早产儿喂养不耐受的临床特征及危险因素

目的探讨早产儿喂养不耐受的临床特征及危险因素。方法本研究为回顾性研究。研究对象为2017年1月至2017年12月在北京大学第三医院新生儿科住院的早产儿,进一步将其中的喂养不耐受组患儿按出生胎龄分为<31周组和≥31周组,以及按出生体重分为<1250 g组和≥1250 g组。分析纳入对象的病历资料,探讨早产儿喂养不耐受的临床特征及其危险因素。采用独立样本t检验、χ^2检验和logistic回归分析等方法,对数据进行统计学分析。结果(1)符合标准的研究对象共612例,其中喂养不耐受组182例(29.7%),喂养耐受组430例(70.3%)。喂养不耐受组中,男婴103例(56.6%),女婴79例(43.4%);胎龄(30.6±2.3)周,其中93例(51.1%)胎龄<31周;出生体重(1298±417)g,其中93例(51.1%)<1250 g;134例(73.6%)为极低出生体重儿。喂养不耐受在极低出生体重早产儿中的发生率为63.2%(134/212)。(2)喂养不耐受的诊断日龄为(2.7±0.9)d,消失日龄为(13.2±6.9)d,持续时间为(10.5±6.7)d,主要症状包括胃潴留100.0%(182/182)、腹胀54.4%(98/182)和呕吐17.0%(31/182)。(3)与胎龄≥31周者相比,胎龄<31周的早产儿喂养不耐受诊断和消失更晚[(2.4±0.8)与(2.9±0.9)d,t=3.977;(10.4±5.2)与(16.0±7.3)d,t=5.935],持续时间更长[(8.0±5.0)与(13.0±7.3)d,t=5.450],恢复出生体重时间更晚[(9.4±4.1)与(12.0±5.1)d,t=3.672](P值均<0.05)。与出生体重≥1250 g的早产儿相比,出生体重<1250 g的早产儿喂养不耐受诊断和消失更晚[(2.5±0.9)与(2.8±0.9)d,t=2.540;(10.0±4.5)与(16.3±7.4)d,t=6.951]、持续时间更长[(7.5±4.3)与(13.5±7.3)d,t=6.690]、更少发生呕吐[23.6%(21/89)与10.8%(10/93),χ^2=5.308](P值均<0.05)。(4)出生体重是早产儿喂养不耐受的保护因素(OR=0.998,95%CI:0.997~0.998),新生儿呼吸窘迫综合征(OR=2.129,95%CI:1.163~3.897)、多胎(OR=1.812,95%CI:1.116~2.941)、生后48 h内应用枸橼酸咖啡因(OR=2.663,95%CI:1.619~4.381)、生后48 h内应用持续气道正压通气(OR=5.211,95%CI:2.861~9.489)和宫内感染(OR=1.988,95%CI:1.060~3.728)是早产儿喂养不耐受的独立危险因素(P值均<0.05)。结论早产儿喂养不耐受发生率较高;胎龄较小、出生体重较低的早产儿喂养不耐受发生和消失时间较晚,持续时间较长;出生体重低、新生儿呼吸窘迫综合征、多胎、生后48 h内应用枸橼酸咖啡因、生后48 h内应用持续气道正压通气和宫内感染是早产儿喂养不耐受的危险因素。     

非营养性吸吮和肠道益生菌治疗足月儿喂养不耐受48例疗效观察

目的观察非营养性吸吮和肠道益生菌治疗足月儿喂养不耐受的临床疗效。方法将48例喂养不耐受的患儿随机分成观察组和对照组,两组患儿均给予常规护理,洗胃、通便及防治感染,维持水、电解质平衡,静脉营养,口服小剂量红霉素等对症支持治疗。观察组在此基础上加用非营养性吸吮和肠道益生菌治疗,疗程10～14d。观察两组患儿开奶时间、胃残留量、呕吐、腹胀消失时间、恢复至出生体质量时间、达全量肠内营养时间。结果观察组较对照组在患儿胃残留量、呕吐、腹胀消失时间、恢复至出生体质量时间、达全量肠内营养时间均有缩短,差异有统计学意义(P0.05)。结论应用非营养性吸吮和肠道益生菌治疗足月儿喂养不耐受疗效显著,可广泛开展。     

早产儿喂养不耐受的影响因素

随着早产儿特别是极低出生体重儿存活率的提高,喂养和营养需求问题逐渐成为决定早产儿住院时间长短及生存质量的关键.早产儿由于胃肠道发育不成熟及生后缺乏合理的喂养指导策略,易发生喂养不耐受.本研究回顾分析421例胎龄＜34周的早产儿发生喂养不耐受的情况,探讨其影响因素,为预防早产儿喂养不耐受提供临床参考.     

