积(PNAC)的相关因素及防治措施.方法 对68例进行静脉营养支持14 d以上的早产儿资料进行分析评价,按是否发生PNAC分PNAC组与非PNAC组.结果 早产儿PNAC发生率为14.7%(10/68),PNAC组的胎龄小于非PNAC组,出生体质量恢复时间长于非PNAC组,而PN持续时间、PN热卡摄入量、脂肪乳最大剂量及累计用量、生后2周时静脉非蛋白热卡所占比例(%)大于非PNAC组.结论 PNAC发生与低胎龄、长PN持续时间、PN提供热卡过高、脂肪乳最大剂量和累计用量、静脉营养中非蛋白热卡所占比例过高相关.防治PNAC的措施包括尽早经口喂养及尽早过渡到全胃肠营养;不过分追求高热卡;调整静脉营养配方,使脂肪乳最大剂量尽量不高于3g/kg.非蛋白热卡的比例尽量不超过85%;双岐杆菌微生态调节剂及腺苷蛋氨酸可以防治PNAC;动态监测直接胆红素(DBIL)、总胆汁酸(TBA)可有助于早期发现PNAC .     

早产儿肠外营养相关性胆汁淤积高危因素

目的 探讨早产儿肠外营养支持的安全性和有效性.方法 对静脉营养支持7 d以上的523例早产儿资料进行分析评价,其中单纯早产儿250例,伴合并症[主要伴窒息和(或)败血症、肺炎、肺透明膜病、坏死性小肠结肠炎]早产儿273例,比较两组胃肠外营养相关性胆汁淤积(PNAC)的发生率及相关因素.按是否发生PNAC分PNAC组和非PNAC组.结果 早产儿PNAC总发生率8.8%(46/523),单纯早产儿组PNAC发生率414%(11/250);伴合并症早产儿组PNAC发生率12.8%(35/273).PNAC组的胎龄、出生体重均小于非PNAC组,开始肠内喂养时间晚于非PNAC组,每日体重增加低于非PNAC组,而平均胃肠外营养(PN)持续时间、PN热卡摄人量大于非PNAC组;单纯早产儿组胎龄、出生体重、生后每日体重增加均大于伴合并症早产儿组,而平均PN持续时间、PN热卡摄人量低于伴合并症早产儿组,开始喂养日龄、体蕈恢复时间均早于伴合并症早产儿组.结论 PNAC发生与低胎龄、低出生体重、长PN持续时间、PN提供热卡过高、肠内喂养过迟以及是否伴有合并症有关.     

Catheter-related complications of total parenteral nutrition in infants

We have reported five complications related to the catheters used for total parenteral nutrition. The only acceptable position for the catheter tip is in the superior vena cava near the junction of the right atrium. Rigid aseptic technique, careful nursing skills and repeated radiographic and clinical examination of the patient can reduce these catheter-related complications.     

早产低出生体质量儿肠外营养相关性胆汁淤积的临床危险因素及近期结局

目的探讨早产低出生体质量儿肠外营养相关性胆汁淤积(PNAC)的临床危险因素以及近期结局。方法回顾分析2018年至2020年期间于新生儿重症监护病房住院的应用肠外营养(PN)≥14 d,出生体质量2 500 g的114例早产低出生体质量儿的临床资料。根据早产儿直接胆红素水平(DB)分为PNAC组(DB34 μmol/L,27例)和非PNAC组(87例),以丙氨酸氨基转移酶50 U/L为合并肝损伤标准,进行比较分析。结果 PNAC发生率23.6%,发生时间为应用PN后(32.8±12.5)d,在PN停止后(52.2±29.5)d 恢复。PNAC组中14例(51.8%)发生肝损伤,发生时间为应用PN后(42.0±14.7)d;肝损伤持续时间为70.5 d(56.0～77.7 d),胆汁淤积持续时间为(90.2±42.1)d。PNAC组住院时间、抗生素应用时间、机械通气时间、PN持续时间及禁食时间均长于非PNAC组,生后开奶时间晚于非PNAC组,氨基酸及脂肪乳累积用量大于非PNAC组,合并坏死性小肠结肠炎(NEC)、败血症比例大于非PNAC组,差异均有统计学意义(P0.05)。多元logistic回归分析示,禁食时间、PN持续时间、NEC是PNAC发生的独立危险因素(P0.05)。结论 PNAC是早产低出生体质量儿进行PN过程中常见并发症。长时间禁食、PN持续时间长及合并NEC提高了PNAC发生的风险。经过治疗,PNAC患儿大多预后良好。     

Comparison of lipid emulsions on antioxidant capacity in preterm infants receiving parenteral nutrition

Background: Although a variety of different lipid emulsions with varying fatty acid contents have been developed, there are some concerns about the administration of these lipid emulsions because of potential adverse effects, including oxidative stress‐related morbidity. The aim of the present study was to evaluate and compare the effects of the standard soybean oil‐based and olive oil‐based i.v. lipid emulsions (ILE) on oxidative stress, determined by total antioxidant capacity (TAC), and to investigate the safety of the use of these two emulsions in terms of biochemical indices. Methods: In this prospective study, premature infants were randomly assigned to two groups, each group consisting of 32 patients who received parenteral ILE of either 20% olive oil or 20% soybean oil. They were given ILE for 7 days and then were evaluated with regard to TAC. Results: No statistically significant difference was observed between the groups in terms of routine biochemical parameters. TAC for both groups on day 7 was significantly lower compared with that on day 0. Although the decrease in TAC within 7 days of ILE administration was greater in the soybean group compared with that in the olive oil group, it was not statistically significant. Conclusions: Olive oil‐based ILE exhibit similar antioxidant activity and can be used as an alternative to soybean oil‐based ILE. TAC significantly decreased in infants following administration of either lipid emulsion, and premature infants tolerated either ILE well, both biochemically and clinically.     

Evaluation of standardized versus individualized total parenteral nutrition regime for neonates less than 33 weeks gestation

OBJECTIVE: To evaluate the difference in nutrient intakes and biochemical responses in newborn infants <33 weeks gestation who received standardized versus individualized total parenteral nutrition (TPN) regimes. METHOD: Comparison of nutrient intakes and daily biochemical responses in newborn infants <33 weeks gestation who received standardized regime versus those who received individualized TPN regimes from day 2 to day 7 of life. RESULTS: Twenty-seven infants in the standardized TPN group and 31 infants in the individualized TPN group were compared. There were no statistically significant differences (P > 0.05) between the two groups in gestation, birthweight, Clinical Risk Index for Babies scores, daily TPN volume intake and biochemical responses. Infants in the standardized TPN group received less sodium (P < 0.01) and no potassium on day 2 as required, more protein (P < 0.02) every day, and more calcium and phosphate (P < 0.02 from day 4). CONCLUSION: There were no significant clinical and statistical differences in biochemical responses in newborn infants <33 weeks gestation who received standardized versus individualized TPN regimes during the first week of life. The economic cost of TPN provision using standardized TPN formulation was approximately 30% lower.