早产儿早期强化静脉营养的临床研究

目的探讨早产儿早期强化静脉营养的临床效果。方法早产儿随机分为强化组46例，对照组42例．强化组24h内给予氨基酸和脂肪乳，初始量各为1．0g／（kg·d），以后每天各增加1．0g／（kg·d），氨基酸最大剂量3．0g／kg·d，脂肪乳最大剂量3~3．5g／（kg·d）；对照组42例，生后第3天静脉应用氨基酸，以后每天增加O．5g／（kg·d），最大剂量3．0g/（kg·d），生后第4天开始用脂肪乳，初始量0．5g／（kg·d），以后每天增加0．5g/（kg·d），最大剂量3．0g／（kg·d）.除静脉营养方式不同外，其它治疗均相同。营养液采用“全合一”方式，经外周静脉24h均匀输入。比较两组患儿营养支持9天后胆红素、尿素氮、甘油三脂、血糖等血生化指标和相关并发症、住院期间存活者的静脉营养时间、体重增长、住院天数。结果两组患儿胆红素、尿素氮、甘油三脂、血糖等血生化指标和相关并发症比较差异无显著性（P〉0．05）；强化组患儿与对照组相比，强化组体重增长（g）高于对照组（31．9±8．3）g／d比（20．9±7．5）g／dP〈0．01]，静脉营养时间及住院时间（天）短于对照组【（8．9±3．50）比（12．8±4．0），（18．1±9．6）比（24．9±10．4）1，差异均有显著性；两组均无静脉炎、氮质血症及高胆红素血症及肝肾功能损害。结论早期强化静脉营养可以改善早产儿氮质平衡，加速体重增长，缩短静脉营养及住院时间，减少住院费用，未增加静脉营养相关并发症的发生，临床应用安全有效。

Clinical Study on Early Fortified Parenteral Nutrition of Premature Infants

Objective To explore the clinical effect of early fortified Parenteral Nutrition of Premature Infants. Methods 88 cases premature infants in our hospital from November of 2010 to November of 2012 were divided into the strength group （40cases） and the control （42 cases） groups. The strengthen group receives amino acids and fat emulsion within 24 hours. The initial dose was 1.0 g/（kg, d） with an increment of 1.0 kg daily. The amino acids maximum dose was 3.0 g/（kg, d）, the maximum dose of fat milk was 3 ~ 3.5 g/（kg, d）. The control group receives of amino acids on the third day after birth. The initial dose was 1）.5 g/（kg, d） with an incre- ment of 0.5 g/（kg, d）daily, the maximum dose was 3.0 g/（kg, d）. The control group receives fat milk on the fourth day after birth, the initial dose was 1）.5 g/（kg, d） with an increment of 0.5 g/（kg, d） daily, the maximum dose was 3.0 g/（kg, d）. Other treatments were the same except for intravenous nutrition. Nutrient solution uses the＂ all-in-one ＂mode, through the perip, through the peripheral vein 24 hours input uniformly. Compare and analysis bilirubin, blood urea nitrogen, triglycerides, blood glucose, related complications, days of venous nutrition supplys, the weight and hospitalization days of the two groups after treatment for nine days. Results There were no difference in bilirubin, blood urea nitrogen, triglycerides, blood glucose and related complications between the two groups, the weight increment of the strength group were higher than the control group （31.98.3）g/d VS. （20.9 7.5） g/d P〈0.01] , days of venous nutrition supplys and days of hospitalization were both shorter in the strength group than in the control group （8.9 3.50）days vs.（12.8 4.0） days, P〈0.01 ], （18.1 ＋ 9.0） days vs. （24,.9 10.4） days ,P〈0.01] . There were no phlebitis, nitrogen qualitative hematic disease and high blood bilirubin and liver and kidney function damage in the two groups. Conclusion Early intensive parenteral nutrition could im- prove nitrogen mass balance in preterm neonates , promote growth, shorten parenteral nutrition time and hospitalization time, reducehispitazation cost and add no parenteral nutrition related complications. Parenteral nutrition infusion is safe for clinical application.