新生儿及新生儿疾病

早产／低出生体重儿营养与喂养适宜技术；口服吗叮啉及液体灌肠治疗早产儿喂养不耐受的临床观察；达立通颗粒鼻饲治疗早产儿喂养不耐受36例临床疗效观察；小剂量红霉素治疗早产儿喂养不耐受疗效观察；新生儿喂养不耐受的临床特征及高危因素分析；476例早产儿早产原因分析。     

复合凝乳酶联合小剂量红霉素治疗早产儿喂养不耐受55例疗效观察简

目的 观察复合凝乳酶联合小剂量红霉素治疗早产儿喂养不耐受的疗效.方法 将107例喂养不耐受早产儿随机分为对照组52例,观察组55例,均给予管饲或口服红霉素,同时给予温箱保温、洗胃、通便、防治感染、静脉营养、维持水电解质平衡等对症支持治疗,观察组同时给予管饲或口服复合凝乳酶胶囊,连用5 d.比较两组3及5 d的临床有效率,观察呕吐次数、腹胀情况、奶量及胃残留量.结果 观察组总有效率96.4%（53/55）高于对照组82.7%（43/52）,差异有统计学意义（P＜0.05）;观察组呕吐或腹胀消失时间短于对照组,差异有统计学意义（P＜0.05）;观察组每日加奶量多于对照组,差异有统计学意义（P＜0.05）.结论 复合凝乳酶联合小剂量红霉素治疗早产儿喂养不耐受效果确切,值得临床推广.     

北京地区晚期早产儿肠内营养支持现状及影响因素

目的分析北京地区不同级别医院收治胎龄34~36周+6晚期早产儿的肠内营养支持现状及相关影响因素。方法前瞻性纳入2015年10月至2017年10月间北京地区共25家医院收治的晚期早产儿,记录其营养管理及营养相关并发症的数据。分析不同胎龄、不同级别医院的晚期早产儿的纯母乳喂养情况,以及晚期早产儿达足量喂养情况及影响因素。采用t检验、Mann-Whitney U检验、方差分析、Kruskal-Wallis检验、χ^2检验等对数据进行统计学分析。多因素分析时采用二元logistic回归、Cox回归分析。结果(1)研究期间,共1463例晚期早产儿纳入,胎龄(35.6±0.8)周,范围为34.9~36.1周。34~34周+6与35~35周+6及36~36周+6晚期早产儿相比,住院时间更长[10(8~13)与8(7~10)、7(6~9)d,P值均<0.05],最低体重下降幅度更大[4.3%(2.6%~6.3%)与3.8%(2.0%~5.6%)、3.3%(1.9%~5.5%),P值均<0.05],呼吸暂停及新生儿呼吸窘迫综合征发生率更高[分别为5.3%(20/369)与2.1%(12/566)、1.3%(7/528),7.1%(28/369)与3.0%(17/566)、3.2%(17/528),P值均<0.05],出院时未恢复出生体重者比例更低[32.5%(120/369)与38.7%(219/566)、47.9%(253/528),P值均<0.05]。34~34周+6、35~35周+6及36~36周+6晚期早产儿母亲孕期并发症方面,仅胎膜早破的发生率差异有统计学意义[6.2%(23/369)与12.7%(72/566)、11.9%(63/528),χ^2=10.244,P=0.007]。(2)晚期早产儿住院期间加奶速度为13.7(10.5~17.3)ml/(kg·d),且以早产儿配方奶喂养为主(46.0%,673/1463);住院期间纯母乳喂养的比例仅为4.5%(66/1463),出院时纯母乳喂养的比例可升高到14.4%(211/1463)。25家医疗单位出院时母乳喂养的比例差异有统计学意义(χ^2=327.893,P<0.001),纯母乳喂养比例最高的单位可以达到32%,最低为0。(3)logistic回归分析显示,妊娠期糖尿病(OR=2.426,95%CI:1.075~5.473,P=0.033),胎膜早破(OR=8.726,95%CI:1.193~63.802,P=0.033)可能是晚期早产儿纯母乳喂养的独立危险因素。出院时肠内营养量达到150 ml/(kg·d)的比例为28.4%(416/1463),达到120 kcal/(kg·d)(1 kcal=4.184 kJ)的比例为19.2%(281/1463)。单因素及多因素Cox回归分析显示,医院级别(HR=1.470,95%CI:1.030~2.098)、住院时间(HR=1.162,95%CI:1.097~1.231)、出生体重(HR=0.946,95%CI:0.898~0.995)、纯母乳喂养(HR=2.354,95%CI:1.031~5.374)、喂养不耐受(HR=3.677,95%CI:1.201~11.253)、肠外营养支持(HR=1.900,95%CI:1.379~2.616)及加奶速度(HR=1.426,95%CI:1.369~1.484)是晚期早产儿出院时能否达到足量喂养的独立影响因素(P值均<0.05)。结论晚期早产儿的营养支持现状特点为纯母乳喂养率较低,各医疗单位间存在较大差异,平均加奶速度较慢,多数晚期早产儿出院时未能达到足量喂养。妊娠期糖尿病和胎膜早破是影响晚期早产儿纯母乳喂养的独立危险因素。而出生体重低、住院期间纯母乳喂养、存在过喂养不耐受、应用过肠外营养支持、住院时间较长或加奶速度更快的晚期早产儿更倾向于能够在出院前达到足量喂养。     

