谷氨酰胺对新生儿临床结局的影响

目的 评价肠内、肠外补充谷氨酰胺对新生儿临床结局的影响.方法 采用平行、随机、双盲、对照试验,将100例新牛儿随机分为5组,分别为对照组(常规肠外营养组)、肠外谷氨酰胺1组[肠外营养1组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d),其中谷氨酰胺取代了处方中相应氨基酸的量]、肠内谷氨酰胺Ⅰ组[肠内营养1组,口服添加谷氨酰胺0.3 g/(kg·d),谷氨酰胺取代了常规肠外营养中相应氨基酸的量]、肠外谷氨酰胺2组[肠外营养2组,在常规肠外营养中静脉补充谷氨酰胺0.3 g/(kg·d)]、肠内谷氨酰胺2组[肠内营养2组,口服添加谷氨酰胺0.3 g/(kg·d)],每组20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)].首要终点指标为达到全肠内喂养日龄[标准配方摄入量≥120ml/(kg·d)]、胃潴留次数、完全脱离肠外营养时间和死亡率.次要终点指标为体重变化和头围变化、肝功能、肾功能、呼吸机应用天数、住院天数.结果 5组患儿达到全肠内喂养日龄、胃潴留次数及脱离肠外营养时间差异均无显著性.患儿肝肾功能水平及体重增长、头围增长、抗生素应用天数、住院天数差异均无显著性(P＞0.05).肠外谷氨酰胺1组和2组较对照组呼吸机应用天数显著减少(P＜0.05).死亡率通过意向性分析显示,与对照组比较,肠外谷氨酰胺1组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺1组RR为1.333,95%CI为1.035～1.717;肠外谷氨酰胺2组RR为1.053,95%CI为0.952～1.164;肠内谷氨酰胺2组RR为1.25,95%CI为1.004～1.556.结论 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;肠外补充谷氨酰胺可以减少新生儿呼吸机应用大数.新生儿肠外补充谷氨酰胺对患儿住院期间的死亡率无明显影响.

Clinical outcomes of glutamine supplementation in neonates

Objective To assess the clinical outcomes of glutamine supplementation in neonates.Methods The study was designed as a double-blind randomized controlled trial.Totally 100 infants were randomly divided into 5 groups with 20 infants in each group:control group:standard parenteral nutrition (PN);PNI group:PN supplemented with 0.3 g/ (kg·d) glutamine;enteral nutrition (EN) 1 group:EN supplemented with 0.3 g/ (kg·d) glutamine;PN2 group:PN supplemented with 0.3 g/ (kg·d) glutamine;and EN2 group:EN supplemented with 0.3 g/ (kg·d) glutamine,The primary endpoints were the time to establish full enteral nutrition [defined as receiving 120 ml/ (kg·d) enterally],episodes of gastric residuals,total duration of PN,and mortality.The second endpoints were weight gain and head circumference gain,liver function,renal function,days on ventilator,and length of hospitalization.Results Time to achieve full enteral nutrition,incidence of gastric residuals,duration of PN,weight gain (g/d) ,head circumference gain (cm/w),liver function,renal function,and length of hospitalization were not significantly different among all five groups.Days of mechanical ventilation were significantly decreased in PN1 group and PN2 group when compared with the control group (P ＜ 0.05).Intention-totreat analyses showed that,when compared with the control group,PN1 group:RR:1.053;95% CI:0.952-1.164;ENI group:RR:1.333,95% CI:1.035-1.717;PN2 group:RR:1.053,95% CI:0.952-1.164;EN2 group:RR:1.25,95% CI:1.004-1.556.Conclusions Glutamine supplementation may not be able to decrease the time to achieve full enteral nutrition,the incidence of gastric residuals,and the duration of PN.However,pareneral glutamine supplementation does reduce the days on ventilator in neonates.Also,parenteral glutamine supplementation has no obvious influence on mortality.