多潘立酮口服液联合非营养性吸吮治疗低体重早产儿喂养不耐受67例疗效观察

目的观察多潘立酮口服液配合非营养性吸吮防治早产儿喂养不耐受的疗效。方法将67例喂养不耐受低体重早产儿随机分为观察组34例和对照组33例,均予保暖、抗感染、维持水电解质平衡、静脉营养支持及对症治疗,外加早期鼻饲管喂养;观察组在此基础上加服多潘立酮口服液及在喂养前后15min给予非营养性吸吮。观察喂养耐受发生率和从静脉营养过渡到完全胃肠道营养需要的时间。结果观察组早产儿喂养不耐受的发生率与对照组比较差异有统计学意义（P〈0.05）,从静脉营养过渡到完全胃肠道营养时间的比较,差异有统计学意义（P〈0.05）。结论多潘立酮配合非营养性吸吮对防治早产儿喂养不耐受有明显效果,且方法安全、可靠。     

强化母乳喂养对住院早产儿生长代谢的影响

目的 回顾性研究强化母乳喂养对早产儿住院期间生长代谢及合并症的影响. 方法 收集中国医学科学院北京协和医院2009年1月1日至2012年12月31日胎龄≤36周且出生体重≤1800 g符合入选条件的早产儿148例,根据喂养方式不同分为强化母乳喂养组(73例)与早产儿配方奶喂养组(75例).比较2组早产儿的生长发育、代谢指标和合并症发生情况.数据采用均数±标准差或中位数和四分位数[M(P25,P75)]表示.采用t检验、x2检验或非参数检验进行统计学分析.结果 强化母乳喂养组和配方奶喂养组早产儿的胎龄、出生体重、出生身长、出生头围、恢复出生体重的日龄及出生时小于胎龄儿、新生儿呼吸窘迫综合征、≥Ⅲ级脑室内出血、窒息的比例差异均无统计学意义(P均＞0.05).强化母乳喂养组早产儿住院期间肠外营养时间为18 d(14 d,25 d),短于配方奶喂养组[24 d(18 d,31 d.),Z=-2.950,P=0.003];奶量达120 ml/(kg·d)日龄为16 d(12 d,23 d),小于配方奶喂养组[22 d(16 d,30 d),Z=-2.895,P=0.004];总热卡达120 kcal/(kg·d)日龄为11 d(8 d,15 d),小于配方奶喂养组[14 d(10 d,18 d),Z=-2.392,P=0.017].强化母乳喂养组住院费用为47 078元(30 802元,67 039元),低于配方奶喂养组[58 400元(38 166元,82 737元)],差异有统计学意义(Z=-1.970,P=0.049).2组早产儿开奶时间、喂养不耐受发生率、恢复出生体重后平均每日体重增长速度、每周身长增长速度、每周头围增长速度、出院时小于胎龄儿发生率、出生体重z评分、出院体重z评分、出院体重、出院身长及出院头围差异均无统计学意义(P均＞0.05).强化母乳喂养组出院前血碱性磷酸酶为(347.7±149.4) U/L,高于配方奶喂养组[(288.6±108.8) U/L,t=2.570,P=0.011],其余生化指标入院时及出院前差异均无统计学意义.强化母乳喂养组败血症的发生率为11.0％(8/73),低于配方奶喂养组[20.0％(15/75)],但差异无统计学意义(x2 =2.30,P＞0.05),视网膜病、支气管肺发育不良及坏死性小肠结肠炎发生率差异均无统计学意义(P均＞0.05). 结论 早产儿强化母乳喂养不仅可达到与配方奶喂养相似的生长速率,且可加速肠内喂养进程,缩短肠外营养时间,减少败血症发生率,降低住院费用.     

早产儿的喂养

随着早产儿存活率的上升 ,早产儿的喂养问题日益突出。如何给早产儿提供全面合理的营养一直困扰着产儿科医生。以下就近年来早产儿的喂养临床研究及实践作以概述。早产儿的生长发育与其生后充足而全面的营养物质摄取及吸收能力密切相关 ,然而由于早产儿胃肠道消化吸收功能、粘膜屏障功能和动力学功能不成熟 ,加之各种疾病的影响造成其喂养困难。目前 ,多采用肠外营养结合肠内营养的方法 ,即静脉营养加微量喂养并逐渐向全肠内喂养过渡。1　静脉喂养早产儿生后的能量消耗高于足月儿 ,但由于早产儿胰脂酶活性低 ,胆盐浓度低 ,对脂肪吸收差 ,加…     

早期微量喂养在极低出生体重儿营养供给中的应用

目的观察极低出生体重儿（VLBL）早期微量喂养的临床作用。方法沈阳市妇婴医院于2005-01-2006-12，将56例VLBL分为2组，甲组25例给以胃肠道外营养，乙组31例延迟开奶在胃肠道外营养的同时于生后24h内给以微量喂养，观察2组患儿胃肠道耐受情况、体重增长情况以及静脉营养时间、过渡到经口喂养的时间差异，监测血清胆红素、肾功能指标改变。结果2组患儿相比，早期微量喂养组缩短了达到全胃肠道喂养的时间和拔除胃管的时间，体重增长优于对照组。生后14d2组血清胆红素、肾功能指标差异均有统计学意义。结论早期微量喂养联合静脉营养可缩短病程，明显增加体重，使VLBL达到全胃肠喂养时间缩短。     

Erythromycin and feeding intolerance in premature infants: a randomized trial.

OBJECTIVES: To evaluate the effectiveness of low-dose oral erythromycin to treat feeding intolerance in preterm infants. DESIGN: This study was a prospective, double-blind, randomized, placebo-controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin 1 mg/kg every 8 h and 30 infants were given placebo (normal saline). Randomization was stratified on enrollment according to gestational age whether >32 weeks or 32 weeks, the erythromycin group achieved full enteral feeding earlier than placebo group (10.5+/-4.1 vs 16.3+/-5.7 days, respectively; P=0.01) had fewer episodes of gastric residuals (P<0.05) and shorter duration of parenteral nutrition (PN) (P<0.05). On the other hand, in infants with gestational age 32 weeks gestation. A similar effect on younger preterm infants was not demonstrable.     

早期母乳喂养量对极低出生体重新生儿坏死性小肠结肠炎和喂养不耐受的影响

目的研究早期母乳喂养量对极低出生体重新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)和喂养不耐受的影响。方法回顾性分析2017年6月至2018年5月在南方医科大学附属深圳妇幼保健院产科出生的275例极低出生体重儿(出生体重<1500 g)的临床资料,按照生后2周内是否母乳喂养以及母乳喂养量占总喂养量的比例,分为母乳喂养量占比>50%组(高母乳喂养量组,n=199)、母乳喂养量占比≤50%组(低母乳喂养量组,n=55)、配方奶喂养组(n=21)。3组NEC和喂养不耐受的发生率比较采用χ^2检验(或Fisher精确概率法),采用单因素和多因素logistic回归分析入院后2周内母乳喂养量对NEC和喂养不耐受的影响。结果高母乳喂养量组、低母乳喂养量组和配方奶喂养组NEC的发生率分别为1.5%(3/199)、27.3%(15/55)和9.5%(2/21)(P<0.01);喂养不耐受发生率分别为17.6%(35/199)、56.4%(31/55)和28.6%(6/21)(χ^2=34.826,P<0.01)。单因素logistic回归分析结果显示,与高母乳喂养量组相比,低母乳喂养量组和配方奶喂养组NEC发生风险增加,OR值分别为24.500(95%CI:6.755~85.594)、6.877(95%CI:1.081~43.744);低母乳喂养量组喂养不耐受发生风险增加,OR值为6.316(95%CI:3.293~12.113)。多因素logistic回归分析结果显示,与高母乳喂养量组相比,低母乳喂养量组和配方奶喂养组NEC发生风险增加,OR值分别为28.452(95%CI:7.280~111.195)和8.610(95%CI:1.262~58.766);低母乳喂养量组喂养不耐受发生风险增加,OR值为7.207(95%CI:3.601~14.425)。结论生后2周内母乳喂养量占总喂养量50%以上可能降低极低出生体重儿NEC和喂养不耐受的发生风险。     

新生儿重症监护病房早产儿脑损伤危险因素分析

目的 调查新生儿重症监护病房(NlCU)早产儿脑损伤的发生情况并分析其高危因素.方法将2006年2月1日至2007年1月31日入住复旦大学附属儿科医院NICU的胎龄≤34周或出生体重≤2000 g的早产儿纳入研究.应用超声诊断仪对早产儿进行系列床边头颅B超检查.同时收集临床资料,分析早产儿脑损伤的发生率,用Logistic回归模型分析其危险因素. 结果 (1)328例早产儿完成系列头颅B超检查,141例(43.0%)发生脑室内出血(IVH),其中轻度101例,重度40例.9.8%的患儿(32/328)发生脑白质损伤(WMD).13.4%的患儿(44/328)发生持续脑室扩大.10.7%的患儿(35/328)在生后初次头颅B超筛查时即发现有颅内囊肿形成.(2)IVH组和WMD组患儿的出生体重和胎龄较未发病组低,差异有统计学意义(P<0.05).(3)Logistic回归分析提示出生体重、感染、小于胎龄儿、机械通气是IVH的独立危险因素.出生体重是WMD的独立危险因素. 结论 NICU早产儿脑损伤发生率较高.出生体重、感染、小于胎龄儿、机械通气是IVH的独立危险因素.出生体重是WMD的独立危险因素.     

Gastrointestinal and feeding issues for infants <25 weeks of gestation

Appropriate nutrition is essential for optimal development and growth of preterm infants. Infants less than 25 weeks corrected gestational age are frequently the most difficult group for which to provide adequate nutrition due to minimal energy stores and high fluid losses. Nutrient delivery becomes an integral, but also very challenging part in their management. Early administration of intravenous nutrients provides a critical bridge to full enteral nutrition. However, enteral feeding is challenging due to immaturities of the intestinal tract, feeding intolerance and the risk of catastrophic gastrointestinal disease such as necrotizing enterocolitis (NEC). Decreased gastric acid production, increased gut permeability, reduced immunoglobulins, immature intestinal epithelia and a decreased mucin barrier all contribute to weakness to gastrointestinal insult. This review aims to illustrate the importance of enteral feeding and the common challenges and approaches in the nutrition of infants born at this age.     

The association between customised small for gestational age infants and pre-eclampsia or gestational hypertension varies with gestation at delivery

OBJECTIVES: (1) To describe the association between small for gestational age (SGA) infants and pre-eclampsia (PE) and gestational hypertension (GH) and (2) to determine how this association changes with gestational age at delivery using customised centiles to classify infants as SGA. DESIGN: A retrospective observational study. SETTING: National Women's Hospital, a Tertiary Referral Centre in Auckland, New Zealand. POPULATION: A total of 17 855 nulliparous women delivering between 1992 and 1999. METHODS: A comparison of the number of women with a customised SGA infant, PE and GH according to gestational age at delivery. MAIN OUTCOME MEASURES: The incidence of SGA infants (defined as birthweight <10th customised centile), PE and GH at <34, 34-36(+6) and > or =37 weeks. RESULTS: A total of 1847 (10.3%) infants were SGA, 520 (2.9%) women had PE and 1361 (7.6%) had GH. SGA, PE and GH all occurred more commonly with increasing gestation at delivery with 85%, 62% and 90% of cases delivered at term. In women delivering SGA infants, coexisting PE was more likely to occur among those delivered preterm than at term (38.6% at <34 weeks [relative risk, RR 10.2 95%CI 7.3-14.4], 22.4% at 34-36(+6) weeks [RR 6.0 95%CI 4.1-8.6] and 3.8% at > or =37 weeks [OR 1.0]). Women with preterm PE were more likely to have a SGA infant than women with term PE (57.1% at <34 weeks [RR 3.1 95%CI 2.3-4.2], 31.7% at 34-36(+6) weeks [RR 1.7 95%CI 1.2-2.5]) and 18.3% at > or =37 weeks [OR 1.0]). There was a similar association between GH and SGA infants as gestation advanced (57.6% at <34 weeks [RR 4.8 95%CI 3.4-6.6], 30.5% at 34-36(+6) weeks [RR 2.5 95%CI 1.8-3.5] and 12.1% > or =37 weeks [OR 1.0]). CONCLUSIONS: SGA infants and PE are more likely to coexist in preterm births compared with term births. This is likely to reflect the degree of placental involvement in each disease process.     

Human milk versus formula feeding among preterm infants: short-term outcomes

We evaluated short-term neonatal outcomes among preterm infants according to type of feeding administered (human milk or formula). Retrospective data were collected on 400 preterm infants at gestational age ≤32 weeks. Groups were chosen and compared according to feeding type. The premature infants who were fed human milk had lower gestational age and birth weight than those who were formula fed. Lower rates of necrotizing enterocolitis (NEC) were detected in the group of infants fed human milk (p = 0.044). Lower rates of retinopathy of prematurity (ROP) were detected in a subgroup of breast-fed infants born at 24 to 28 weeks' gestational age, but the results did not reach statistical significance using univariate analysis (p = 0.06). Using multivariate analysis, however, ROP stage III among this subgroup was significantly lower (p = 0.022). No differences were recorded for other neonatal complications such as infections or for growth parameters. The advantage of human milk feeding, found mainly among preterm infants with respect to rates of NEC and ROP, supports efforts to encourage mothers to feed their infants human milk.     

Strategies for prevention of neonatal invasive candidiasis

A single-center randomized, placebo-controlled trial has found that intravenous fluconazole prophylaxis in preterm infants < or = 1,000 g with a central venous catheter or endotracheal tube until such infants no longer required intravenous access or attained 6 weeks postnatal age was effective in preventing fungal sepsis. Infants at high risk for fungal sepsis are preterm infants < or = 32 weeks' gestation with one or more of the following additional risk factors: receipt of more than 2 antibiotics, third-generation cephalosporins, histamine-2 receptor antagonists, postnatal steroids, parenteral nutrition, or intravenous lipids; central venous catheter, skin disruption, dermatitis, necrotizing enterocolitis, or abdominal surgery. Further study in larger populations is needed to explore whether antifungal chemoprophylaxis or other strategies may be effective in preventing fungal infection in high-risk neonates. Effective prophylaxis strategies will decrease the high mortality and morbidity associated with fungal infection in high risk infants.     

静脉补充谷氨酰胺对极低出生体重儿肠道功能的影响

目的 评价含丙氨酰谷氨酰胺(Ala-Gln)肠外营养(parenteral-nutrition,PN)对极低出生体重儿肠道功能的影响.方法 对两家儿童医疗中心2006年4月至2007年2月收治的30例极低出生体重儿进行研究,采用平行、随机、双盲、对照试验,随机分为常规PN组(对照组)和常规PN+Ala-Gin组(研究组),两组各15例,对照组按照常规给予肠外营养支持,氨基酸的剂量按照中国新生儿营养支持临床应用指南给予[从1.0～2.0 g/(kg·d)开始,增至3.5 g/(kg·d)];研究组添加0.3 g/(kg·d)Ala-Gln双肽,其中Ala-Gln双肽取代了处方中相应氨基酸的量,谷氨酰胺应用的时间和肠外营养应用的时间一致.本项研究的首要终点指标为达到全肠内喂养日龄(标准配方摄人量≥120 ml/(kg·d))、胃潴留次数、完全脱离肠外营养时间和病死率.结果 两组患儿比较,达到全肠内喂养日龄[研究组(20±6)d,对照组(21±9)d]、胃潴留次数[研究组(3±4)次,对照组(1±2)次]、以及脱离肠外营养时间[研究组(17±7)d,对照组(17±8)d)]差异均无统计学意义.对照组无患儿死亡,4例自动出院,研究组2例放弃治疗(未完成此项研究),2例自动出院,病死率通过意向性分析,RR值为1.182,95%CJ为0.937～1.490,病死率比较差异无统计学意义.结论 静脉补充谷氨酰胺未能缩短达到全肠内喂养天数、减少胃潴留次数、缩短全肠外营养应用时间及降低病死率.